title: Intravenous levosimendan-norepinephrine combination during off-pump coronary artery bypass grafting in a hemodialysis patient with severe myocardial dysfunction.
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 microg/kg/min and 0.05 microg/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.
authors.affiliation: Department of Cardiac Surgery, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Papadopoulos
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Baikoussis
authors.forename: Petros
authors.initials: P
authors.lastname: Tzimas
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Siminelakis
authors.forename: Menelaos
authors.initials: M
authors.lastname: Karanikolas
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D047549:Coronary Artery Bypass, Off-Pump; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage*; D011724:Pyridazines / Q000008:administration & dosage*; D006435:Renal Dialysis; D000077464:Simendan
chemical_list: D000316:Adrenergic alpha-Agonists; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D009638:Norepinephrine