title: [Anesthetic management of MIDCAB with high dose diltiazem].
abstract: Precise management of blood pressure and heart rate is required during minimally invasive direct coronary artery bypass (MIDCAB). Previously, low dose diltiazem and beta-blokers have been employed for control of circulation during this procedure, but we report 2 patients whose blood pressure and heart rate were managed during MIDCAB by high-dose diltiazem. In both patients, anesthesia was induced with propofol, vecuronium and fentanyl, and maintained by continuous infusion of propofol and inhalation of oxygen and nitrous oxide. Fentanyl, midazolam, and sevoflurane were administered occasionally. Immediately after the induction, a continuous infusion of nicorandil (2 to 4 mg.hr-1) was started and diltiazem (4 to 15 micrograms.kg-1.min-1) was administered continuously from the beginning of the surgery. Following discontinuation of diltiazem administration, blood pressure and heart rate returned to their preoperative values. These results suggest that safe anesthetic management during MIDCAB can be performed with highdose diltiazem.
authors.affiliation: Department of Anesthesia, Toyoko Hospital, St. Marianna University School of Medicine, Kawasaki 211-0063.
authors.forename: Noboru
authors.initials: N
authors.lastname: Sugiuchi
authors.forename: Taiji
authors.initials: T
authors.lastname: Yazaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Chiaki
authors.initials: C
authors.lastname: Fujiwara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Horiguchi
mesh_terms: D000368:Aged; D000758:Anesthesia; D000787:Angina Pectoris / Q000601:surgery; D001026:Coronary Artery Bypass; D003329:Coronary Vasospasm / Q000517:prevention & control; D004110:Diltiazem / Q000008:administration & dosage*; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D019060:Minimally Invasive Surgical Procedures
chemical_list: D004110:Diltiazem