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(Circulation. 1999;100:II-357.)
© 1999 American Heart Association, Inc.

Myocardial Protection and Vascular Biology

Opiate Drugs and -Receptor–Mediated Myocardial Protection

Patrick E. Benedict, MD; Mary B. Benedict, MD; Tsung-Ping Su, PhD; Steven F. Bolling, MD

From the University of Michigan Health System (P.E.B., S.F.B.) and St. Joseph Mercy Hospital (M.B.B.), Ann Arbor, Mich; and the National Institutes of Health, Bethesda, Md (T.-P.S.).

Correspondence to Patrick E. Benedict, MD, Department of Anesthesiology, University of Michigan Health System, 1500 E. Medical Center Drive, 1G323 Box 0048, University Hospital, Ann Arbor, MI 48109-0048. E-mail pbenedic{at}umich.edu

Background—Hypothermic myocardial arrest is necessary to complete most cardiac surgery, which limits the success of such operations. Similarly, cold, inhospitable environments limit the survival of warm-blooded animals. Animals have successfully adapted to this challenge through hibernation. Hibernation is an energy-conserving state, now known to be governed by cyclical variation in endogenous opiate compounds. It may also be induced in nonhibernators via hibernating animal serum factors or -opiate peptides. Furthermore, hibernation-induction triggers extend organ preservation in many models. This study examined whether opiate drugs with an affinity for the -opiate receptor confer similar protection.

Methods and Results—Isolated hearts harvested from New Zealand White rabbits were treated with either cardioplegia alone or -opiate drugs (fentanyl, morphine, buprenorphine, pentazocine) followed by 2 hours of 34°C ischemia. Hearts were then reperfused, and functional and metabolic indices of treated groups were compared with untreated controls. Isovolumic developed pressure, coronary flow, and oxygen consumption were compared as a percent of preischemia versus 45 minutes after reflow. Developed pressure and oxygen consumption were better preserved in the morphine, buprenorphine, and pentazocine groups when compared with cardioplegia alone.

Conclusions—Drugs with -opiate activity confer myocardial protection, which is additive to cardioplegia. Use of -opiate drugs in this context may have important clinical implications.

Key Words: cardioplegia • cardiopulmonary bypass • drugs • hibernation • receptors

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