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Intravenous levosimendan-norepinephrine combination during off-pump coronary artery bypass grafting in a hemodialysis patient with severe myocardial dysfunction

Authors :
Siminelakis Stavros N
Tzimas Petros
Baikoussis Nikolaos G
Papadopoulos Georgios
Karanikolas Menelaos
Source :
Journal of Cardiothoracic Surgery, Vol 5, Iss 1, p 9 (2010)
Publication Year :
2010
Publisher :
BMC, 2010.

Abstract

Abstract This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis), unstable angina and significantly impaired myocardial contractility with low left ventricular ejection fraction, who underwent off-pump one vessel coronary bypass surgery. Combined continuous levosimendan and norepinephrine infusion (at 0.07 μg/kg/min and 0.05 μg/kg/min respectively) started immediately after anesthesia induction and continued for 24 hours. The levosimendan/norepinephrine combination helped maintain an appropriate hemodynamic profile, thereby contributing to uneventful completion of surgery and postoperative hemodynamic stability. Although levosimendan is considered contraindicated in ESRD patients, this case report suggests that combined perioperative levosimendan/norepinephrine administration can be useful in carefully selected hemodialysis patients with impaired myocardial contractility and ongoing myocardial ischemia, who undergo off-pump myocardial revascularization surgery.

Details

Language :
English
ISSN :
17498090
Volume :
5
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Cardiothoracic Surgery
Publication Type :
Academic Journal
Accession number :
edsdoj.bd850a0618f49e6a556ee8c6d614f65
Document Type :
article
Full Text :
https://doi.org/10.1186/1749-8090-5-9