Remifentanil induces systemic arterial vasodilation in humans with a total artificial heart.
BACKGROUND
To assess intrinsic vascular effects of remifentanil, increased concentrations were infused in critically ill patients with a total artificial heart.


METHODS
In the early postoperative period after implantation of a total artificial heart, nine ventilated patients requiring short general anesthesia were included in this study. After anesthesia was induced with 0.3 mg/kg intravenous etomidate, the artificial heart settings were modified to render cardiac output "preload-independent." While maintenance of anesthesia was ensured by a continuous infusion of etomidate, increased concentrations of remifentanil (from 0.1 to 1 microg x kg(-1) x min(-1)) were infused in steps of 5 min under hemodynamic monitoring, including left and right atrial pressures, systemic and pulmonary arterial pressures, and left and right cardiac indices. The invasive procedure was started under the highest concentration of remifentanil tolerated by the patient. Infusion of remifentanil was stopped at the end of the invasive procedure, while etomidate infusion was maintained. New hemodynamic measurements were performed at the end of the 12-min recovery period.


RESULTS
Remifentanil produced a dose-dependent and significant decrease in systemic arterial pressure and vascular resistances (n = 9) from a concentration of 0.25 microg x kg(-1) x min(-1). No significant changes were observed on pulmonary vascular resistances (n = 6). Neither right (n = 9) nor left (n = 6) atrial pressures were affected by remifentanil infusion. Hemodynamic variables returned to baseline value over the 12-min recovery period.


CONCLUSIONS
In humans with a total artificial heart, remifentanil induces a systemic arterial vasodilation without significant effect on the capacitance vessels.
Ouattara
Alexandre
A
Institut de Cardiologie, Département d' Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France. alexandre.ouattara@psl.ap-hop-paris.fr
Boccara
Gilles
G
Köckler
Uwe
U
Lecomte
Patrick
P
Leprince
Pascal
P
Léger
Philippe
P
Riou
Bruno
B
Rama
Akthar
A
Coriat
Pierre
P
D000328:Adult; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D005045:Etomidate / Q000494:pharmacology; D005260:Female; D006354:Heart, Artificial; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D011184:Postoperative Period; D000077208:Remifentanil; D014655:Vascular Resistance / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects*
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D005045:Etomidate