Intravenous Diltiazem Prevents Intraoperative Myocardial Ischemia During Noncardiac Surgery

• Published in: Nihon Rinshō Masui Gakkai shi Vol. 18; no. 9; pp. 707 - 714
• Main Authors: SUZUKI, Hidehiro, TSUNODA, Chiharu, IWADE, Motoyo, TAKAHASHI, Kaoru, NOMURA, Yuhko, NOMURA, Minoru
• Format: Journal Article
• Language: English
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 1998
• Subjects: Diltiazem; Intraoperative myocardial ischemia; Transesophageal echocardiography
• ISSN: 0285-4945; 1349-9149
• DOI: 10.2199/jjsca.18.707

We evaluated the usefulness of prophylactic diltiazem on the incidence of intraoperative myocardial ischemia in patients with known or suspected coronary artery disease who underwent noncardiac surgery. Patients were randomly assigned to either a control group (n=7), a group to receive 1μg/kg/min (D1, n=12) or one to receive 2μg/kg/min (D2, n=13) of intravenous diltiazem. Diagnosis of myocardial ischemia was based on electrocardio-gram recording and scoring of segmental wall motion abnormality (SWMA) at the left ventricular short axis view by transesophageal echocardiography (TEE). Arterial pressure and heart rate did not change in the three groups. Myocardial ischemia occurred more frequently in the control group than the D1 and the D2 groups. Intraoper-ative average score of SWMA in the control group worsened significantly than the preoper-ative value. Among the three groups, the score of SWMA in the control group worsened than those of the D1 and D2 groups. There was no significant difference in the intraoperative scores of SWMA between the D1 and the D2 groups. Left ventricular ejection fraction (LVEF) decreased in the D1 and the D2 groups compared with the preoperative values. The LVEF of the D2 group decreased more rapidly than the D1 group during the intraoperative period. In conclusion, the administration of diltiazem prevented the intraoperative myocardial ischemia in these patients. and a dose of diltiazem 1/μg/kg/min infusion is better than 2μg/kg/min in maintenance of the LVEF.