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

TitleRemifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: A randomized trial
Authors
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
Citation
Journal Of Cardiothoracic And Vascular Anesthesia, 2010, v. 24 n. 5, p. 790-796 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/129087
ISSN
2014 Impact Factor: 1.463
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWong, GTCen_HK
dc.contributor.authorHuang, Zen_HK
dc.contributor.authorJi, Sen_HK
dc.contributor.authorIrwin, MGen_HK
dc.date.accessioned2010-12-23T08:32:16Z-
dc.date.available2010-12-23T08:32:16Z-
dc.date.issued2010en_HK
dc.identifier.citationJournal Of Cardiothoracic And Vascular Anesthesia, 2010, v. 24 n. 5, p. 790-796en_HK
dc.identifier.issn1053-0770en_HK
dc.identifier.urihttp://hdl.handle.net/10722/129087-
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.en_HK
dc.languageengen_US
dc.publisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/jvcaen_HK
dc.relation.ispartofJournal of Cardiothoracic and Vascular Anesthesiaen_HK
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 preconditioningen_HK
dc.subjectcardiac surgeryen_HK
dc.subjectmyocardial protectionen_HK
dc.subjectopioiden_HK
dc.subjectremifentanilen_HK
dc.titleRemifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: A randomized trialen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1053-0770&volume=24&issue=5&spage=790&epage=796&date=2010&atitle=Remifentanil+reduces+the+release+of+biochemical+markers+of+myocardial+damage+after+coronary+artery+bypass+surgery.+A+randomized+trail-
dc.identifier.emailWong, GTC:gordon@hku.hken_HK
dc.identifier.emailIrwin, MG:mgirwin@hku.hken_HK
dc.identifier.authorityWong, GTC=rp00523en_HK
dc.identifier.authorityIrwin, MG=rp00390en_HK
dc.description.naturepostprint-
dc.identifier.doi10.1053/j.jvca.2009.09.012en_HK
dc.identifier.pmid20056436en_HK
dc.identifier.scopuseid_2-s2.0-77957693411en_HK
dc.identifier.hkuros177956en_US
dc.identifier.hkuros184520-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77957693411&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume24en_HK
dc.identifier.issue5en_HK
dc.identifier.spage790en_HK
dc.identifier.epage796en_HK
dc.identifier.eissn1532-8422-
dc.identifier.isiWOS:000282669200010-
dc.publisher.placeUnited Statesen_HK

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