Levosimendan or milrinone in the type 2 diabetic patient with low ejection fraction undergoing elective coronary artery surgery.
OBJECTIVE
The purpose of this study was to compare the hemodynamic profiles and the postoperative insulin requirements in 2 groups of type 2 diabetic patients with depressed myocardial function who underwent elective surgery for coronary artery disease and who received levosimendan or milrinone for postcardiopulmonary bypass low-output syndrome.


METHODS
Randomized controlled trial.


METHODS
The Chest Diseases Hospital, Safat, Kuwait.


METHODS
Type 2 diabetic patients undergoing elective surgery for coronary artery disease.


METHODS
Fourteen patients and 16 patients received levosimendan and milrinone infusions, respectively, for treatment of the low-output syndrome.


RESULTS
The hemodynamic, mixed venous oxygen saturation, oxygen extraction ratios, arterial lactate concentrations, and postoperative insulin infusion rates were serially documented for the first 48 hours after the diagnosis. The cardiac index and mixed venous oxygen saturation were significantly higher in the levosimendan group. The pulmonary capillary wedge pressure, systemic vascular resistance, and oxygen extraction ratios were significantly higher in the milrinone treatment group. The insulin requirements were similar for both of the treatment groups.


CONCLUSIONS
Levosimendan was more efficient than milrinone for treating the hemodynamic manifestations of the postcardiopulmonary bypass low-output syndrome. However, all the values in the milrinone treatment group were normalized. In this small population, both treatment groups had similar postoperative insulin requirements.
Al-Shawaf
Emad
E
Department of Anesthesia, The Chest Diseases Hospital, Ministry of Health, Safat, Kuwait. ealshawaf@hsc.edu.kw
Ayed
Adel
A
Vislocky
Ivan
I
Radomir
Bosko
B
Dehrab
Najat
N
Tarazi
Riad
R
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002303:Cardiac Output, Low / Q000188:drug therapy*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D006835:Hydrazones; D010726:Phosphodiesterase Inhibitors; D011724:Pyridazines; D000077464:Simendan; D020105:Milrinone