Remifentanil is a selective mu-opioid receptor agonist characterized by a rapid onset and ultrashort predictable duration of action
providing intense analgesia without prolonged respiratory depression. Remifentanil has been implicated in the causation of intraoperative
bradyarrhythmias and asystole both in adults and in pediatric patients. Electrophysiological studies in humans and animals show
that remifentanil provokes a dose-dependent depressor effect on sinus and AV node function, manifested by a significant prolongation of
sinus node recovery time, sino-atrial conduction time and Wenckebach cycle length. These electrophysiologic effects of remifentanil
suggest that it should be used with attention in vulnerable patients with predisposition to bradiarritmias during anesthesia.
Keywords: Remifentanil, cardiac conduction system, electrophysiology.
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