Levosimendan as a Rescue Drug in Experimental Propranolol-Induced Myocardial Depression: A Randomized Study

Leppikangas, Heli; Ruokonen, Esko; Rutanen, Juha; Kiviniemi, Vesa; Lindgren, L.; Kurola, Jouni

doi:10.1016/j.annemergmed.2009.06.512

Cited by 15 publications

(9 citation statements)

References 22 publications

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“…Current recommendations for the treatment of β-blocker poisoning advocate infusion of catecholamines [12], calcium chloride [13], glucagon [14,15] and extracorporeal life support [16] in instances of refractory cardiovascular collapse. More recently, high-dose insulin-glucose euglycaemia [17,18] and Levosimendan [19] have been demonstrated effective in animal models and clinical cases of β-blocker toxicity.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

2010

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Intravenous lipid emulsion (ILE) has been demonstrated to be an effective treatment for systemic toxicity associated with local anaesthetics and increasingly non-local anaesthetic agents of high lipophilicity. Effect for ILE has been demonstrated in animal models of propranolol poisoning; however, any benefit for ILE in more hydrophilic β-blockers remains uncertain. We determined to examine the effect of ILE on haemodynamic recovery following induction of hypotension with the relatively hydrophilic β-blocker, metoprolol. Twenty sedated, invasively monitored and mechanically ventilated adult New Zealand white rabbits underwent metoprolol infusion to mean arterial pressure (MAP) 60% baseline. Intravenous rescue was given according to the following groups: 6 mL/kg 20% lipid emulsion or 6 mL/kg 0.9% saline solution over 4 min. Haemodynamic parameters were obtained in 15 min. MAP was 70 (interquartile range (IQR), 58-82) mmHg saline group and 79 (IQR,(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89) mmHg ILE group at baseline, and 38 (IQR, 33-40) mmHg saline group and 41 (IQR, 40-43) mmHg ILE group, respectively, following metoprolol infusion. No statistically significant difference between ILE and saline-treated groups was observed in MAP, or pulse rate, at any time point following rescue therapy. ILE was not effective in reversal of metoprolol-induced hypotension in this rabbit model. These findings lend inferential support for the 'lipid sink' as principal mechanism for the beneficial effect observed with ILE administration in other models of lipophilic β-blocker-induced toxicity.

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Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

2010

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“…These improvements were superior to dobutamine. 13 A critique of this study observed that there was a significant difference in peak toxicity BP between the treatment groups. Beta-receptor blockade only appeared to be significant in the control group, as the fall in BP and HR were most evident in this group.…”

Section: Discussionmentioning

confidence: 92%

“…Leppikangas et al reported that a single bolus injection of levosimendan at a dose of 1.2 mg, approximately 50 mg/kg, improved cardiac function and BP in a swine model of propranolol toxicity. 13 The degree of propranolol poisoning in this study was described as ''moderate'' and there may have been some mismatch in the severity of poisoning between the control group and the levosimendan group prior to the initiation of treatment. 14 Additionally, levosimendan was only administered as a single dose rather than as an infusion as is usually the case in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Levosimendan Does Not Improve Cardiac Output or Blood Pressure in a Rodent Model of Propranolol Toxicity When Administered Using Various Dosing Regimens

Kalam

Graudins

2012

Int J Toxicol

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“…Sodium bicarbonate may restore cardiac output and narrow the QRS complex [ 129 ]. Levosimendan improved cardiac function and survival from propranolol intoxication in an animal model [ 130 ]. ILE has been benefi cial in a case report and may be considered following routine therapy [ 124 ].…”

Section: Beta-blockers (β-Blockers)mentioning

confidence: 97%

Toxic Ingestions

Sullivan

McDonald

2014

Pediatric Critical Care Medicine

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IntroductionEven with public heightened awareness for potential home toxin exposures, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age [ 1 ]. This represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % of exposures and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %) [ 1 ]. The intensivist must be prepared to care for the children who have serious and sometimes life-threatening exposures. AbstractDespite the public's heightened awareness of potential toxin exposures in children, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, the United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age which represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %). The intensivist must be prepared to care for children who have serious and sometimes life-threatening exposures. Supportive care is the mainstay of therapy because many poisons have no specifi c antidote. Much of the current clinical practices for treating the poisoned patient are based on anecdotal reports because there are limited evidenced-based clinical trials that provide guidance for treatment, safety, and outcome.

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Levosimendan as a Rescue Drug in Experimental Propranolol-Induced Myocardial Depression: A Randomized Study

Cited by 15 publications

References 22 publications

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

Levosimendan Does Not Improve Cardiac Output or Blood Pressure in a Rodent Model of Propranolol Toxicity When Administered Using Various Dosing Regimens

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