**Perioperative myocardial protection**

The ultimate goal of perioperative myocardial protection is to limit the extent and consequences of myocardial ischaemia-reperfusion injury. This injury is caused by free radical formation, calcium overload and impairment of the coronary vasculature. Protective measures include the use of free radical oxygen scavengers, inhibitors of the complement system and neutrophil activation, modulation of intracellular gradients and maintenance of sufficient myocardial high energy phosphate stores. Drugs affecting the complementinflammation pathways, adenosine modulators, cardioplegia solution adjuvants, Na+/H+ exchange inhibitors, KATP channel openers such as volatile anaesthetics and levosimendan, and anti-apoptotic agents are all used for this purpose. (23,24)
