Drug Combinations in Anesthesia -2

Another pet combination of mine is!!!!!...... Hold your breath

Inj Diltiazem with Inj Nitroglycerine.

I generally take 5 mgs of Diltiazem and mix it with 25 mgs of Nitriglycerine. I find it especially useful when the pressures shoot up on initiation of  Cardipulmonarybypass(CPB).

Some of our patients( nearly 20%), happen to be neonates with or without Cyanaotic Heart disease requiring surgery by going on CPB. However skilled the surgeon may be one in three kids you do encounter times during initiation of bypass when the line pressures are very high probably due to initial struggling in placement or mal positioning of cannulas. These are extremely crucial times as any body who has worked with small neonates will vouch for. It takes a while for the pressures to settle down both for surgeon to rectify and position cannulas more correctly and the perfusionist to adjust to all this and still maintain proper perfusion and pressures.

It is during these times most of us including me are prone to use NTG or SNP to bring down or maintain more acceptable pressures. I have been using the above mentioned combination in a titrated way to a good effect for a long time and in quite a big number of surgeries. I find it very useful in the above scenario to say the least.

Most of our patients are for CABG, and today CPB is rarely used as we tend to go for OPCAB in almost all patients. At times during surgery when there are appreciable St changes i use the above combination. It has a tendency to produce less tachy or no tachy at all as compared to NTG alone, and the effect slightly lingers on....... even after stopping the infusion as compared to NTG alone; which i use for the benefit of patient.

Like in the previous combination I heartily recommend the use of this combination and please use it with caution till you get the hang of it. I hope there will be good peer review on this combination too.