title: Myocardial protection induced by fentanyl in pigs exposed to high-dose adrenaline.
abstract: The use of high doses of adrenaline is common in critical patients, especially during cardiac arrest. During these situations, myocardial dysfunction can be a result of multiple factors, including adrenaline use. In addition, opioids have been shown to have anti-arrhythmic and anti-ischemic mechanisms that may confer cardiac protection. This study aimed to evaluate the effects of fentanyl on myocardial function in pigs exposed to high-dose adrenaline. After institutional ethics committee approval, 26 pigs were randomly allocated to receive either 20 μg/kg fentanyl (n = 10; fentanyl group) administered 5 min before five doses of adrenaline (20 μg/kg), equivalent-volume saline (n = 10; saline group) using the same adrenaline dosing protocol, or neither fentanyl nor adrenaline (n = 6; sham group). The fentanyl group showed lower levels of troponin at the end of the sixth hour compared with the saline group (1.91 ± 1.47 vs 5.44 ± 5.35 ng/mL, P = 0.019). Transmission electron microscopy and immunohistochemistry also showed less myocardial injury in the fentanyl group. The conclusion was reached that fentanyl attenuates myocardial injury caused by high-dose adrenaline without blunting the hemodynamic effect of adrenaline.
authors.affiliation: Department of Anaesthesiology, São Paulo, Brazil.
authors.forename: Vinicius Fernando
authors.initials: VF
authors.lastname: da Luz
authors.affiliation: University of Sao Paulo Medical School, Department of Anaesthesiology, São Paulo, Brazil.
authors.forename: Denise Aya
authors.initials: DA
authors.lastname: Otsuki
authors.affiliation: Heart Institute (InCor), São Paulo, Brazil.
authors.forename: Maria Margarita Castro
authors.initials: MM
authors.lastname: Gonzalez
authors.affiliation: Department of Pathology, São Paulo, Brazil.
authors.forename: Elnara Marcia
authors.initials: EM
authors.lastname: Negri
authors.affiliation: Department of Pathology, São Paulo, Brazil.
authors.forename: Elia Garcia
authors.initials: EG
authors.lastname: Caldini
authors.affiliation: Laboratory for Cell Biology LIM 59, São Paulo, Brazil.
authors.forename: Nilsa Regina
authors.initials: NR
authors.lastname: Damaceno-Rodrigues
authors.affiliation: Department of Anaesthesiology, São Paulo, Brazil.
authors.forename: Luiz Marcelo Sá
authors.initials: LM
authors.lastname: Malbouisson
authors.affiliation: University of Sao Paulo Medical School, São Paulo, Brazil.
authors.forename: Bruno Gonçalves
authors.initials: BG
authors.lastname: Viana
authors.affiliation: Department of Anaesthesiology, São Paulo, Brazil.
authors.forename: Matheus Fachini
authors.initials: MF
authors.lastname: Vane
authors.affiliation: Department of Anaesthesiology, São Paulo, Brazil.
authors.forename: Maria Jose Carvalho
authors.initials: MJ
authors.lastname: Carmona
mesh_terms: D000818:Animals; D002316:Cardiotonic Agents / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000009:adverse effects*; D005283:Fentanyl / Q000494:pharmacology*; D006321:Heart / Q000187:drug effects* / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects; D008297:Male; D009206:Myocardium / Q000378:metabolism; D013552:Swine; D013997:Time Factors; D014336:Troponin / Q000378:metabolism
chemical_list: D002316:Cardiotonic Agents; D014336:Troponin; D005283:Fentanyl; D004837:Epinephrine
keywords: adrenaline; analgesics; animals; cardioprotection; catecholamines; fentanyl; myocardial preconditioning; opioid; swine