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The cardioprotective effects of remifentanil preconditioning (RPC) against ischemia reperfusion injury have been demonstrated in intact and isolated rat hearts.1,2 This study aimed to investigate the protective effects of RPC against hypoxia/reoxygenation (H/R) injury in cultured adult rat ventricular myocytes, and its mechanisms involving opioid receptors and phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT), extracellular signal-regulated kinase (ERK) signaling pathways.