Related Experiment Videos
[Anesthetic management of MIDCAB with high dose diltiazem]
Noboru Sugiuchi1, Taiji Yazaki, Hiroyuki Ito
1Department of Anesthesia, Toyoko Hospital, St. Marianna University School of Medicine, Kawasaki 211-0063.
Insights
High-dose diltiazem effectively managed blood pressure and heart rate in two patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) surgery. This approach offers a safe anesthetic option for this cardiac procedure.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) requires precise hemodynamic control.
- Traditional methods for circulation control during MIDCAB include low-dose diltiazem and beta-blockers.
Observation:
- Two patients undergoing MIDCAB were managed with high-dose diltiazem.
- Anesthesia involved propofol, vecuronium, fentanyl, oxygen, and nitrous oxide, with additional fentanyl, midazolam, and sevoflurane as needed.
- Nicorandil infusion was initiated post-induction, and high-dose diltiazem was administered throughout the surgery.
Findings:
- High-dose diltiazem (4 to 15 µg/kg/min) successfully controlled blood pressure and heart rate during MIDCAB.
- Hemodynamics returned to preoperative levels upon discontinuation of diltiazem.
- No adverse events related to high-dose diltiazem were reported in these cases.
Implications:
- High-dose diltiazem represents a potentially safe and effective anesthetic management strategy for MIDCAB.
- This finding may offer an alternative to traditional pharmacologic interventions for hemodynamic stabilization during MIDCAB.
- Further research is warranted to confirm the safety and efficacy of high-dose diltiazem in a larger MIDCAB patient cohort.
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.