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CARDIOVASCULAR ANESTHESIA

The In Vitro Effects of Remifentanil, Sufentanil, Fentanyl, and Alfentanil on Isolated Human Right Atria

Jean-Luc Hanouz, MD, PhD^*, Alexandra Yvon, BSc, Géraldine Guesne, BSc, Cyrille Eustratiades, MD^*, Gérard Babatasi, MD, PhD, René Rouet, PhD, Pierre Ducouret, PhD, André Khayat, MD, Henri Bricard, MD^*, and Jean-Louis Gérard, MD, PhD^*

*Department of Anesthesiology, Laboratory of Experimental Anesthesiology and Cellular Physiology, and Department of Cardiac and Thoracic Surgery, Center Hospitalier Universitaire, Caen, France

Address correspondence and reprint requests to Dr. Jean-Luc Hanouz, Département d’Anesthésie-Réanimation, CHU de Caen, Avenue Côte de Nacre, 14033 Caen Cedex, France. Address e-mail to hanouz-jl{at}chu-caen.fr

Because some clinical studies have suggested that opioids used in anesthesia may have different deleterious hemodynamic effects, we compared the direct myocardial effects of cumulative concentrations of remifentanil, sufentanil, fentanyl, and alfentanil on inotropic and lusitropic variables of isolated human myocardium in vitro. Human right atrial trabeculae, obtained from patients scheduled for coronary bypass surgery or aortic valve replacement, were suspended vertically in an oxygenated (95% oxygen/5% CO₂) Tyrode’s modified solution ([Ca²⁺]_o = 2.0 mM, 37°C, pH 7.40, stimulation frequency 1 Hz). The effects of cumulative concentrations (10^-11, 10^-10, 10^-9, 10^-8, 10^-7, and 10^-6 M) of remifentanil (n = 8), sufentanil (n = 8), fentanyl (n = 8), and alfentanil (n = 8) on inotropic and lusitropic variables of isometric twitches were measured. Remifentanil, sufentanil, and fentanyl did not modify active isometric force and peak of the positive force derivative as compared with the Control group. Alfentanil induced a dose-dependent decrease in active isometric force and peak of the positive force derivative. This effect was abolished in the presence of [Ca²⁺]_o = 4.0 mM. None of these opioids altered lusitropic variables.

IMPLICATIONS: In isolated human right atria, remifentanil, sufentanil, and fentanyl did not modify inotropic variables in isometric conditions. In contrast, alfentanil induced a concentration-dependent negative inotropic effect possibly related, at least in part, to a decrease in Ca²⁺ inward transient. None of these opioids altered lusitropic variables.

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