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

Zaballos, M.; Jimeno, Concepción; Almendral, Jesús; Atienza, Felipe; Patiño, Daniel; Valdés, E. López; Navia, Juan M.; Anadón, M.J.

doi:10.1093/bja/aep131

Cited by 48 publications

(35 citation statements)

References 29 publications

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“…The complication rates in this study were similar to those observed by other authors 1,3,16,29,30 and were similar for both groups. The incidence of recurrence (outcome) of AF in three months was equal in both G1 and G2.…”

Section: Discussion Discussion Discussion Discussionsupporting

confidence: 91%

“…Zaballos et al 16 concluded that the hemodynamic effects of remifentanil are associated with decreased vagal tone, being able to produce marked decrease in heart rate.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…The literature, however, is scarce 8 as for research that discuss advantages and disadvantages of the techniques, as well as to the establishment of specific guidelines on the subject. Most works show how the anesthetic technique used intravenous sedation (conscious or unconscious), based on the preference of the anesthesiologist or institutional protocols [14][15][16][17] . This study aims to compare the techniques of deep sedation and general anesthesia for curative ablation of atrial fibrillation and evaluate the hemodynamic and respiratory parameters, complications, and recurrence (outcome).…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Ablação curativa da fibrilação atrial: comparação entre sedação profunda e anestesia geral

Firme¹,

Cavalcanti

Barrucand

et al. 2012

Rev. Col. Bras. Cir.

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OBJETIVO: Comparar sedação profunda com anestesia geral para ablação curativa de fibrilação atrial. MÉTODOS: Estudo prospectivo, aleatório, com 32 pacientes, idades entre 18 e 65 anos, ASA 2 e 3, IMC d" 30kg/m², distribuídos em dois grupos: sedação profunda (G1) e anestesia geral (G2). Todos receberam midazolan (0,5mg/kg) venoso. O G1 recebeu propofol (1mg/kg) e máscara facial de O2, seguido da infusão contínua de propofol (25-50mg/kg/min) e remifentanil (0,01-0,05µg/kg/min). O G2 recebeu propofol (2mg/kg) e máscara laríngea com tubo de drenagem, seguido da infusão contínua de propofol (60-100mg/kg/min) e remifentanil (0,06-0,1µg/kg/min). Foram comparados: frequência cardíaca, pressão arterial invasiva, complicações, recidiva (desfecho) em três meses e gasometrias. RESULTADOS: Os pacientes do G1 apresentaram gasometrias arteriais com níveis de PaCO2 maiores e pH menores (p=0,001) e maior incidência de tosse. Ocorreu diminuição da PAM e FC no G2. Exceto a tosse, as complicações e recidivas foram semelhantes em ambos os grupos. CONCLUSÃO: Ambas as técnicas podem ser utilizadas para a ablação curativa da fibrilação atrial. A anestesia geral proporcionou menores alterações respiratórias e maior imobilidade do paciente.

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Section: Discussion Discussion Discussion Discussionsupporting

confidence: 91%

“…Zaballos et al 16 concluded that the hemodynamic effects of remifentanil are associated with decreased vagal tone, being able to produce marked decrease in heart rate.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Ablação curativa da fibrilação atrial: comparação entre sedação profunda e anestesia geral

Firme¹,

Cavalcanti

Barrucand

et al. 2012

Rev. Col. Bras. Cir.

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“…Hence, new anaesthetics are constantly sought, and the effects of the available anaesthetic drugs are being widely studied. The most common drugs used to anesthetise pigs include midazolam, azaperon, fentanyl, droperidol, ketamine and barbiturates (5,19,36). Alpha-2 adrenergic agonists, which are commonly used in companion animals, are rarely used in laboratory animals prior to cardiovascular procedures, because they reduce the blood pressure and heart rate.…”

Section: Praca Oryginalnamentioning

confidence: 99%

Effect of xylazine, medetomidine and dexmedetomidine on cardiac conduction in pigs

