Hemodynamic effect of calcium channel blockade during anesthesia for coronary artery surgery.
Because the choice of anesthetic technique does not influence the incidence of perioperative myocardial ischemia, reduction of ischemic risk may require specific antianginal therapy. Calcium entry blockers are effective drugs in antianginal therapy. Diltiazem reduces myocardial oxygen demand through decreases in heart rate, inotropy, and systolic function, while increasing myocardial oxygen delivery through coronary vasodilation. These potentially beneficial effects of diltiazem were evaluated in 15 of 29 patients (diltiazem v placebo, double-blind study) scheduled for coronary artery bypass graft surgery. Continuous infusion of diltiazem (0.15 mg/kg bolus followed by 2 micrograms/kg/min), during anesthesia and surgery before cardiopulmonary bypass, significantly reduced the major MVO2 determinants during anesthesia with moderate doses of fentanyl and a benzodiazepine (midazolam in 8 of 14 control patients and 9 of 15 treated patients, or flunitrazepam in the others). Heart rate, mean arterial pressure, and inotropy were decreased during the most stressful events of surgery when plasma diltiazem concentrations were in the therapeutic range (greater than 96 ng/mL). The number of patients with perioperative ischemia was 2 of 15 in the treated group and 4 of 14 in the control group. Provided that diltiazem plasma concentrations are sufficient, it can contribute to lowering the ischemic burden during anesthesia for coronary artery surgery.
Colson
P
P
Department of Anesthesiology, St-Eloi Hospital, Montpellier, France.
Médioni
P
P
Saussine
M
M
Séguin
J R
JR
Cuchet
D
D
Grolleau
D
D
Chaptal
P A
PA
Roquefeuil
B
B
D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000517:prevention & control*; D004110:Diltiazem / Q000097:blood / Q000627:therapeutic use*; D004311:Double-Blind Method; D004329:Droperidol; D005283:Fentanyl; D005445:Flunitrazepam; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000517:prevention & control*; D008874:Midazolam; D008875:Middle Aged; D010919:Placebos; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D013997:Time Factors; D014655:Vascular Resistance / Q000187:drug effects
D010919:Placebos; D005445:Flunitrazepam; D004110:Diltiazem; D004329:Droperidol; D008874:Midazolam; D005283:Fentanyl