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British Journal of Anaesthesia, 2000, Vol. 84, No. 5 578-583
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigation

Myocardial consequences of remifentanil in patients with coronary artery disease

S. Kazmaier1, G.-G. Hanekop1, W. Buhre1, A. Weyland1, T. Busch2, O. C. Radke,1, R. Zoelffel1 and H. Sonntag1

1 Department of Anaesthesiology, Emergency and Intensive Care Medicine and
2 Department of Thoracic, Cardiovascular and Vascular Surgery, Georg August University of Göttingen, Göttingen, Germany

Corresponding author: Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany

Remifentanil may be an alternative to conventional opioids for minimally invasive direct coronary artery bypass surgery because of its extremely short duration of action. The aim of this study was to investigate the effects of remifentanil on myocardial blood flow, metabolism and systemic haemodynamic variables in patients with coronary artery disease. After approval by the local ethics committee, 12 male patients were investigated before elective coronary artery bypass grafting. Systemic haemodynamic variables, myocardial blood flow and metabolism were measured when patients were awake and when they were anaesthetized with high-dose remifentanil (2.0 µg kg–1 min–1), or with remifentanil 0.5 µg kg–1 min–1 combined with propofol (target-controlled infusion aiming at a plasma concentration of 2.0 µg ml–1). Myocardial blood flow was measured using a modified Kety–Schmidt technique. High-dose remifentanil anaesthesia significantly reduced cardiac index (CI) (–25%) as a consequence of a decrease in stroke volume index (SVI) (-14%) and heart rate (-13%). Mean arterial pressure (MAP) was 30% lower than that in the awake patient. Myocardial blood flow and myocardial oxygen uptake (MV2) decreased by 30% and 42%, respectively. In contrast to high-dose remifentanil anaesthesia, systemic vascular resistance index (-14%) during remifentanil/propofol anaesthesia was significantly lower than that in the awake patient. Other haemodynamic variables, and myocardial blood flow and MV2, did not significantly differ from the high-dose remifentanil period. In conclusion, high-dose remifentanil reduces SVI, heart rate, MAP, myocardial blood flow and MV2 and its effects do not differ from those of remifentanil/propofol anaesthesia.


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