Effects of fentanyl and remifentanil on the H-FABP in patients undergoing heart valve replacement

Objective To compare the effects of fentanyl and remifentanil on the H-FABP undergoing cardiopulmonary bypass in patients with valve replacement surgery. Methods 40 cases with single valve replacement surgery under cardiopulmonary bypass were selected and randomly divided into two groups( n = 20). Fentanyl group( group F) and remifentanil group( group R). Anesthesia was induced with intravenous injection to midazolam 0. 05 mg·kg-1,etomidate 0.2 mg·kg-1and cis-atracurium 0. 15 mg·kg-1,group F fentanyl 10 μg·kg-1or group R remifentanil 2 μg·kg-1. Both groups using continuous infusion of propofol 4 ~ 6 mg·kg-1·h-1maintain sedation by,cis-atracurium was used to maintain muscle relaxation by intravenous infusion. At the following time point: before the skin incision,before the CPB,CPB,after the CPB,group F used fentanyl 10 ~ 15 μg·kg-1by intravenous injection,group R used remifentanil 0. 2 ~ 0. 5 μg·kg-1·min-1by continuous intravenous infusion adjust the infusion rate according to blood pressure and heart rate. In both groups respectively collected 5 milliliters artery blood for determination of serum levels of H-FABP activity before induction of anesthesia( T0),before aortic cross-clamping( T1),1 hour after aortic opening( T2),3 hours after aortic opening( T3),6 hours after aortic opening( T4),12 hours after aortic opening( T5),24 hours after aortic opening( T6). Results Cardiopulmonary bypass time,operation time,dose of propofol and other narcotic drugs,MAP,HR and CVP were no statistically significant difference with each other( P 0. 05); The serum levels of H-FABP at T2,T3,T4 and T5 were higher between two groups of patients,there were statistically significant differences compared with T0( P 0. 05),T3 increased more significantly; There were no statistically significant difference with two groups at each time point( P 0. 05).Conclusion The serum levels of H-FABP is increased after valve replacement surgery in patients during cardiopulmonary bypass. Clinical dose of fentanyl compared with remifentanil can achieve similar effect on the H-FABP and myocardial protection.