Abstract
The potential for inducing hypotension during fentanyl anaesthesia by administering either diltiazem (n = 7) or sodium nitroprusside (n = 7) was investigated during total hip arthroplasty. Haemodynamic variables were obtained in the lateral position before, during and after administration of the hypotensive agent. Diltiazem 0.15 mg·kg1 given as an IV bolus followed by a 12.5 ± 3 µg·kg;−1·min−1 continuous infusion decreased mean arterial pressure (MAP) from 77 ± 11 mmHg to 63 ± 16 mmHg (p < 0.05) while other haemodynamic parameters showed only minor and insignificant changes. Hypotension continued for at least 30 min after the cessation of diltiazem. With sodium nitroprusside MAP decreased immediately from 81 ± 11 mmHg to 59 ± 9 mmHg (p < 0.01) and rapidly returned to its control value after cessation of the infusion. Cl and Qs/Qt rose significantly (p < 0.05) while the systemic vascular resistance index (SVRI) (p < 0.01) and pulmonary vascular resistance index (PVRI) (p < 0.05) fell significantly. The haemo dynamic profile was significantly different between hypotensive agents for MAP (p < 0.02), heart rate (HR) (p < 0.01), SVRI (p < 0.05), and PVRI (p < 0.05). HR was lower with diltiazem than with nitroprusside. A bradycardia less than 50 beatslmin was observed in five patients in the diltiazem group. MAP, SVRI and PVRI were lower with nitroprusside than with diltiazem. Diltiazem can induce and maintain moderate hypotension without tachycardia and decreased cardiac output in humans during fentanyl anaesthesia but the modulation of the level of arterial pressure and the depression of atrioventricular conduction are unpredictable.
Résumé
Le diltiazem a été testé comparativement au nitroprussiate de sodium pour provoquer une hypotension contrôlée au cours des arthroplasties de hanche (n = 14). Les données hémodynamiques ont été recueillies sous anesthésie générate (thiopental – fentanyl – pancuronium) en décubitus latéral avant, pendant et après administration de l’agent hypotenseur (choix randomisé). Le diltiazem (bolus IV de 0.15 mg·kg-1 suivi d’une perfusion continue de 12.5 ± 3 µg·kg-1·min-1) a entraîné une baisse de pression artérielle moyenne (PAM) de 77 ± 11 mmHg à 63 ± 16 mmHg (p < 0.05) sans modifications significatives des autres données hemodynamiques. L’hypotension s’est maintenue au moins 30 min après arrêt du diltiazem. Le nitroprussiate de sodium a entraîné une baisse immédiate de PAM de 81 ±11 mmHg à 59 ±9 mmHg (p <0.01); le retour de PAM à la valeur contrôle est obtenue rapidement après arrêt du nitroprussiate. L’index cardiaque et Qs/Qt se sont élevés significativement (p < 0.05) alors que l’index des résistances vasculaires systémiques (RVS) (p < 0.01) et l’index des résistances vasculaires pulmonaires (RVP) (p < 0.05) se sont abaissés significativement. Ces profits hémodynamiques ont été significativement différents pour la MAP (p < 0.02), la fréquence cardiaque (FC) (p < 0.01), les RVS(p<0.05)et les RVP(p<0.05). FC a été plus basse sous diltiazem que sous nitroprussitate; une bradycardie inférieure à 50/min a été observée chez cinq des sept patients. PAM, RVS et RVP ont été plus basses sous nitroprussiate que sous diltiazem. Le diltiazem est susceptible d’induire, de maintenir une hypotension sans tachycardie et sans diminution du débit cardiaque chez l’homme pendant une anesthésie au fentanyl, mais, la modulation du niveau d’hypotension et la dépression de la conduction auriculo-ventriculaires sont imprévisibles.
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This work was supported in part by the University of Nantes Institutional Grants Program, and in part by LNSERM (Institut National de la Sameé et de la Recherche Médicale) Contract number 825019.
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Bernard, J.M., Pinaud, M., Carteau, S. et al. Hypotensive actions of diltiazem and nitroprusside compared during fentanyl anaesthesia for total hip arthroplasty. Can Anaesth Soc J 33, 308–314 (1986). https://doi.org/10.1007/BF03010742
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DOI: https://doi.org/10.1007/BF03010742