Haemodynamics 3
`
`Method: Eight infants with a median age of 6 months (range 3 days–
`8 months) undergoing cardiac surgery with CPB for congenital heart disease
`with increased pulmonary flow and/or increased pulmonary vascular resist-
`ance were included in this case-control-study. After weaning off CPB,
`infants with mean pulmonary artery pressure ⬎15 mmHg received inhaled
`iloprost (2.5 g kg⫺1 over 15 min) using an ultrasonic nebulizer (Optineb®,
`Nebu-Tec, Elsenfeld, Germany). Mean pulmonary artery pressure (MPAP)
`and mean arterial pressure (MAP) were measured and the ratio MPAP/MAP
`was calculated before and 30 min and 60 min after starting iloprost inhala-
`tion. The need of vasoactive drugs after weaning off CPB was analysed.
`Repeated measures ANOVA with Tukey test was used to compare
`MPAP/MAP. P ⬍ 0.05 was considered significant.
`Results: Mean MPAP/MAP decreased after
`from
`iloprost
`inhaled
`0.64 ⫾ 0.1 to 0.5 ⫾ 0.1 at 30 min and 0.47 ⫾ 0.1 at 60 min, respectively
`(P ⬍ 0.05). To keep MAP ⬎45 mmHg a norepinephrine infusion was neces-
`sary in one patient. The individual courses of MPAP/MAP are demonstrated
`in the figure.
`
`12345678
`
`mean
`
`*
`
`*
`
`* ⫽ p ⬍ 0.05 vs. before iloprost
`
`before
`iloprost
`
`iloprost ⫹
`30 min
`
`iloprost ⫹
`60 min
`
`1.0
`
`0.8
`
`0.6
`
`0.4
`
`0.2
`0.1
`
`0.0
`
`MPAP/MAP
`
`Discussion: A single dose inhaled iloprost decreases MPAP/MAP in infants
`after weaning off CPB by 21% and 25% after 30 min and 60 min, respec-
`tively. This indicates selective pulmonary vasodilating effects. However,
`vasopressor support was necessary in one infant. Although inhaled nitric
`oxide (iNO) is widely used to decrease pulmonary vascular resistance in
`infants undergoing cardiac surgery, the effects of iNO varies among patients,
`rebound phenomena have been described, and cumbersome devices are
`necessary to administer iNO safely. Inhaled iloprost may therefore be an
`alternative for selective pulmonary vasodilatation in infants undergoing car-
`diac surgery because it is effective, easy to use and long acting. Furthermore,
`from the economic point of view, inhaled iloprost may be attractive because
`iNO became very expensive after FDA approval.
`References:
`1 Celermajer DS, Culen S, Deanfield JE, et al. Impairment of endothelium-dependent
`pulmonary artery relaxation in children with congenital heart disease and abnormal
`pulmonary hemodynamics. Circulation 1993; 87: 440–446.
`2 Olschewski H, Simonneau G, Galie N, et al. Inhaled iloprost for severe pulmonary
`hypertension. N Engl J Med 2002; 347: 322–329.
`
`036
`Incentive spirometry for preoperative preparation
`of cardiac patients
`A.E. Balandiuk, I.A. Kozlov
`Research Institute of Transplantology and Artificial Organs,
`Moscow, Russia
`Introduction: Arterial hypoxaemia is not a rare complication of CABG.
`Incentive spirometry (IS) is a simple and low cost training method, which
`encourages an increase of lung volumes and inspiratory capacity. The purpose
`of the study was to investigate the efficiency of preoperative IS in CABG
`patients [1].
`Method: The study included 65 randomly selected CABG patients 41 to 73
`years of age. Patients were divided into 2 groups: patients of group S (37)
`used IS before surgery, group C (28 patients) were controls. IS was adminis-
`tered to group S patients for 2 days before surgery. Spirometry training was
`performed for 10 min each hour. Further, we started IS training at the second
`postoperative day. Anaesthesia and ventilation parameters were the same in
`both groups. Oxygenation index PaO2/FiO2, difference and Qs/Qt were
`observed at the following operation stages: before sternotomy (1), 10 min
`
`References:
`1
`Zacharias A, Habib RH. Factors predisposing to median sternotomy complications.
