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Intravenous Diltiazem Worsens Regional Function in Compromised Myocardium

Department of Anaesthetics, Oxford University, RadcliffeInfirmary, Oxford, United Kingdom.

Abstract

The effect of intravenous diltiazem on regional myocardial function was assessed in a canine model of critical constriction of the left anterior descending coronaryartery (LAD). Maintenance anesthesia with fentanyl (1.5 µg·kg^–1. min^–1), 60% inspired nitrous oxide, and 0.7% inspired halothane resulted in regional dysfunction, measured as postsystolic shortening (20.6 ± 10.7%), which was significantly worsened after 0.1 mg/kg (48.7 ± 12.5%, P < 0.05) and after 0.2 mg/kg (68.8 ± 71.7%, P < 0.05) intravenous diltiazem. Systolic shortening in the compromised LAD territory was substantially depressed after 0.1 mg/kg diltiazem (8.2 ± 0.6% to 5.3 ± 2.3%, P < 0.05) and was essentially abolished after 0.2 mg/kg diltiazem (8.2 ± 0.6% to 0.7 ±2.3%, P < 0.05). At the higher dose of diltiazem, cardiac output was substantially decreased (1.37 ± 0.23 L/min to 0.88 ± 0.30 L/min, P < 0.05) and LV dP/dt_max significantly depressed (1090 ± 90 mm Hg/sec to 744 ± 80 mm Hg/sec, P < 0.05). These resultsdemonstrate significant depression of regional systolic shortening and substantial worsening of regional dysfunction in myocardium with a compromised blood supply, in association with significant depression of left ventricular performance, with intravenous diltiazem administration during anesthesia.

Key Words: HEART, MYOCARDIAL FUNCTION—ischemia • IONS, CALCIUM ANTAGONISTS—diltiazem • PHARMACOLOGY—diltiazem

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999