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Levosimendan infusion improves haemodynamics in elderly heart failure patients undergoing urgent hip fracture repair

Published online by Cambridge University Press:  01 August 2008

M. Ponschab ,
N. Hochmair ,
N. Ghazwinian ,
T. Mueller  and
W. Plöchl
M. Ponschab*
Affiliation:
Trauma Hospital Linz, Department of Anaesthesiology and Intensive Care Medicine, Linz
N. Hochmair
Affiliation:
Trauma Hospital Linz, Department of Anaesthesiology and Intensive Care Medicine, Linz
N. Ghazwinian
Affiliation:
Trauma Hospital Linz, Department of Anaesthesiology and Intensive Care Medicine, Linz
T. Mueller
Affiliation:
Konventhospital Barmherzige Brueder, Department of Laboratory Medicine, Linz
W. Plöchl
Affiliation:
University of Vienna, Vienna General Hospital, Department of Anaesthesiology and General Intensive Care, Vienna, Austria
*
Correspondence to: Ponschab Martin, Department of Anaesthesiology and Intensive Care, Trauma Hospital Linz, Garnisonstraße 7, 4020 Linz, Austria. E-mail: [email protected]; Tel/Fax: +43 732 616202
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Summary

Background

Elderly patients with heart failure undergoing urgent major surgery suffer substantial cardiac morbidity and mortality. Levosimendan, a novel calcium sensitizer, enhances myocardial contractility while simultaneously having vasodilatory and cardioprotective properties. This could be advantageous in perioperative management of heart failure patients.

Methods

Ten consecutive patients with symptomatic heart failure and left ventricular ejection fraction <35% undergoing urgent hip fracture repair were studied. Levosimendan was administered with an infusion rate of 0.1 μg kg−1 min−1 in a total dose of 12.5 mg starting a minimum of 2 h prior to surgery. Haemodynamic parameters were obtained at baseline and at 4, 8, 12, 16, 20, 24, 28, 36 and 48 h after start of levosimendan. B-type natriuretic peptide was measured on admission and after 48 h.

Results

Patients were 86 ± 7 yr (mean ± SD) of age. Levosimendan significantly increased cardiac index from 2.4 ± 0.3 L min−1 m−2 at baseline to 3.2 ± 0.6 L min−1 m−2 after 24 h by increases in stroke volume index (baseline 27 ± 5 mL m−2, after 24 h 37 ± 10 mL m−2, P < 0.05). Systemic vascular resistance index significantly decreased from 2718 ± 841 to 1964 ± 385 dyn s cm−5 m−2 within 24 h. Haemodynamic changes exerted by levosimendan persisted up to 48 h. B-type natriuretic peptide plasma concentrations decreased from 1143 ± 792 to 935 ± 724 ng L−1 after 48 h (P = 0.006).

Conclusion

In patients with heart failure, preoperative start of levosimendan infusion improves intraoperative and postoperative haemodynamics. These findings suggest that levosimendan is a useful drug for preoperative optimization of cardiac function in high-risk patients undergoing major surgery.

Keywords

SIMENDAN, levosimendanCARDIAC OUTPUTHIP FRACTURESSURGERY ORTHOPAEDICNATRIURETIC PEPTIDEBRAINCARDIOTONIC AGENTSHEART FAILURE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 627 - 633
Copyright
Copyright © European Society of Anaesthesiology 2008

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