title: [Prevention of per- and postoperative myocardial ischemia in non-cardiac surgery by intravenous diltiazem].
abstract: A controlled double-blind trial was carried out to assess the efficacy and safety of a continuous intravenous infusion of diltiazem in preventing perioperative myocardial ischaemia in patients with coronary artery disease. Sixty-six patients undergoing non cardiac surgical procedures (vascular surgery, n = 37; other, n = 29) were randomly chosen to receive either diltiazem (group D, n = 32); or placebo (group P, n = 34); there was no difference between these groups in the number of patients in each NYHA class (I: 13/16; II: 14/14; III: 5/4) or having had a previous myocardial infarct (20/22). ECG leads CM5 and CL5 were recorded continuously with an ICR 7200 Holter monitor. After starting recording, either placebo or a loading dose (0.5 mg.kg-1) of diltiazem was given, followed by an infusion of 5 micrograms.kg-1.min-1. Anaesthesia was induced by thiopentone and suxamethonium, and maintained with nitrous oxide (50%), fentanyl and either halothane or droperidol. The number of myocardial ischaemic episodes was significantly (p less than 0.05) lower in group D (2 ST depressions in two patients) than in group P (8 ST depressions in six patients, 2 myocardial infarcts and 1 pulmonary oedema). No conduction disturbance was observed; the lowest cardiac frequency was found in group P (32 b.min-1). Systolic and diastolic arterial blood pressures were lower in group D than in group P, but no difference was found in heart rate and rate-pressure product.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Département d'Anesthésie-Réanimation, Hôpital Bichat, Paris.
authors.forename: J P
authors.initials: JP
authors.lastname: Caramella
authors.forename: G
authors.initials: G
authors.lastname: Goursot
authors.forename: B
authors.initials: B
authors.lastname: Carcone
authors.forename: J M
authors.initials: JM
authors.lastname: Desmonts
authors.forename: J M
authors.initials: JM
authors.lastname: Fargnoli
authors.forename: J
authors.initials: J
authors.lastname: Marty
authors.forename: J L
authors.initials: JL
authors.lastname: Cazor
authors.forename: F
authors.initials: F
authors.lastname: Elkik
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000517:prevention & control*; D004110:Diltiazem / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007275:Injections, Intravenous; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period
chemical_list: D004110:Diltiazem
vernacular_title: Prévention de l'ischémie myocardique per- et postopératoire en chirurgie non cardiaque par le diltiazem intraveineux.