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BJA Advance Access originally published online on May 20, 2009
British Journal of Anaesthesia 2009 103(2):191-198; doi:10.1093/bja/aep131
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Cardiac electrophysiological effects of remifentanil: study in a closed-chest porcine model

M. Zaballos1,*, C. Jimeno1, J. Almendral2, F. Atienza2, D. Patiño3, E. Valdes4, J. Navia1 and M. J. Anadón5

1 Department of Anaesthesia
2 Department of Cardiology
3 Hospital Universitario Gregorio Marañón
4 Department of Family, Los Yebenes Primary Care Health Center
5 Department of Toxicology, Universidad Complutense, Madrid, Spain

* Corresponding author. E-mail: mati{at}plagaro.net

Background: Remifentanil has been implicated as causing intraoperative bradyarrhythmias, but little information is available regarding its cardiac electrophysiological effects. Thus, we evaluated the cardiac electrophysiological properties before and after remifentanil in a closed-chest porcine model.

Methods: Eighteen Landrace–Large pigs were premedicated with ketamine and anaesthetized with propofol (4.5 mg kg–1 bolus followed by 13 mg kg–1 h–1). After instrumentation, an electrophysiological evaluation was performed under propofol and repeated after remifentanil (bolus of 1 µg kg–1, followed by an infusion of 0.5 µg kg–1 min–1). We evaluated sinus node function [sinus node recovery time (SNRT) and sinoatrial conduction time (SACT)], atrioventricular (AV) nodal function [AH intervals during sinus rhythm (SR) and atrial pacing, Wenckebach cycle length (WCL), and effective refractory periods (ERP)], atrial, His-Purkinje, and ventricular conduction and refractoriness. Significant changes between ‘propofol protocol’ and ‘propofol+remifentanil protocol’ were evaluated.

Results: Remifentanil caused a significant increase in sinus cycle length (21%, P=0.001) and a significant prolongation of SNRT (43%, P=0.001), corrected SNRT (136%, P=0.003), SACT (40%, P=0.005), AH interval during SR (17%, P=0.02), AH interval during atrial pacing (25%, P=0.01), and ventricular ERP (12%, P=0.004). There was a tendency towards a prolongation of WCL and AV nodal refractoriness. Similar significant changes were observed in a reference group of seven animals in which sevoflurane was used instead of propofol. No significant changes were observed in atrial parameters, His-Purkinje function, parameters of intraventricular conduction, and QT intervals.

Conclusions: Remifentanil depresses sinus node function and most parameters of AV nodal function. This contributes to an explanation for clinical observations of remifentanil-related severe bradyarrhythmias.

Keywords: analgesics opioid, remifentanyl; heart, arrhythmia, bradycardia; heart, chronotropism; heart, conduction


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