The direct comparison of inhaled versus intravenous levosimendan in children with pulmonary hypertension undergoing on-cardiopulmonary bypass cardiac surgery: A randomized, controlled, non-inferiority study

Abdelbaser, Ibrahim; Mageed, Nabil A; Elfayoumy, Sherif I.; Elgamal, Mohamed; Elmorsy, Mohamed M.; Taman, Hani I.

doi:10.1016/j.jclinane.2021.110231

Cited by 9 publications

(3 citation statements)

References 21 publications

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“…However, limited data exist concerning the intraoperative use of LS in cardiac surgical patients with PH, and there are even less available data regarding the relation between extracorporeal circulation and the pharmacokinetic and pharmacodynamic properties of the drug. Ebade et al demonstrated that LS was superior to dobutamine in improving CI and lowering MPAP in children younger than 4 years with PH due to congenital heart disease undergoing cardiac surgery [ 42 ], while Abdelbaser et al suggested that both intravenous and inhaled LS were effective in reducing pulmonary artery pressure in pediatric cardiac surgical patients with PH [ 43 ]. It is very interesting that apart from the intravenous use of LS, some studies support the administration of the drug via inhalation in order to avoid systemic hypotension that could reduce RV perfusion [ 34 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Monitoring of Levosimendan Administration in Patients with Pulmonary Hypertension Undergoing Cardiac Surgery and Effect of Two Different Dosing Schemes on Hemodynamic and Echocardiographic Parameters

Ftikos,

Falara,

Rellia

et al. 2023

Pharmaceuticals

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Introduction: The perioperative management of patients with pulmonary hypertension (PH) undergoing cardiac surgery represents one of the most challenging clinical scenarios. This fact mainly depends on the relationship existing between PH and right ventricular failure (RVF). Levosimendan (LS) is an inodilator that might be an effective agent in the treatment of PH and RVF. The aim of this study was to examine the impact of the duration of cardiopulmonary bypass (CPB) on the therapeutic drug monitoring of LS and to evaluate the effect of preemptive administration of LS on perioperative hemodynamic and echocardiographic parameters in cardiac surgical patients with preexisting PH. Materials and Methods: In this study, LS was administered in adult patients undergoing cardiac surgery before CPB in order to prevent exacerbation of preexisting PH and subsequent right ventricular dysfunction. Thirty cardiac surgical patients with preoperatively confirmed PH were randomized to receive either 6 μg/kg or 12 μg/kg of LS after the induction of anesthesia. The plasma concentration of LS was measured after CPB. In this study, a low sample volume was used combined with a simple sample preparation protocol. The plasma sample was extracted by protein precipitation and evaporated; then, the analyte was reconstituted and detected using specific and sensitive bioanalytical liquid chromatography with mass spectrometry (LC-MS/MS) methodology. The clinical, hemodynamic, and echocardiographic parameters were registered and evaluated before and after the administration of the drug. Results: A fast bioanalytical LC-MS/MS methodology (a run time of 5.5 min) was developed for the simultaneous determination of LS and OR-1896, its main metabolite in human plasma. The LC-MS/MS method was linear over a range of 0.1–50 ng/mL for LS and 1–50 ng/mL for its metabolite OR-1896. Measured plasma concentrations of LS were inversely related to the duration of CPB. LS administration before CPB during cardiac surgery was effective in reducing pulmonary artery pressure and improving hemodynamic parameters after CPB, with a more pronounced and durable effect of the drug at the dose of 12 μg/kg. Additionally, administration of LS at a dose of 12 μg/kg in cardiac surgical patients with PH before CPB improved right ventricular function. Conclusion: LS administration decreases pulmonary artery pressure and may improve right ventricular function in patients with PH undergoing cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Monitoring of Levosimendan Administration in Patients with Pulmonary Hypertension Undergoing Cardiac Surgery and Effect of Two Different Dosing Schemes on Hemodynamic and Echocardiographic Parameters

Ftikos,

Falara,

Rellia

et al. 2023

Pharmaceuticals

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“…Our data showed that pulmonary vasodilator medication reduced risk, which might explain why researchers observed no link among problems also cruelty of PAH. Airway instrumentation was just been linked to reality or fatal increases in pulmonary artery volumes, and researchers discovered that intubating predicted problems [16].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Problems in Infants Having Pulmonary Hypertension Following Ketamine General Anesthesia

Ali¹,

Khan²,

Bashir³

et al. 2022

PJMHS

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Aim: In adolescents, pulmonary arterial hypertension (PAH) is linked through the substantial postoperative danger of serious problems such as pulmonary severe illness and heart attack. The efficacy of ketamine anesthesia inside this patient group is still unknown. Examine the health information about children having PAH in the past to identify the kind and occurrence of peri-procedural issues, as well as whether ketamine medication been connected to peri-procedural difficulties. Methods: Adolescents having PAH who had general anesthesia for operations throughout the one-year interval (May 2020–April 2021) were eligible to participate. Specifics concerning the patient, PAH, surgery, anesthesia, and post-procedural course were recorded, as well as any untoward events that occurred while or inside 48 hours of the operation. Complication rates were reported separately for each surgery. The relationship among ketamine and peri-procedural problems has been investigated. Results: Seventy-five children (median age 8.4 years, average weight 23 kg) had 193 surgeries performed on them. PAH intensity has been classified as mild (26%), medium (37%), or severe (37%). (41 percent). Medical intervention (n = 21), moderate surgery (n = 28), cardiac catheterization (n = 129), and nonsurgical treatments (n = 18) have been performed. During 152 surgeries, ketamine has been given. Thirty mild problems and nine significant problems reported identified. Cardiac arrest occurred in 0.79 percent of cardiac catheterization operations, 11 percent of significant medical procedures, and 2.7 percent of all processes. There has been no death as a result of the surgery. Ketamine administration was not linked to increases in problems. Conclusion: Ketamine looks to be a safe anesthetic alternative for patients. people suffering from PAH We present data on cardiopulmonary resuscitation rates and significant death rates that are higher than that found. Keywords: Pulmonary Arterial Hypertension, Infants, Hypertension, Cardiac Arrest.

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“…The basic results of this pilot study were recently confirmed in a study in children with PH undergoing surgery for congenital heart disease. 10 Thus inhaled levosimendan for the perioperative treatment of PH appears to be an interesting strategy, but needs further investigation.…”

mentioning

confidence: 99%

Perioperative Management of Pulmonary Hypertension During Cardiac Surgery: A Call for Interdisciplinary Networking

Dumitrescu

Koster

Erdoes

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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The direct comparison of inhaled versus intravenous levosimendan in children with pulmonary hypertension undergoing on-cardiopulmonary bypass cardiac surgery: A randomized, controlled, non-inferiority study

Cited by 9 publications

References 21 publications

Monitoring of Levosimendan Administration in Patients with Pulmonary Hypertension Undergoing Cardiac Surgery and Effect of Two Different Dosing Schemes on Hemodynamic and Echocardiographic Parameters

Monitoring of Levosimendan Administration in Patients with Pulmonary Hypertension Undergoing Cardiac Surgery and Effect of Two Different Dosing Schemes on Hemodynamic and Echocardiographic Parameters

Perioperative Problems in Infants Having Pulmonary Hypertension Following Ketamine General Anesthesia

Perioperative Management of Pulmonary Hypertension During Cardiac Surgery: A Call for Interdisciplinary Networking

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