`Deep vs. superficial infection. Chest, 1996; 110: 1173–1178.
`2 Muller M, Schmid R, Georgopoulos A, et al. Application of microdialysis to clinical
`pharmacokinetics in humans. Clin Pharmacol Ther 1995; 57(4): 371–380.
`3 Wysocki M, Delatour F, Faurisson F, et al. Continuous versus intermittent infusion of
`vancomycin in severe staphylococcal infections: prospective multicenter randomized
`study. Antimicrob Agents Chemother 2001; 45: 2460–2467.
`
`112
`The effects of levosimendan in cardiac surgery patients
`C. Romana, J. Kokotsakis1, M. Argyriou1, C. Soutzopoulou,
`P. Stratigopoulou, E. Karamichali
`Departments of Anaesthesiology and 1Cardiac Surgery, Evangelismos
`General Hospital, Athens, Greece
`Introduction: The aim of the study was to evaluate the effects of levosi-
`mendan, a new calcium sensitizer, used during cardiac surgery to facilitate
`separation from cardiopulmonary bypass (CPB) [1].
`Method: Twenty ASA II–III patients, undergoing elective CABG, received,
`after the aortic clamp release, the same loading dose of levosimendan of
`24 g kg⫺1 over 10 minutes, followed by a continuous infusion of 0.1 g kg⫺1
`min⫺1 (group I, n ⫽ 10) or 0.2 g kg⫺1 min⫺1 (group II, n ⫽ 10). All patients
`had measured ejection fraction ⬎25%, sinus rhythm, cardiac index
`(CI) ⬎1.8 L min⫺1m⫺2, mean arterial pressure (MAP) ⬎60 mmHg and pul-
`monary capillary wedge pressure (PCWP) 8–20 mmHg. They all received the
`same anaesthetic scheme. Cardiac output (CO) was obtained by Swan-
`Ganz catheter and thermodilution (Baxter-Edwards Lab). Haemodynamic
`measurements: Heart Rate (HR), MAP, PCWP, CO, CI, stroke volume (SV),
`systemic vascular resistance (SVR) were performed at: T0: baseline, T1 at
`15 min after infusion, T2 at 60 min, T3 after 12 h and T4 at 24 h after the end of
`infusion. Statistical analysis was performed by ANOVA for repeated mea-
`surements, P ⬍ 0.05 was considered significant.
`Results: There were no significant differences in the demographic data.
`Haemodynamic results are shown in the table.
`
`Heart rate
`(beats/min)
`Mean arterial
`pressure (mmHg)
`Stroke volume (ml)
`
`Cardiac index
`(L min⫺1 m2)
`PCWP (mmHg)
`
`Gp
`I
`II
`I
`II
`I
`II
`I
`II
`I
`II
`
`T1
`T0
`78 ⫾ 1.8
`80 ⫾ 2
`89* ⫾ 2.0
`80 ⫾ 3
`76 ⫾ 3.8
`85 ⫾ 4
`65* ⫾ 5
`82 ⫾ 5
`57 ⫾ 4.2
`55 ⫾ 4
`59 ⫾ 7.1
`56 ⫾ 5.6
`2 ⫾ 0.6
`1.9 ⫾ 0.3
`1.9 ⫾ 0.6 2.2 ⫾ 0.7
`18 ⫾ 4
`12* ⫾ 3
`16 ⫾ 3
`11* ⫾ 2.5
`
`T4
`T3
`T2
`81 ⫾ 3
`84 ⫾ 3.2
`84 ⫾ 3
`88 ⫾ 3.8
`94* ⫾ 4
`93* ⫾ 4
`78 ⫾ 4.8
`78 ⫾ 5
`73 ⫾ 4
`74 ⫾ 3.2
`76 ⫾ 5
`73 ⫾ 5
`58 ⫾ 5.4
`60* ⫾ 5
`58 ⫾ 3.7
`59 ⫾ 7
`63* ⫾ 9.9
`60* ⫾ 8.5
`2.3* ⫾ 0.6 2.5* ⫾ 0.7 2.3* ⫾ 0.4
`2.4* ⫾ 0.7 2.6* ⫾ 0.8 2.3* ⫾ 0.8
`13* ⫾ 5
`13 * ⫾ 6
`12* ⫾ 4
`12* ⫾ 4
`12* ⫾ 5
`10* ⫾ 5
`
`*P ⬍ 0.05 in comparison to T0
`
`Conclusion: Both doses of levosimendan were effective, achieving a suc-
`cessful separation from CPB during the initial attempt. Levosimendan may
`offer an alternative inotropic therapy in patients following cardiac surgery.
