title: [Remifentanil prevents hyperglycemia and reduces insulin use during cardiopulmonary bypass in adult cardiac surgery].
abstract: BACKGROUND
  Remifentanil may be beneficial in patients undergoing cardiac surgery, by attenuating the neurohumoral stress response to surgical stimulation and inflammation evoked by cardiopulmonary bypass (CPB).
  
  
  METHODS
  We retrospectively examined blood glucose monitored every 30 minutes during CPB and insulin dose in patients during CPB under remifentanil anesthesia (remifentanil group) and those under low dose fentanyl anesthesia (fentanyl group) in adult cardiac surgery. Furthermore we also investigated incidence of atrial fibrillation within 72 hours after surgery in both groups.
  
  
  RESULTS
  There were 35 patients in remifentanil group and 22 patients in fentanyl group. Although blood glucose at the beginning and the end of CPB in both groups were not different, remifentanil group showed lower maximum blood glucose (median 172 mg x dl(-1), interquatile range 156-205 mg x dl(-1)) during CPB than in fentanyl group (197 mg x dl(-1), 176-219 mg x dl(-1); P = 0.009). Significantly less insulin was administered during CPB in remifentanil group than in fentanyl group. Incidence of postoperative atrial fibrillation was similar between the groups.
  
  
  CONCLUSIONS
  Maximum blood glucose was lower and less insulin was administered during CPB in remifentanil group. These data may suggest that remifentanil reduce stress response to surgical stimulation in cardiac surgery.
authors.affiliation: Department of Anesthesiology, Kobe City Medical Center General Hospital, Kobe 650-0046.
authors.forename: Keita
authors.initials: K
authors.lastname: Sato
authors.forename: Shun
authors.initials: S
authors.lastname: Maekawa
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Seo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Naoki
authors.initials: N
authors.lastname: Higashibeppu
authors.forename: Shun
authors.initials: S
authors.lastname: Okazaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mima
authors.forename: Ikuko
authors.initials: I
authors.lastname: Miyawaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamazaki
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000517:prevention & control; D001786:Blood Glucose / Q000032:analysis; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D011183:Postoperative Complications / Q000517:prevention & control; D000077208:Remifentanil; D012189:Retrospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D001786:Blood Glucose; D007328:Insulin; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl