Remifentanil functions in the adaptive protection of cardiac function following ischemia

The present study aimed to investigate the effects of remifentanil during adaptation followinsg myocardial ischemia, and its possible clinical applications. Remifentanil was used during the simulation of adaptation following ischemia, which was performed using a Langendorff heart perfusion system. A total of 75 rats were divided into five groups, and the coronary flow, cardiac output and the cardiac enzyme content in coronary effluent prior to ischemia and post-reperfusion were recorded. Electron microscopy was used to observe myocardial ultrastructure, and the volume of aortic and coronary effluent was also measured. The recovery of cardiac output upon reperfusion was significantly higher following remifentanil treatment (91%), as compared with the ischemic control group (78%; P<0.05). The coronary flow of the experimental group following reperfusion decreased by 4 ml/min compared with the control group not exposed to ischemia, whilst the coronary flow of the ischemic control group was reduced by 20-24 ml/min. Flameng scoring of the mitochondria demonstrated improved mitochondrial ultrastructure following remifentanil treatment (score, 1.25±0.31), as compared the ischemic control group (score, 3.14±0.17). Lactate dehydrogenase (LDH) levels in the remifentanil-treated group were significantly lower at 10 and 30 min post-reperfusion (15.3±7.1 and 10.2±6.8 U/l, respectively), as compared with the control group (29.7±8.3 and 20.6±6.8 U/l, respectively; P<0.05). The results of the present study suggested that the application of remifentanil following ischemia protected heart function via the opioid receptors by reducing myocardial enzyme release, and attenuating ischemia-induced changes to the myocardial cell and mitochondrial structure.