Remifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: a randomized trial.
OBJECTIVE
Opioids, including remifentanil, have been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluated whether remifentanil preconditioning is protective in first-time elective on-pump coronary artery bypass surgery patients receiving a standardized fentanyl (25 μg/kg in total) and propofol anesthetic.


METHODS
A prospective, double blind, randomized, controlled study.


METHODS
University hospital; single institution.


METHODS
Forty patients scheduled for first-time elective, on-pump coronary artery bypass surgery for at least 3 diseased vessels.


METHODS
Patients randomized to the remifentanil group (n = 20) received a 1 μg/kg bolus followed by a 0.5 μg/kg/min infusion for 30 minutes after induction but before sternotomy, while the control group (n = 20) received normal saline. Serial samples for measurement of creatine kinase (CK-MB), cardiac troponin I (cTnI), ischemia-modified albumin (IMA) and heart-type fatty-acid-binding protein (hFABP) were taken at baseline, prebypass, T = 10 minutes, 2, 6, 12, and 24 hours after cross-clamp release, to assess the degree of myocardial damage.


RESULTS
Patients in the remifentanil group had lower levels of CK-MB from T = 2 hours to 24 hours, cTnI from T = 10 minutes to T = 12 hours, IMA from T = 10 minutes to T = 2 hours and h-FABP from T = 10 minutes to T = 12 hours (p < 0.05). The time to tracheal extubation was shorter in patients in the remifentanil group. The overall lengths of ICU and hospital stays were not different.


CONCLUSIONS
The addition of remifentanil to the anesthesia regimen reduced the degree of myocardial damage. This incremental benefit may be attributable either to remifentanil itself or to an overall increased opioid dose, the latter may be necessary to trigger cardiac protection.
Wong
Gordon T C
GT
Department of Anaesthesiology, University of Hong Kong, Hong Kong, China.
Huang
Zhiyong
Z
Ji
Shangyi
S
Irwin
Michael G
MG
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology*; D010880:Piperidines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000097:blood* / Q000188:drug therapy*; D011446:Prospective Studies; D000077208:Remifentanil
D015415:Biomarkers; D010880:Piperidines; D000077208:Remifentanil