Article: Remifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: A randomized trial

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TitleRemifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: A randomized trial
AuthorsWong, GTC1
Huang, Z2
Ji, S2
Irwin, MG1
Keywordsanesthetic preconditioning
cardiac surgery
myocardial protection
opioid
remifentanil
Issue Date2010
PublisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/jvca
CitationJournal Of Cardiothoracic And Vascular Anesthesia, 2010, v. 24 n. 5, p. 790-796 [How to Cite?]
DOI: http://dx.doi.org/10.1053/j.jvca.2009.09.012
AbstractObjective: 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. Design: A prospective, double blind, randomized, controlled study. Setting: University hospital; single institution. Participants: Forty patients scheduled for first-time elective, on-pump coronary artery bypass surgery for at least 3 diseased vessels. Interventions: 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. Measurements and Main 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. © 2010 Elsevier Inc. All rights reserved.
ISSN1053-0770
2011 Impact Factor: 1.64
2011 SCImago Journal Rankings: 0.112
DOIhttp://dx.doi.org/10.1053/j.jvca.2009.09.012
ISI Accession Number IDWOS:000282669200010
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorWong, GTC
dc.contributor.authorHuang, Z
dc.contributor.authorJi, S
dc.contributor.authorIrwin, MG
dc.date.accessioned2010-12-23T08:32:16Z
dc.date.available2010-12-23T08:32:16Z
dc.date.issued2010
dc.description.abstractObjective: 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. Design: A prospective, double blind, randomized, controlled study. Setting: University hospital; single institution. Participants: Forty patients scheduled for first-time elective, on-pump coronary artery bypass surgery for at least 3 diseased vessels. Interventions: 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. Measurements and Main 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. © 2010 Elsevier Inc. All rights reserved.
dc.description.naturepostprint
dc.identifier.citationJournal Of Cardiothoracic And Vascular Anesthesia, 2010, v. 24 n. 5, p. 790-796 [How to Cite?]
DOI: http://dx.doi.org/10.1053/j.jvca.2009.09.012
dc.identifier.doihttp://dx.doi.org/10.1053/j.jvca.2009.09.012
dc.identifier.epage796
dc.identifier.hkuros177956
dc.identifier.hkuros184520
dc.identifier.isiWOS:000282669200010
dc.identifier.issn1053-0770
2011 Impact Factor: 1.64
2011 SCImago Journal Rankings: 0.112
dc.identifier.issue5
dc.identifier.openurl
dc.identifier.pmid20056436
dc.identifier.scopuseid_2-s2.0-77957693411
dc.identifier.spage790
dc.identifier.urihttp://hdl.handle.net/10722/129087
dc.identifier.volume24
dc.languageeng
dc.publisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/jvca
dc.publisher.placeUnited States
dc.relation.ispartofJournal of Cardiothoracic and Vascular Anesthesia
dc.relation.referencesReferences in Scopus
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
dc.rightsNOTICE: this is the author’s version of a work that was accepted for publication in Journal of Cardiothoracic and Vascular Anesthesia. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Cardiothoracic and Vascular Anesthesia, 2010, v. 24 n. 5, p. 790-796. DOI: 10.1053/j.jvca.2009.09.012
dc.subjectanesthetic preconditioning
dc.subjectcardiac surgery
dc.subjectmyocardial protection
dc.subjectopioid
dc.subjectremifentanil
dc.titleRemifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: A randomized trial
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong
  2. null