Remifentanil reduces the release of biochemical markers of myocardial damage in patients undergoing on pump coronary artery bypass surgery

Abstract

INTERVENTIONS: Patients randomized to the remifentanil group (n = 20) received a 1 µg/kg bolus followed by 0.5 µg/kg/min infusion for 30 minutes after induction but before sternotomy, whilst the control group (n = 20) received normal saline. Serial samples for measurement of creatine kinase (CKMB), cardiac troponin I (cTnI), ischemia modified albumin (IMA) and heart type fatty acid binding protein (hFABP) were taken at baseline, pre bypass, T = 10 minutes, 2, 6, 12, and 24 hours after cross clamp release, to assess the degree of myocardial damage. MEASUREMENTS AND MAIN RESULTS: Patients in the remifentanil group had lower levels of CKMB from T _ 2 hours to 24 hours, cTnI from T = 10 minutes to T = 12 hours, IMA from T = 10 min 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 length of ICU and hospital stays was not different. CONCLUSIONS: The addition of remifentanil to the anesthesia regimen reduced the degree of myocardial damage. This incremental benefit may be attributable to either to remifentanil itself or to an overall increased opioid dose, the latter may be necessary to trigger cardiac protection. © 2009 Elsevier Inc. All rights reserved.postprin