Endocrine stress response and inflammatory activation during CABG surgery. A randomized trial comparing remifentanil infusion to intermittent fentanyl

Winterhalter, Michael; Brandl, K.; Rahe‐Meyer, Niels; Osthaus, A.; Hecker, Hartmut; Hagl, Christian; Adams, Hans Anton; Piepenbrock, S.

doi:10.1017/s0265021507003043

Cited by 91 publications

(57 citation statements)

References 28 publications

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“…decreased in cardiac patients using remifentanil (7). When comparing the cardiac protective effect of remifentanil with fentanyl, lower CKMB and troponin T levels were observed with remifentanil (24,25). In this study, CKMB levels and lactate levels at T2 were lower in the sevoflurane-dexmedetomidine group than in the sevoflurane-remifentanil group at all times.…”

Section: Discussionmentioning

confidence: 43%

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Türktan¹,

Güneş²,

Yaliniz³

et al. 2017

Turk J Med Sci

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IntroductionMyocardial protection is important in preventing the damaging effects of a cardiopulmonary bypass (CPB) on the myocardium, including ischemic and reperfusion injury (1). Eliminating or reducing myocardial injury can improve the clinical prognosis of patients undergoing cardiac surgery. Cardiac biomarkers are associated with the degree of cardiac injury and cardiac troponin I (cTnI), lactate, and creatine phosphokinase-MB (CKMB) are especially sensitive biomarkers for evaluating cardiac cell damage (2-4). Pyruvate, lactate, glucose, and insulin are respiratory substrates indicating heart perfusion. The level of pyruvate in the blood increases in the anaerobic state and pyruvate is converted to lactate under these conditions (3-5).Sevoflurane, a potent inhalation agent, decreases the inflammatory response and improves myocardial function after CPB (6). Dexmedetomidine, a selective and specific α-2 adrenoceptor agonist, has been frequently used as a sedative or adjuvant anesthetic drug in cardiac surgery. Dexmedetomidine has also been known to have some neuroprotective effects; however, data are insufficient for its cardioprotective effects in human studies. Remifentanil, a fast-acting opioid, has been generally used in cardiac surgery for cardiac protection before sternotomy (7).This study compared the cardiac effects of sevoflurane plus dexmedetomidine with those of sevoflurane plus remifentanil during adult cardiac surgery with CPB by examining levels of lactate, pyruvate, CKMB, and cTnI in patient blood samples. The hypothesis is that a difference Background/aim: Myocardial protection is an important factor of open heart surgery and biological biomarkers (lactate, CKMB, cardiac troponin I, and pyruvate) are used to assess myocardial damage. This study compares the effects of dexmedetomidine and remifentanil on myocardial protection during coronary artery bypass grafting (CABG) surgery. Materials and methods:Patients scheduled for elective CABG surgery (n = 60) were included in this study. Anesthesia induction was introduced with propofol, fentanyl, and vecuronium bromide. Anesthesia was maintained with remifentanil infusion and sevoflurane in the remifentanil group (Group R) and with dexmedetomidine infusion and sevoflurane in the dexmedetomidine group (Group D). Blood samples for biochemical markers were taken from the coronary sinus catheter before cardiopulmonary bypass (T1), 20 min after aortic cross-clamping (T2), 20 min after removal of the aortic cross-clamping (T3), and 10 min after separation from cardiopulmonary bypass (T4).Results: Demographic data were similar between the groups. Lactate level at the T2 period and CKMB levels during the study period were lower in Group D than in Group R. In both groups, all values except pyruvate significantly increased over time. Conclusion:The dexmedetomidine-sevoflurane combination may improve the cardioprotective effect in comparison with remifentanilsevoflurane in CABG surgery.

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Section: Discussionmentioning

confidence: 43%

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Türktan¹,

Güneş²,

Yaliniz³

et al. 2017

Turk J Med Sci

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“…In this study, both remifentanil and fentanyl attenuated the elevation of troponin T and CK-MB after cardiac surgery and the levels of postoperative cardiac enzymes in the remifentanil group were kept significantly lower compared with the fentanyl group. Similarly, Winterhalter et al [29] reported there was a trend towards lower CK-MB level in the remifentanil group and statistically lower CK-MB and a trend towards lower troponin T level.…”

Section: Discussionmentioning

confidence: 77%

Remifentanil Attenuates Systemic Inflammatory Response in Patients undergoing Cardiac Surgery with Cardiopulmonary Bypass

Lee¹,

Tin²,

Kim³

et al. 2017

Arch Med.

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“…23,24 This may be the reason why no difference between groups was observed. A follow-up study might include cardiac patients with similar renal dysfunctions to compare ketamine and remifentanil in terms of their immune protective effects determined by more elaborated markers.…”

Section: Discussionmentioning

confidence: 94%

A comparison of the effects of ketamine and remifentanil on renal functions in coronary artery bypass graft surgery

et al. 2015

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We have investigated the effects of ketamine-based and remifentanil-based anesthetic protocol on perioperative serum cystatin-C levels, and creatinine and/or cystatin-C-based eGFR equations in terms of acute kidney injury in coronary artery bypass graft (CABG) surgery. Using a simple randomization method (coin tossing), patients were divided into the two groups and not-blinded to the anesthetist. Remifentanil-midazolam-propofol or ketamine-midazolam-propofol-based anesthetic regimen was chosen. Different eGFR formulas using creatinine (MDRD, CKD-EPI, Cockrauft Gault); cystatin-C (eGFR1, eGFR2) or a combination of creatinine and cystatin-C (eGFR 3) were used to calculate estimated glomerular filtration rates (eGFRs). Highsensitive troponin T was used to determine if ketamine use in coronary surgery contributed to myocardial cell damage. Thirty-seven patients were included in the study (remifentanil group ¼ 19, ketamine Group ¼ 18). Urea, creatinine, cystatin-C levels were comparable between the groups in all the measurement times and also postoperative day 2 samples showed statistically higher results compared to baseline (p50.001). Effects of ketamine and remifentanil on renal functions were found similar. Creatinine and cystatin-C-based eGFR equations resulted similar in our study. Reversible stage 1 acute kidney injury (AKI) was observed on postoperative day 2 in seven patients from the remifentanil group and six patients from the ketamine group. Hs-troponin T was found to be higher in postoperative day 1 samples; there were no significant difference between the groups. Our results indicated that patients who have normal renal functions undergoing on-pump coronary bypass surgery, effects of ketamine and remifentanil on renal functions in terms of AKI were found to be similar.

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Endocrine stress response and inflammatory activation during CABG surgery. A randomized trial comparing remifentanil infusion to intermittent fentanyl

Abstract: The perioperative endocrine stress response was attenuated in patients supplemented with continuous remifentanil infusion as compared to intermittent fentanyl.

Cited by 91 publications

References 28 publications

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery*

Remifentanil Attenuates Systemic Inflammatory Response in Patients undergoing Cardiac Surgery with Cardiopulmonary Bypass

A comparison of the effects of ketamine and remifentanil on renal functions in coronary artery bypass graft surgery

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