| Objective Cardiopulmonary bypass (CPB) can induce myocardial ischemia reperfusion injury in patients undergoing open heart surgery. Remifentanil is an ultra-short-acting opioid that is gaining popularity in the practice of modern anesthesia. Studies have shown that remifentanil postconditioning can attenuate myocardial ischemia reperfusion injury in rats and dogs. However, remifentanil postconditioning on myocardial ischemia-reperfusion (I/R) injury in patients undergoing open heart surgery under CPB has not been reported. This article is to evaluate the effect of remifentanil postconditioning on myocardial ischemia-reperfusion (I/R) injury in patients undergoing open heart surgery under CPB.Methods Sixty patients with congenital ventricular septal defect and/or artial septal (ASA grade II or III , NYHA class III) aged 1845 year were randomly divided into 4 groups (n=15 each): low, medium and high remifentanil postconditioning groups (R1, R2, R3) and control group (C). Anesthesia was induced with midazolam, sufentanil, propofol and rocuronium. Patients received an aortic infusion of remifentanil (diluted to 10, 20, 40μg/ml with normal saline) 2, 4, 8μg·kg-1·min-1 8 min before aortic unclamping and lasted for 5 min in group R1, R2, R3. In group C, the same volume of normal saline was infused in the same way. Before induction of anesthesia (baseline) and 4 h, 8 h, 24 h, 48 h after aortic unclamping venous blood samples 4 ml were obtained from the right internal jugular vein, 0.2 ml blood samples were used for determination of red blood cell specific volume (Hct), the remaining 3.8 ml blood samples were used for determination of plasma concentrations of cTnI, MDA and activities of CK-MB, SOD. The same myocardium protection was provided in four groups. Record the hemodynamic parameter, the time of aortic clamping, the time of CPB, the time of surgery, the minimum nasopharyngeal temperature, the comsumption of propofol and sufentanil during the surgery, the drainage of within 72 h after the surgical, the time of tracheal extubation, the time of ICU stay and the postoperative duration of vasoactive drugs and so on. Finally, normally distributed data were expressed as mean±SD. Data of different groups were analyzed using one-way analysis of variance (ANOVN), with repeated measures analysis of variance for group comparisons, qualitative data using Fisher exact test. Statistical differences were considered significant if the P value was <0.05.Results The case of patients, the aortic clamping time, the CPB time, the operation time, the minimum nasopharyngeal temperature has no significant difference between the four groups (P> 0.05). Four groups at each time point HR, MAP and CVP was not statistically significant (P >0.05). The plasma concentrations of cTnI and MDA and the activity of CK-MB were significantly lower at 4 h and 8 h after aortic unclamping in groups R1, R2 and R3 as compared with group C, while the activity of SOD was significantly higher (P<0.05). The plasma concentrations of cTnI and MDA and the activity of CK-MB were significantly lower at 4 h and 8 h after aortic unclamping in groups R2 and R3 than in group R1, while the activity of SOD was significantly higher (P<0.05). The plasma concentrations of cTnI and MDA and the activity of CK-MB were significantly lower at 24 h after aortic unclamping in groups R3 than in groups R1, R2 and C (P<0.05). The amount of protamine, the comsumption of propofol and sufentanil during the surgery, the time of tracheal extubation, the time of ICU stay, the drainage of within 72 h after the surgical has no significant difference (P> 0.05); automatically after ascending aortic resuscitation rate of resuscitation after stable incidence of arrhythmia is different, but has no significant difference among four groups (P> 0.05). The postoperative duration of vasoactive drugs was significantly shorter in groups R1, R2 and R3 as compared with group C (P<0.01).Conclusions Remifentanil postconditioning can attenuate myocardial I/R injury in patients undergoing open heart surgery under CPB through inhibiting lipid peroxidation.
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