Cardiac electrophysiological effects of remifentanil: study in a closed-chest porcine model

Br J Anaesth. 2009 Aug;103(2):191-8. doi: 10.1093/bja/aep131. Epub 2009 May 20.


Background: Remifentanil has been implicated as causing intraoperative bradyarrhythmias, but little information is available regarding its cardiac electrophysiological effects. Thus, we evaluated the cardiac electrophysiological properties before and after remifentanil in a closed-chest porcine model.

Methods: Eighteen Landrace-Large pigs were premedicated with ketamine and anaesthetized with propofol (4.5 mg kg(-1) bolus followed by 13 mg kg(-1) h(-1)). After instrumentation, an electrophysiological evaluation was performed under propofol and repeated after remifentanil (bolus of 1 microg kg(-1), followed by an infusion of 0.5 microg kg(-1) min(-1)). We evaluated sinus node function [sinus node recovery time (SNRT) and sinoatrial conduction time (SACT)], atrioventricular (AV) nodal function [AH intervals during sinus rhythm (SR) and atrial pacing, Wenckebach cycle length (WCL), and effective refractory periods (ERP)], atrial, His-Purkinje, and ventricular conduction and refractoriness. Significant changes between 'propofol protocol' and 'propofol+remifentanil protocol' were evaluated.

Results: Remifentanil caused a significant increase in sinus cycle length (21%, P=0.001) and a significant prolongation of SNRT (43%, P=0.001), corrected SNRT (136%, P=0.003), SACT (40%, P=0.005), AH interval during SR (17%, P=0.02), AH interval during atrial pacing (25%, P=0.01), and ventricular ERP (12%, P=0.004). There was a tendency towards a prolongation of WCL and AV nodal refractoriness. Similar significant changes were observed in a reference group of seven animals in which sevoflurane was used instead of propofol. No significant changes were observed in atrial parameters, His-Purkinje function, parameters of intraventricular conduction, and QT intervals.

Conclusions: Remifentanil depresses sinus node function and most parameters of AV nodal function. This contributes to an explanation for clinical observations of remifentanil-related severe bradyarrhythmias.

MeSH terms

  • Analgesics, Opioid / pharmacology*
  • Anesthetics, Intravenous / pharmacology*
  • Animals
  • Atrioventricular Node / drug effects
  • Carbon Dioxide / blood
  • Disease Models, Animal
  • Electrocardiography / drug effects
  • Heart Conduction System / drug effects*
  • Hemodynamics / drug effects
  • Oxygen / blood
  • Partial Pressure
  • Piperidines / pharmacology*
  • Propofol / pharmacology
  • Remifentanil
  • Sinoatrial Node / drug effects
  • Sus scrofa


  • Analgesics, Opioid
  • Anesthetics, Intravenous
  • Piperidines
  • Carbon Dioxide
  • Remifentanil
  • Oxygen
  • Propofol