Journal
JOURNAL OF INTERNATIONAL MEDICAL RESEARCH
Volume 36, Issue 6, Pages 1235-1247Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/147323000803600610
Keywords
OPIOID; INFLAMMATION; CARDIOPULMONARY BYPASS; SUPPRESSOR OF CYTOKINE SIGNALLING-3; CELL-MEDIATED IMMUNE RESPONSE
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This prospective randomized pilot study compared the influence of fentanyl-based versus remifentanil-based anaesthesia on cytokine responses and expression of the suppressor of cytokine signalling (SOCS)-3 gene following coronary artery bypass graft surgery. Forty patients were assigned to receive anaesthesia with either intravenous remifentanil (0.3 - 0.6 mu g/kg per min; n = 20) or intravenous fentanyl (5 - 10 mu g/kg per h; n = 20). Levels of interleukin (IL)-6, IL-10, tumour necrosis factor-alpha and interferon-gamma (IFN-gamma) and the expression of SOCS-3 were measured pre- and post-operatively. The data from 33 of the patients were analysed. The IFN-gamma/IL-10 ratio after concanavalin A stimulation in whole blood cells on postoperative day 1 and SOCS-3 gene expression on post-operative day 2 were significantly lower in the remifentanil group than in the fentanyl group. The time in the intensive care unit was also significantly lower in the remifentanil group. These findings suggest that remifentanil can attenuate the exaggerated inflammatory response that occurs after cardiac surgery with cardiopulmonary bypass. Further clinical trials are required to define the influence of choice of intra-operative opioid on postoperative outcome.
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