Cepiel¹,

Noszczyk-Nowak²,

Janiszewski³

et al. 2018

Medycyna Weterynaryjna

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SummaryThe majority of anaesthetics used in studies regarding heart arrhythmias may affect the cardiac conduction system, thus influencing the results. In veterinary medicine, xylazine, medetomidine and dexmedetomidine are commonly used for premedication in laboratory and companion animals. To date, there have been no studies assessing the effect of these substances on the cardiac conduction system. The aim of this study was to assess the effect of xylazine, medetomidine and dexmedetomidine on the parameters of the cardiac conduction system in pigs. The study was carried out on 18 Great White Polish male pigs weighing from 21 to 40 kg. The animals were divided into three equal groups. The animals from the first group received xylazine at a dose of 2 mg/ kg i.v.; those from the second group received medetomidine at 40 mcg/kg i.v.; and those from the third group received dexmedetomidine at 10 mcg/kg i.v. The electrophysiological activity of the heart was analysed using an invasive electrophysiological study (EPS). During the EPS, a decrease in the heart rate after substance administration was observed in all animals, but there were no statistically significant differences in the cardiac conduction parameters. A pro-arrhythmic effect of xylazine was observed, but no statistically significant changes in the EPS parameters were noted. Our results indicate that medetomidine and dexmedetomidine may be used as standard premedication drugs in electrophysiological studies in pigs. Their use may facilitate animal preparation procedures without affecting study results.

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“…After obtaining written, informed consent from each patient and/or their family, patients were divided into 3 groups according to a previous study by Zaballos et al [17]: 1) control group (group C, N=20), in which all patients received a single 20-ml injection of saline solution prior to mECT; 2) low-dose remifentanil group (group L, N=20), in which all patients received a single 20-ml injection of saline solution containing 0.5 μg/kg of remifentanil prior to mECT; and 3) high-dose remifentanil group (group H, N=20), in which all patients received a single 20-ml injection of saline solution containing 1.0 μg/kg of remifentanil prior to mECT.…”

Section: Patient Classificationmentioning

confidence: 99%

Remifentanil can Prevent the Increase in Qt Dispersion During Modified Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

Kageyama¹,

Hamaguchi²

2015

J Anesth Clin Res

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Objective: To clarify the hemodynamic-stabilizing effect of remifentanil in the context of modified electroconvulsive therapy (mECT), we measured electrocardiographic alterations in the corrected QT interval (QTc) and corrected QT dispersion (QTcD), considered predictive of ventricular arrhythmia, during mECT. Methods:Sixty patients scheduled for mECT were divided randomly into 3 groups. Patients in the low-dose remifentanil administration group (group L, N=20) were administered 0.5 μg/kg of remifentanil before mECT. Patients in the high-dose group (group H, N=20) were administered 1.0 μg/kg of remifentanil, and those in the control (group C, N=20) were administered a similar volume of normal saline solution. Modified ECT was performed in the same manner in all groups with propofol and suxamethonium. Changes in QTc and QTcD values were analyzed using a repeated measures analysis of variance, and between-group comparisons were conducted using the Bonferroni method.Results: During mECT, an increase in the mean arterial pressure, decrease in the R wave-to-R wave interval, elongation of QTc, and increase in QTcD were observed in group C, whereas these alterations were attenuated in group L and were not observed in group H. The differences observed in group C relative to the other groups were statistically significant (P<0.05). Conclusion:Compared with the control treatment and a 0.5 μg/kg dose, a 1.0 μg/kg dose of remifentanil had a preventive effect on ventricular arrhythmia after mECT, as well as on hemodynamic changes, according to the observed alterations in QTc and QTcD. Therefore, our results indicate that a 1.0 μg/kg dose of remifentanil could suppress hemodynamic changes, prevent myocardial ischemia or cerebral hemorrhage, and minimize the development of fatal arrhythmias such as ventricular tachycardia and/or ventricular fibrillation.

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

Abstract: 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.

Cited by 48 publications

References 29 publications

Ablação curativa da fibrilação atrial: comparação entre sedação profunda e anestesia geral

Ablação curativa da fibrilação atrial: comparação entre sedação profunda e anestesia geral

Effect of xylazine, medetomidine and dexmedetomidine on cardiac conduction in pigs

Remifentanil can Prevent the Increase in Qt Dispersion During Modified Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

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