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

Background: Systemic response plays pivotal roles in pathogenesis of organ dysfunction after with cardiopulmonary bypass (CPB). The aim of this study was to investigate whether remifentanil has the effects on systemic response induced cardiac with CPB.Methods: Sixty adult patients undergoing cardiac surgery with CPB randomly assigned to two groups: remifentanil (n=30) a fentanyl group (n=30). The levels of IL-6, IL-8 malondialdehyde (MDA) were measured at preinduction (T1), before aortic clamping (T2), before aortic declamping (T3), 5 (T4), 30 (T5), and 60 (T6) min after aortic declamping. Hemodynamic variables serially recorded at that same times. Myocardial cell damage as assessed by plasma level of creatine kinase-MB (CK-MB) troponin T measured before hours after surgery.Results: The levels of IL-6, IL-8 MDA increased from before aortic declamping in groups. In remifentanil group, all of those were significantly lower compared to fentanyl group from just before aortic declamping (Pu003c0.05). The level of CK-MB and troponin T significantly increased at 24 hours after surgery preoperative baseline in both groups. In the remifentanil group, both significantly lower than fentanyl group at 24 hours after surgery.Conclusion: Remifentanil attenuates systemic inflammatory response more effectively fentanyl in cardiac surgery with CPB. The mechanism of its effects is likely to be through proinflammatory cytokines (including IL-6, IL-8) and oxidative stress mediator (MDA).