title: Cardiac electrophysiological effects of remifentanil: study in a closed-chest porcine model.
abstract: BACKGROUND
  Remifentanil has been implicated as causing intraoperative bradyarrhythmias, but little information is available regarding its cardiac electrophysiological effects. Thus, we evaluated the cardiac electrophysiological properties before and after remifentanil in a closed-chest porcine model.
  
  
  METHODS
  Eighteen Landrace-Large pigs were premedicated with ketamine and anaesthetized with propofol (4.5 mg kg(-1) bolus followed by 13 mg kg(-1) h(-1)). After instrumentation, an electrophysiological evaluation was performed under propofol and repeated after remifentanil (bolus of 1 microg kg(-1), followed by an infusion of 0.5 microg kg(-1) min(-1)). We evaluated sinus node function [sinus node recovery time (SNRT) and sinoatrial conduction time (SACT)], atrioventricular (AV) nodal function [AH intervals during sinus rhythm (SR) and atrial pacing, Wenckebach cycle length (WCL), and effective refractory periods (ERP)], atrial, His-Purkinje, and ventricular conduction and refractoriness. Significant changes between 'propofol protocol' and 'propofol+remifentanil protocol' were evaluated.
  
  
  RESULTS
  Remifentanil caused a significant increase in sinus cycle length (21%, P=0.001) and a significant prolongation of SNRT (43%, P=0.001), corrected SNRT (136%, P=0.003), SACT (40%, P=0.005), AH interval during SR (17%, P=0.02), AH interval during atrial pacing (25%, P=0.01), and ventricular ERP (12%, P=0.004). There was a tendency towards a prolongation of WCL and AV nodal refractoriness. Similar significant changes were observed in a reference group of seven animals in which sevoflurane was used instead of propofol. No significant changes were observed in atrial parameters, His-Purkinje function, parameters of intraventricular conduction, and QT intervals.
  
  
  CONCLUSIONS
  Remifentanil depresses sinus node function and most parameters of AV nodal function. This contributes to an explanation for clinical observations of remifentanil-related severe bradyarrhythmias.
authors.affiliation: Department of Anaesthesia, Los Yebenes Primary Care Health Center, Madrid, Spain. mati@plagaro.net
authors.forename: M
authors.initials: M
authors.lastname: Zaballos
authors.forename: C
authors.initials: C
authors.lastname: Jimeno
authors.forename: J
authors.initials: J
authors.lastname: Almendral
authors.forename: F
authors.initials: F
authors.lastname: Atienza
authors.forename: D
authors.initials: D
authors.lastname: Patiño
authors.forename: E
authors.initials: E
authors.lastname: Valdes
authors.forename: J
authors.initials: J
authors.lastname: Navia
authors.forename: M J
authors.initials: MJ
authors.lastname: Anadón
mesh_terms: D000701:Analgesics, Opioid / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D000818:Animals; D001283:Atrioventricular Node / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D004195:Disease Models, Animal; D004562:Electrocardiography / Q000187:drug effects; D006329:Heart Conduction System / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010880:Piperidines / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology; D000077208:Remifentanil; D012849:Sinoatrial Node / Q000187:drug effects; D034421:Sus scrofa
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D002245:Carbon Dioxide; D000077208:Remifentanil; D010100:Oxygen; D015742:Propofol