A Comparative Study of Hemodynamic Effects of Levosimendan and Milrinone in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting:

Chand Kishan Vyas; Ramesh Kumar; Neelu Sharma; Indu Verma; Anjum Saiyed

doi:10.21276/aan.2020.5.1.26

Chand Kishan Vyas Professor, Department of Anesthesia, SMS Medical College, Jaipur, Rajasthan, India
Ramesh Kumar Post Graduate Student, Department of Anesthesia, SMS Medical College, Jaipur, Rajasthan, India
Neelu Sharma Assistant Professor, Department of Anesthesia, SMS Medical College, Jaipur, Rajasthan, India
Indu Verma Professor, Department of Anesthesia, SMS Medical College, Jaipur, Rajasthan, India
Anjum Saiyed Professor, Department of Anesthesia, SMS Medical College, Jaipur, Rajasthan, India

DOI: https://doi.org/10.21276/aan.2020.5.1.26

Keywords: Off-pump CABG, Levosimendan, Milrinone, Hemodynamics

Abstract

Background: Off-Pump CABG or beating heart surgery possess a challenge to the anesthesiologist. Main goals are provision of safe anesthesia with maximum myocardial protection and maintenance of hemodynamics with various manipulation of heart during in order to visualize and graft the coronary arteries. Anesthetic regimen and ionotropic support influences postoperative myocardial function and outcome in coronary bypass surgery patients.Objective: To compare and assess haemodynamic effects of Levosimendan and Milrinone in patient undergoing off pump coronary artery bypass grafting with compromised cardiac function (NYHA III,IV) and pre-operative, left ventricular ejection fraction (LVEF) < 45%.Subjects and Methods:Patients were randomly allocated to 2 groups (64 patients in each group). Levosimendan Group (Group A) received infusion of Inj. Levosimendan 0.1g/kg/min after loading dose of 12?g/kg over 10 mins. While Milrinone Group (Group B) received infusion of inj. Milrinone 0.5g/kg/min after loading dose of 50 ?g/kg over 10 mins. HR, MAP, CVP, CI, SVRI, lactate levels were monitored at baseline, after induction, after sternotomy, at 30mins ,thereafter 6, 12, and 24 hours using Flo-Trac sensor (Edwards Life sciences).Results:Heart Rate, CI was significantly higher in Levosimendan group while MAP, SVRI and lactate levels were lower in Levosimendan group as compared to Milrinone group. Need of other inotropic support is more in Milrinone group.Conclusion:Levosimendan maintained the haemodynamic parameters better as compared to Milrinone in off pump CABG patients with low preoperative ejection fraction and also better end organ perfusion represented by lower lactate levels.

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