Iwatsuki N, Katoh M, Ono K, Amaha K
Anesth Analg. 1985 Oct;64(10):964-70.
The antiarrhythmic effects of diltiazem (DL), a slow channel inhibitor, were evaluated in the presence of epinephrine-halothane-induced arrhythmias in dogs, of premature ventricular contractions (PVCs) during anesthesia in patients (n = 10), and of tachyarrhythmias with associated atrial fibrillation (AF) during anesthesia in patients (n = 9). The arrhythmogenic dose of epinephrine (ADE) during one MAC of halothane in dogs was increased from 1.13 +/- 0.21 to 3.14 +/- 0.89 microgram X kg-1 X min-1 by the administration of 0.3 mg/kg of DL. This suggests that DL significantly increases the threshold for the induction of arrhythmias associated with epinephrine and halothane. In 10 patients, PVCs that appeared spontaneously during halothane anesthesia were eliminated by the intravenous administration of DL (0.1 mg/kg). With an additional nine patients who had had AF preoperatively and suffered tachyarrhythmias during anesthesia, the intraoperative intravenous administration of DL significantly decreased heart rate (to less than 100 beats/min) within 10-15 min. Diltiazem is an effective means for the treatment of PVCs and AF-mediated tachyarrhythmias during anesthesia. Because of the pharmacologic properties of DL (e.g., depressing sinus and atrioventricular (AV) node function), DL should be used with caution in patients with a sick sinus syndrome or an AV block, or in the presence of beta-adrenergic antagonists.
在犬肾上腺素-氟烷诱导的心律失常、患者麻醉期间的室性早搏（PVCs）（n = 10）以及患者麻醉期间伴有房颤（AF）的快速心律失常模型中，评估了慢通道抑制剂地尔硫䓬（DL）的抗心律失常作用。犬在1个最低肺泡有效浓度（MAC）氟烷麻醉下，肾上腺素致心律失常剂量（ADE）通过给予0.3mg/kg的DL，从1.13±0.21微克·千克⁻¹·分钟⁻¹增加到3.14±0.89微克·千克⁻¹·分钟⁻¹。这表明DL显著提高了与肾上腺素和氟烷相关的心律失常诱发阈值。在10例患者中，氟烷麻醉期间自发出现的PVCs通过静脉注射DL（0.1mg/kg）得以消除。另外9例术前有房颤且麻醉期间出现快速心律失常的患者，术中静脉注射DL在10 - 15分钟内显著降低心率（至低于100次/分钟）。地尔硫䓬是治疗麻醉期间PVCs和AF介导的快速心律失常的有效手段。由于DL的药理特性（如抑制窦房结和房室（AV）结功能），病态窦房结综合征或AV阻滞患者，或在使用β-肾上腺素能拮抗剂的情况下，应谨慎使用DL。
