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[Comparison between diltiazem and nicardipine used during anesthesia for coronary revascularization]
Y Furuya1, K Atarashi, C Tachibana
1Department of Anesthesiology, Tokyo Women's Medical College Daini Hospital.
Insights
Diltiazem and nicardipine, both calcium-channel blockers, were evaluated during coronary revascularization anesthesia. Diltiazem offered cardiac protection via suppression, while nicardipine reduced afterload through vasodilation, proving useful in managing ischemic heart disease.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Ischemic heart disease poses risks during coronary revascularization.
- Anesthesia management is critical for hemodynamic stability in these patients.
- Calcium-channel blockers are considered for their cardioprotective and vasodilatory effects.
Purpose of the Study:
- To compare the effects of diltiazem and nicardipine on circulatory parameters.
- To assess the utility of these calcium-channel blockers during anesthesia for coronary revascularization.
- To determine the distinct mechanisms of action of diltiazem and nicardipine in this context.
Main Methods:
- A comparative study involving 30 patients undergoing coronary revascularization.
- Intravenous administration of diltiazem or nicardipine during fentanyl anesthesia.
- Hemodynamic monitoring using a Swan-Ganz catheter to measure circulatory parameters.
Main Results:
- Diltiazem significantly decreased heart rate, mean arterial pressure, cardiac output, left ventricular stroke work, and rate-pressure product.
- Nicardipine significantly decreased mean arterial pressure, systemic vascular resistance, rate-pressure product, and pressure-rate quotient.
- Significant inter-group differences were observed in cardiac output, stroke volume, systemic vascular resistance, and left ventricular stroke work.
Conclusions:
- Diltiazem provides myocardial protection through mild cardiac suppression.
- Nicardipine effectively reduces afterload via significant vasodilation.
- Both diltiazem and nicardipine are beneficial calcium-channel blockers for managing patients undergoing coronary revascularization under anesthesia.
Abstract:
The effects of diltiazem (0.1 mg.kg-1 + 3 micrograms.kg-1.min-1) and nicardipine (0.01 mg.kg-1 + 2 micrograms.kg-1.min-1) on circulatory parameters were compared in 30 patients with ischemic heart disease, who underwent coronary revascularization. These drugs were administered intravenously via a Swan-Ganz catheter after induction of fentanyl anesthesia. The group injected with diltiazem showed significant decreases in heart rate, mean arterial pressure, cardiac output, left ventricular stroke work and rate-pressure product. The group injected with nicardipine showed significant decreases in mean arterial pressure, systemic vascular resistance, rate-pressure product and pressure-rate quotient. There were significant differences between the two groups in cardiac output, stroke volume, systemic vascular resistance and left ventricular stroke work. The results suggest that diltiazem protects the ischemic heart by slight cardiac suppression and that nicardipine reduces afterload by marked vascular dilatation during anesthesia for coronary revascularization. Both Ca-channel blockers were demonstrated to be useful.