Key result
Remifentanil depresses sinus and AV node function in a dose-dependent manner.
Why the study?
Remifentanil has been implicated in causing intraoperative bradyarrhythmias and asystole, but its electrophysiological effects on the cardiac conduction system require clarification.
Does remifentanil affect cardiac conduction system parameters in patients undergoing anesthesia?
Does remifentanil affect cardiac conduction system parameters in patients undergoing anesthesia?
Remifentanil has dose-dependent depressor effects on the sinus and AV nodes, warranting caution in patients predisposed to bradyarrhythmias during anesthesia.
May warrant arrhythmia monitoring with remifentanil; leaves open need for prospective dose-safety trials.
Remifentanil is a selective mu-opioid receptor agonist characterized by a rapid onset and ultrashort predictable duration of action providing intense analgesia without prolonged respiratory depression. Remifentanil has been implicated in the causation of intraoperative bradyarrhythmias and asystole both in adults and in pediatric patients. Electrophysiological studies in humans and animals show that remifentanil provokes a dose-dependent depressor effect on sinus and AV node function, manifested by a significant prolongation of sinus node recovery time, sino-atrial conduction time and Wenckebach cycle length. These electrophysiologic effects of remifentanil suggest that it should be used with attention in vulnerable patients with predisposition to bradiarritmias during anesthesia.
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Narciso et al. (2014) conducted a review in Anesthesia. Remifentanil was evaluated on Sinus and AV node function. Remifentanil provokes a dose-dependent depressor effect on sinus and AV node function, prolonging sinus node recovery time, sino-atrial conduction time, and Wenckebach cycle length.
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