`The effects of the drug were not abolished after terminating the infusion [2].
`References:
`1
`Follath F, Cleland JG, Just H, et al. Efficacy and safety of intravenous levosimendan
`compared with dobutamine in severe low-output heart failure (the LIDO study): a ran-
`domised double-blind trial. Lancet 2002; 360: 196–202.
`Lilleberg J, Nieminen MS, Akkila J, et al. Effects of a new calcium sensitizer, levosi-
`mendan, on haemodynamics, coronary blood flow and myocardial substrate utilization
`early after coronary artery bypass grafting. Eur Heart J 1998; 19: 660–668.
`
`2
`
`084
`Inhaled iloprost in the management of pulmonary
`hypertension in infants undergoing congenital
`heart surgery
`M. Mueller, C. Neuhaeuser, R. Noest, H. Akintuerk, I. Welters,
`G. Hempelmann
`Department of Anaesthesiology, Intensive Care, Pain Therapy, University
`Hospital Giessen, Giessen, Germany
`Introduction: Impaired endothelium-dependant pulmonary artery relaxation
`is present in children with high pulmonary flow and pressure which might be
`exacerbated by cardiopulmonary bypass (CPB) [1]. The use of aerosolized
`Iloprost has shown to be safe and effective in adults with pulmonary hyper-
`tension [2]. However, no data is available about the intra-operative use of
`inhaled iloprost in infants ⬍1 year with pulmonary hypertension undergoing
`cardiac surgery.
`
`© 2004 European Academy of Anaesthesiology, European Journal of Anaesthesiology 21 (Suppl. 33): 2–36
`
`WATSON LABORATORIES, INC. , IPR2017-01622, Ex. 1041, p. 1 of 1
`
`
`
`Method: Eight infants with a median age of 6 months (range 3 days–
`8 months) undergoing cardiac surgery with CPB for congenital heart disease
`with increased pulmonary flow and/or increased pulmonary vascular resist-
`ance were included in this case-control-study. After weaning off CPB,
`infants with mean pulmonary artery pressure ⬎15 mmHg received inhaled
`iloprost (2.5 g kg⫺1 over 15 min) using an ultrasonic nebulizer (Optineb®,
`Nebu-Tec, Elsenfeld, Germany). Mean pulmonary artery pressure (MPAP)
`and mean arterial pressure (MAP) were measured and the ratio MPAP/MAP
`was calculated before and 30 min and 60 min after starting iloprost inhala-
`tion. The need of vasoactive drugs after weaning off CPB was analysed.
`Repeated measures ANOVA with Tukey test was used to compare
`MPAP/MAP. P ⬍ 0.05 was considered significant.
`Results: Mean MPAP/MAP decreased after
`from
`iloprost
`inhaled
`0.64 ⫾ 0.1 to 0.5 ⫾ 0.1 at 30 min and 0.47 ⫾ 0.1 at 60 min, respectively
`(P ⬍ 0.05). To keep MAP ⬎45 mmHg a norepinephrine infusion was neces-
`sary in one patient. The individual courses of MPAP/MAP are demonstrated
`in the figure.
`
`12345678
`
`mean
`
`*
`
`*
`
`* ⫽ p ⬍ 0.05 vs. before iloprost
`
`before
`iloprost
`
`iloprost ⫹
`30 min
`
`iloprost ⫹
`60 min
`
`1.0
`
`0.8
`
`0.6
`
`0.4
`
`0.2
`0.1
`
`0.0
`
`MPAP/MAP
`
`Discussion: A single dose inhaled iloprost decreases MPAP/MAP in infants
`after weaning off CPB by 21% and 25% after 30 min and 60 min, respec-
`tively. This indicates selective pulmonary vasodilating effects. However,
`vasopressor support was necessary in one infant. Although inhaled nitric
`oxide (iNO) is widely used to decrease pulmonary vascular resistance in
`infants undergoing cardiac surgery, the effects of iNO varies among patients,
`rebound phenomena have been described, and cumbersome devices are
`necessary to administer iNO safely. Inhaled iloprost may therefore be an
`alternative for selective pulmonary vasodilatation in infants undergoing car-
`diac surgery because it is effective, easy to use and long acting. Furthermore,
`from the economic point of view, inhaled iloprost may be attractive because
`iNO became very expensive after FDA approval.
