title: Levosimendan decreases intracranial pressure after hypothermic circulatory arrest in a porcine model.
abstract: OBJECTIVE
  Hypothermic circulatory arrest (HCA) provides an optimal operating field in aortic arch surgery, but it is associated with neurological complications. Levosimendan is an inotropic agent with clinical indications for open-heart surgery. Through peripheral vasodilatation, cardiac contractility enhancement and anti-inflammatory function it has a potential to improve cerebral protection after HCA.
  
  
  METHODS
  Eighteen piglets were randomly assigned to a levosimendan group (n = 9) and a placebo group (n = 9) and underwent a 60-minute period of hypothermic circulatory arrest at 18°C. A levosimendan or placebo infusion (0.2 μg/kg/min) was commenced at the onset of anesthesia and continued for 24 hours. Animals were followed for one week and their neurological recovery was assessed daily. Finally the animals were electively sacrificed and their brain was harvested for histopathological examination.
  
  
  RESULTS
  Levosimendan decreased intracranial pressure during the experiment. There were no differences between the groups in terms of hemodynamic or metabolic data, brain metabolism, neurological recovery or histopathology of the cerebral tissue. In the levosimendan group, cardiac enzymes were slightly more elevated.
  
  
  CONCLUSIONS
  Levosimendan decreased intracranial pressure during the experiment, but in terms of cerebral metabolism, neurological recovery and histopathology of the brain tissue levosimendan did not improve brain protection in this experimental setting.
authors.affiliation: Clinical Research Center, Oulu University Hospital, University of Oulu, Finland. hanna.alaoja.jensen@gmail.com
authors.forename: Hanna
authors.initials: H
authors.lastname: Jensen
authors.forename: Rimpiläinen
authors.initials: R
authors.lastname: Eija
authors.forename: Mäkelä
authors.initials: M
authors.lastname: Tuomas
authors.forename: Mäkelä
authors.initials: M
authors.lastname: Jussi
authors.forename: Yannopoulos
authors.initials: Y
authors.lastname: Fredrik
authors.forename: Alestalo
authors.initials: A
authors.lastname: Kirsi
authors.forename: Pokela
authors.initials: P
authors.lastname: Matti
authors.forename: Kiviluoma
authors.initials: K
authors.lastname: Kai
authors.forename: Tuominen
authors.initials: T
authors.lastname: Hannu
authors.forename: Anttila
authors.initials: A
authors.lastname: Vesa
authors.forename: Juvonen
authors.initials: J
authors.lastname: Tatu
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001831:Body Temperature / Q000187:drug effects; D001921:Brain / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects; D006835:Hydrazones / Q000008:administration & dosage / Q000494:pharmacology*; D007262:Infusions, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects*; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000494:pharmacology*; D010101:Oxygen Consumption / Q000187:drug effects; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D011724:Pyridazines / Q000008:administration & dosage / Q000494:pharmacology*; D000077464:Simendan; D013552:Swine; D013997:Time Factors
chemical_list: D006835:Hydrazones; D018696:Neuroprotective Agents; D011724:Pyridazines; D000077464:Simendan