[The effect of prophylactic intravenous diltiazem drip infusion on myocardial ischemia during noncardiac surgery].

ABSTRACT

We evaluated the effect of intravenous diltiazem infusion in 105 noncardiac surgical patients. Subjects were elective surgical patients with coronary artery disease and coronary risk factors which were hypertension (WHO standards), diabetes mellitus, hyperlipemia (total cholesterol > or = 220 mg.dl-1), obesity (body mass index male > or = 26 kg.m-2, female > or = 25) and old age (70 years old or above). The prophylactic intravenous diltiazem infusion (1.0 micrograms.kg-1.min-1) was started immediately after induction of general anesthesia or epidural analgesia and continued until the end of operation. All patients were monitored by ST trend graph during anesthesia, and ischemia pattern was defined as > or = 1 mm ST changes and lasting over 1 min. Ischemic ST-T changes were noted in 4 cases in the operating room. ST depression was noted in 2 cases before starting anesthesia and these 2 cases showed improvement with diltiazem infusion lasting until the end of operation. ST-T changes were noted in 2 cases during surgery and these 2 cases showed improvement with diltiazem isosorbide dinitrate. We conclude that prophylactic intravenous diltiazem infusion may prevent ischemia during noncardiac surgery.