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Levosimendan is a calcium-sensitizing drug that enhances myocardial contractility without increasing intracellular calcium. By activating adenosine triphosphate-dependent potassium channels it exerts cardioprotective and vasodilatory effects.
A retrospective matched pair analysis was performed in 52 patients undergoing emergency coronary artery bypass grafting for acute myocardial ischaemia with or without cardiogenic shock. A total of 27 patients received levosimendan (bolus 6 μg kg−1; continuous infusion 0.2 μg kg−1 min−1) in addition to catecholamines, while 25 patients were treated with catecholamines only.
Predicted mortality by logistic EuroSCORE was 42% (14–90%) in the levosimendan group and 38% (9–90%) in the control group (median, range). Cardiogenic shock was diagnosed in 52% of the patients in both groups. Compared to the control group, levosimendan-treated patients had fewer intra-aortic balloon pumps inserted (33% vs. 76%, P < 0.05) and were ventilated for a shorter period (39 ± 39 h vs. 106 ± 109 h, P < 0.05). In this limited number of patients, the reduction in mortality at day 30 (26% levosimendan; 44% control, P > 0.05) and need for dialysis (11% levosimendan; 32% control, P > 0.05) did not reach statistical significance. Length of hospital stay did not differ (14 ± 18 days, levosimendan; 13 ± 19 days, control; P > 0.05) between the two groups.
In this retrospective matched pair analysis of 52 patients undergoing emergency coronary artery bypass grafting for acute ischaemia, levosimendan reduced morbidity. The reduced morbidity did not translate into reductions in mortality or length of stay. A larger, prospective randomized trial is warranted to confirm the potentially beneficial effects of levosimendan in patients with acute ischaemia.
This study was conducted to compare bispectral index, state entropy and response entropy in patients undergoing coronary artery bypass grafting.
In 66 patients, anaesthesia was maintained at two different levels using bispectral index. Doses of sufentanil and midazolam were adjusted to achieve a bispectral index in the range of 45–55 in 33 patients (BIS 50 group) and 35–44 in another 33 patients (BIS 40 group). Simultaneously, state entropy and response entropy were recorded.
The targeted values of bispectral index were achieved in both groups and the bispectral index values differed significantly during whole anaesthesia. Median response entropy and state entropy fell to 19–26 during anaesthesia in both groups. Response entropy and state entropy values in the two groups differed significantly only after induction of anaesthesia and did not differ during further anaesthesia. There was no explicit intraoperative recall in both groups. Patients in Group BIS 40 received significantly (P < 0.05) more sufentanil than the BIS 50 group (704 ± 181 μg vs. 490 ± 107 μg, respectively) and midazolam (18.5 ± 6.1 mg vs. 15.6 ± 3.8 mg, respectively). After cardiopulmonary bypass, significantly (P < 0.05) more patients in Group BIS40 needed inotropic support with dobutamine (79%) than in the BIS50 group (52%). Time to extubation did not differ between the two groups.
In patients undergoing coronary artery bypass grafting, no relationship was found between bispectral index levels and state entropy and response entropy at two different stages of a sufentanil–midazolam anaesthesia. A bispectral index level of 45–55 reduced anaesthetic medications used and the need for inotropic support.
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