Анестезия и клинические исследования
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Remifentanil and Sufentanil Preserve Left Ventricular Systolic and Diastolic Function in Patients with Ischemic Heart Disease-A Randomised Comparative Study

Christian A Frederiksen, Peter Juhl-Olsen, Michael Kremke, Linda A Rasmussen, Anne-Grethe Lorenzen, Erik Sloth and Carl-Johan Jakobsen

Although the impact of drugs on cardiac function seems unchanged by standard haemodynamic measurements, it might be followed by injurious stress and deterioration of myocardial function as stable conventional monitoring not necessarily represent unaffected function. The aim of the study was to assess changes in global haemodynamic measures, primarily by changes in cardiac index, and contemporary indices of LV systolic and diastolic function during induction of anaesthesia with remifentanil compared to sufentanil. The aim was to compare the effect of sufentanil and remifentanil with primary focus on the opioids given as a single drug and secondary in conjunction with Propofol. Methods: Thirty patients with ischaemic heart disease scheduled for elective cardiac surgery were randomized to receive either remifentanil or sufentanil as basic opioid. Cardiac function was evaluated with invasive haemodynamic measures established before administration of the opioids, combined with echocardiographic left ventricular systolic (longitudinal peak systolic strain) and diastolic function (tissue Doppler-index, E/e’). Results: In single drug administration, no differences were found in cardiac index (CI), stroke volume index (SVI) and heart rate (HR) between the opioids. A minor fall was seen in mean arterial blood pressure (MAP) after remifentanil (104 ± 14 to 91 ± 15 mmHg; P=0.001) and sufentanil (107 ± 21 to 94 ± 24 mmHg; P=0.003), with no difference between groups (P=0.933). Central venous pressure (CVP) increased after sufentanil (P=0.022) and mean pulmonary artery pressure (mPAP) in both groups. No changes were observed for cardiac index, stroke volume index and heart rate or in longitudinal peak strain (remifentanil -14.3 ± 4.0 to -16.3 ± 4.6; P=0.059 and sufentanil -14.5 ± 2.8 to -15.1 ± 2.3; P=0.469). After initiation of propofol all parameters declined over time. Remifentanil patients had lower MAP (P<0.001) and CVP (P=0.003), while heart rate (P=0.025) was higher. No other statistically significant differences between the groups. Conclusions: In a single drug setting, the haemodynamic effects of remifentanil are comparable to sufentanil in ischaemic patients. Combined with propofol, identical greater changes are seen in especially MAP, HR and SVI in both groups, likely designated to propofol and its combination with opioids.