Effects of Intravenous Diltiazem on Sinus Node Function and Atrioventricular Conduction in Patients

Valette, Héric; Barnay, C; Lopez, Michel; Jl, Hebert; Gallet, Michel; Apoil, E; Moyse, Dominique; Jl, Medvedowsky

doi:10.1097/00005344-198301000-00009

Cited by 15 publications

(8 citation statements)

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“…In our study, time to achieve target MAP cannot be determined accurately from the parameters chosen for the study, but it can be narrowed down roughly to less than 45min and more than 45min. In our study, there is no reports of rebound hypertension with nitroglycerine which is in accordance with Rodrigo [13] . One of the shortcomings of our study is that exact time to achieve the target MAP cannot be determined.…”

Section: Discussionsupporting

confidence: 91%

“…In our study, the diltiazem was used as a bolus dose followed by infusion in contrast to nitroglycerine, which was used as an infusion. The choice of the initial dosage IV bolus of 0.15 mg.kg -1 followed by a continuous infusion was as a result of the work of Valette et al [13] One of the shortcomings of the controlled hypotension is the time taken to achieve the desired MAP level. However, this could be offset with the fact that it reduces blood loss to a significant degree, and thus provides a better surgical field, which not only reduces the overall surgical time but also provides scope for a better surgical outcome.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison between Diltiazem and Nitroglycerine for Hypotensive Anaesthesia in Total Hip Arthroplasty

Nayak¹,

Mahapatra²,

Nitha³

2016

AIMDR

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Background: To compare controlled induced hypotension for facilitating surgical exposure and reducing intraoperative blood loss, using diltiazem and nitroglycerin in total hip arthroplasty under general anesthesia. Methods: 60 adults of American Society of Anesthesiologists (ASA) grade I and II posted for total hip arthroplasty in the department of orthopaedics were selected for prospective, randomized study and allocated randomly into three groups: Group A (control group), group B (diltiazem-controlled hypotension), and group C (nitroglycerin-controlled hypotension).Statistical analysis done using SPSS 20 software. Analysis of variance (ANOVA) test was used to compare the demographic data. Intergroup comparison between A and B,B and C,A and C of the heart rate (HR) and mean arterial pressure (MAP)were done using student t test. A P value <0.05 was considered significant. Results: The mean HR of group B showed a statistically significant decrement which continued 30 min after stoppage of infusion compared to group A (p=0.001)and C(p=0.001).The mean HR of group C showed a statistically significant increase upto the stoppage of infusion compared to group A(P=0.001) and group B(P=0.001). MAP of group C (59.9+4.28)is decreased to the target MAP between 15 and 45min after starting infusion whereas group B (71.2+4.65)remained above target MAP even after 45min. Group B showed a significant decrease in mean MAP (64.43+4.34)continuing upto 30 min after stoppage of infusion(p=0.001) compared to group A(105.8+3.86) and group C(106.4+4.9). Conclusion: Diltiazem is a poor agent for the management of controlled hypotension.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

A Comparison between Diltiazem and Nitroglycerine for Hypotensive Anaesthesia in Total Hip Arthroplasty

Nayak¹,

Mahapatra²,

Nitha³

2016

AIMDR

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“…On the contrary, such drugs have been reported to suppress cardiac abnormalities in experimental preparations (Nattel and Quantz 1988;January and Riddle 1989). However, there is a possibility that sinus and atrioventricular arrhythmias are induced by I Ca inhibition, in fact, Ca 2+ channel blockers were demonstrated to produce sinus bradycardia and to block atrioventricular conduction (Valette et al 1983;Bongrani et al 1985;Yano et al 1985). Moreover, terodiline was found to reduce heart rate significantly after seven days of administration (Stewart et al 1992) and to induce sinus bradycardia or atrioventricular conduction disturbances (Connolly et al 1991;McLeod et al 1991).…”

Section: Discussionmentioning

confidence: 99%

Cardiac electrophysiological actions of NS-21 and its active metabolite, RCC-36, compared with terodiline

Hayashi

Natsukawa

Suma

et al. 1997

Naunyn-Schmiedeberg's Arch Pharmacol

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Terodiline, an anticholinergic drug with a Ca2+ blocking action, is thought to be associated with torsade de pointes, a serious ventricular tachycardia. NS-21 is a newly developed drug for the treatment of urinary frequency and urinary incontinence and it has pharmacological properties similar to those of terodiline. It remains unknown, however, whether NS-21 and its active metabolite, RCC-36, have any proarrhythmic activity. The electrophysiological properties of NS-21 and RCC-36 were examined in guinea pig ventricular myocytes and were compared with those of terodiline using the whole-cell patch-clamp technique. NS-21, RCC-36 and terodiline inhibited L-type Ca2+ currents in a concentration-dependent manner with IC50 values of 27.0, 27.0 and 33.5 microM, respectively. At a concentration of 10 microM, terodiline inhibited both the time-dependent current and the tail current of the delayed rectifier K+ current, with the latter being significantly inhibited at voltages more positive than +10 mV. In contrast, NS-21 and RCC-36 had almost no effect on either of these currents. Terodiline also inhibited the inward rectifier K+ current significantly at voltages more negative than -100 mV, whereas NS-21 and RCC-36 had little effect. If the proarrhythmic activity of terodiline resulted primarily from the combined inhibition of K+ and Ca2+ currents, one might expect that NS-21 and RCC-36, which inhibit L-type Ca2+ currents without affecting either the delayed rectifier K+ current or the inward rectifier K+ current, would not share the proarrhythmic activities of terodiline.

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“…Intravenous diltiazem may have no effect on the sinus node recovery time [19] or may lengthen the CSNRT in normal subjects and produce bradycardia in patients with sinus node dysfunction [20]. Diltiazem prolonged the AH interval and slowed the rate required to produce Wenckebach block [23].…”

Section: Discussionmentioning

confidence: 99%

The acute effects of intravenously administered mibefradil, a new calcium antagonist, on the electrophysiologic characteristics of the human heart

Rosenquist

Brembilla‐Perrot²,

Meinertz

et al. 1997

European Journal of Clinical Pharmacology

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Effects of Intravenous Diltiazem on Sinus Node Function and Atrioventricular Conduction in Patients

Cited by 15 publications

References 0 publications

A Comparison between Diltiazem and Nitroglycerine for Hypotensive Anaesthesia in Total Hip Arthroplasty

A Comparison between Diltiazem and Nitroglycerine for Hypotensive Anaesthesia in Total Hip Arthroplasty

Cardiac electrophysiological actions of NS-21 and its active metabolite, RCC-36, compared with terodiline

The acute effects of intravenously administered mibefradil, a new calcium antagonist, on the electrophysiologic characteristics of the human heart

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