Comparison of 5 Different Remifentanil Strategies Against Myocardial Ischemia-Reperfusion Injury

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 25; no. 6; pp. 926 - 930
• Main Authors: Chun, Kook Jin, MD, PhD, Park, Yong Hyun, MD, PhD, Kim, Jeong Su, MD, Jang, Youngho, MD, PhD, Kim, June Hong, MD, PhD, Kim, Jun, MD, PhD, Lee, Mi Young, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2011
• Subjects: Anesthesia & Perioperative Care; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - pharmacology; Animals; Body Weight - physiology; cardiodynamics; Cardiotonic Agents; Coloring Agents; Coronary Circulation - physiology; Critical Care; Heart - drug effects; Heart Function Tests; In Vitro Techniques; Ischemic Postconditioning - methods; Ischemic Preconditioning, Myocardial - methods; Male; Myocardial Infarction - pathology; Myocardial Infarction - prevention & control; myocardial ischemia; Myocardial Reperfusion Injury - prevention & control; Organ Size - physiology; Piperidines - administration & dosage; Piperidines - pharmacology; postconditioning; preconditioning; Rats; Rats, Sprague-Dawley; remifentanil; Reperfusion; Tetrazolium Salts; Ventricular Function, Left - physiology; postconditioning; myocardial ischemia; remifentanil; cardiodynamics; preconditioning
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2011.02.019

Objective The purpose of this study was to investigate the effects of various remifentanil strategies (preconditioning, postconditioning, or continuous infusion) against myocardial ischemia-reperfusion injury. Design An in vitro experimental study using the Langendorff system. Setting A university research laboratory. Participants Male Sprague-Dawley rats (each n = 9). Interventions Five different remifentanil strategies were performed in isolated rat hearts as follows: remifentanil preconditioning (R-Pre), remifentanil postconditioning (R-Post), ischemic targeting remifentanil (R1), reperfusion targeting remifentanil (R2), or both ischemic and reperfusion targeting remifentanil (R3). Infarct size and cardiodynamics were compared. Measurement and Main Results The infarct-risk volume ratio in groups R-Pre (13.7% ± 9.9%), R-Post (13.7% ± 12.3%), and R3 (12.6% ± 6.1%) were decreased significantly compared with the untreated control hearts (32.9% ± 11.1%, p &lt 0.01). There was no significant difference in the left ventricular–developed pressure (LVDP) recovery after reperfusion between the control (43.6% ± 14.5%) and R-Pre (34.8% ± 12.9%, p > 0.05) groups after reperfusion. However, the LVDP recovery in R-Post (21.6% ± 7.7%, p < 0.05), R1 (16.7% ± 19.8%, p < 0.01), R2 (22.2% ± 13.9%, p < 0.05), and R3 (16.2% ± 7.8%, p < 0.01) was decreased significantly compared with control hearts. There was no significant difference in the recovery of dP/dtmax after reperfusion between the R-Pre (42.0% ± 16.9%) and control groups (39.0% ± 15.4%, p > 0.05), whereas the dP/dtmax in R3 group (16.9% ± 9.0%) was decreased significantly compared with R-Pre ( p < 0.05). Conclusions Preconditioning or postconditioning by remifentanil and the continuous infusion of remifentanil effectively reduce myocardial infarction, whereas reperfusion targeting ischemic targeting or reperfusion targeting remifentanil does not. Remifentanil preconditioning better preserves myocardial function, especially LVDP, than other remifentanil strategies.