Remifentanyl vs Fentanyl impact on Ejection Fraction and Troponin in off pump cardiac surgery

Abstract

Background: Remifentanil is structurally synthesized from fentanyl. It offers markedly superior analgesic effects compared to fentanyl and reaches peak efficacy within minutes after parenteral dosing (1). This study compared the effects of fentanyl and remifentanil on ejection fraction (EF) and troponin I measurement during elective off-pump coronary artery bypass graft (OPCABG) surgery.
Methods: Seventy-two patients, aged 35-75 years, were included. Parameters recorded include arterial oxygen saturation (SaO2), heart rate (HR), invasive blood pressure (IBP), and EF. Baseline IBP was recorded before any surgical or anesthetic interventions. In addition, a baseline blood sample was collected for troponin I measurement. Before anesthesia induction, all patients received 100% oxygen for at least 3 minutes, followed by intravenous midazolam 0.06 mg/kg, propofol 1.3 mg/kg, rocuronium 1.2 mg/kg, and sevoflurane 0.5 MAC. Patients were then randomly assigned to one of the two groups (randomization was done using patient numbering: odd-numbered patients were assigned to Group R (remifentanil group), and even numbered patients to Group F (fentanyl group); Group R received 0.5 μg/kg remifentanil over 1 minute for induction and 0.1–1 μg/kg/hour for maintenance. Meanwhile, Group F received 5 μg/kg fentanyl over 1 minute for induction and 0.1–1 μg/kg/hour for maintenance. Data were analyzed using SPSS version 23 (IBM Corp., USA). Normality was assessed with the Kolmogorov–Smirnov and Shapiro–Wilk tests. Normally distributed data were expressed as mean ± SD and nonnormally distributed data as median (IQR). EF and serum troponin were analyzed using the Friedman and Wilcoxon signed-rank tests, respectively, and group comparisons were performed using the Mann–Whitney U test. A p-value < 0.05 was considered statistically significant.
Results: Group R showed a median preoperative EF of 55% (IQR 0.110, MR 29.23), while Group F had 58% (IQR 0.113, MR 1.77). The overall median preoperative EF was 56% (IQR 0.100), with no significant difference between groups (p=0.567). Intraoperatively, Group R demonstrated a higher median EF of 60% (IQR 0.12, MR 37.33) compared with 52% (IQR 0.10, MR 23.67) in Group F. The overall intraoperative EF was 52% (IQR 0.10), with a statistically significant difference (p=0.002). The p-value of 0.001 indicates a highly statistically significant difference in serum troponin I levels from preoperative to 24 hours post intensive care unit (ICU) admission for both R and F groups. The p value of 0.024 indicates a highly statistically significant difference in serum troponin I levels between Group R and Group F, with Group R having a higher median 24 hours...