`References:
`1 Celermajer DS, Culen S, Deanfield JE, et al. Impairment of endothelium-dependent
`pulmonary artery relaxation in children with congenital heart disease and abnormal
`pulmonary hemodynamics. Circulation 1993; 87: 440–446.
`2 Olschewski H, Simonneau G, Galie N, et al. Inhaled iloprost for severe pulmonary
`hypertension. N Engl J Med 2002; 347: 322–329.
`
`036
`Incentive spirometry for preoperative preparation
`of cardiac patients
`A.E. Balandiuk, I.A. Kozlov
`Research Institute of Transplantology and Artificial Organs,
`Moscow, Russia
`Introduction: Arterial hypoxaemia is not a rare complication of CABG.
`Incentive spirometry (IS) is a simple and low cost training method, which
`encourages an increase of lung volumes and inspiratory capacity. The purpose
`of the study was to investigate the efficiency of preoperative IS in CABG
`patients [1].
`Method: The study included 65 randomly selected CABG patients 41 to 73
`years of age. Patients were divided into 2 groups: patients of group S (37)
`used IS before surgery, group C (28 patients) were controls. IS was adminis-
`tered to group S patients for 2 days before surgery. Spirometry training was
`performed for 10 min each hour. Further, we started IS training at the second
`postoperative day. Anaesthesia and ventilation parameters were the same in
`both groups. Oxygenation index PaO2/FiO2, difference and Qs/Qt were
`observed at the following operation stages: before sternotomy (1), 10 min
`
`References:
`1
`Zacharias A, Habib RH. Factors predisposing to median sternotomy complications.
`Deep vs. superficial infection. Chest, 1996; 110: 1173–1178.
`2 Muller M, Schmid R, Georgopoulos A, et al. Application of microdialysis to clinical
`pharmacokinetics in humans. Clin Pharmacol Ther 1995; 57(4): 371–380.
`3 Wysocki M, Delatour F, Faurisson F, et al. Continuous versus intermittent infusion of
`vancomycin in severe staphylococcal infections: prospective multicenter randomized
`study. Antimicrob Agents Chemother 2001; 45: 2460–2467.
`
`112
`The effects of levosimendan in cardiac surgery patients
`C. Romana, J. Kokotsakis1, M. Argyriou1, C. Soutzopoulou,
`P. Stratigopoulou, E. Karamichali
`Departments of Anaesthesiology and 1Cardiac Surgery, Evangelismos
`General Hospital, Athens, Greece
`Introduction: The aim of the study was to evaluate the effects of levosi-
`mendan, a new calcium sensitizer, used during cardiac surgery to facilitate
`separation from cardiopulmonary bypass (CPB) [1].
`Method: Twenty ASA II–III patients, undergoing elective CABG, received,
`after the aortic clamp release, the same loading dose of levosimendan of
`24 g kg⫺1 over 10 minutes, followed by a continuous infusion of 0.1 g kg⫺1
`min⫺1 (group I, n ⫽ 10) or 0.2 g kg⫺1 min⫺1 (group II, n ⫽ 10). All patients
`had measured ejection fraction ⬎25%, sinus rhythm, cardiac index
`(CI) ⬎1.8 L min⫺1m⫺2, mean arterial pressure (MAP) ⬎60 mmHg and pul-
`monary capillary wedge pressure (PCWP) 8–20 mmHg. They all received the
`same anaesthetic scheme. Cardiac output (CO) was obtained by Swan-
`Ganz catheter and thermodilution (Baxter-Edwards Lab). Haemodynamic
`measurements: Heart Rate (HR), MAP, PCWP, CO, CI, stroke volume (SV),
`systemic vascular resistance (SVR) were performed at: T0: baseline, T1 at
`15 min after infusion, T2 at 60 min, T3 after 12 h and T4 at 24 h after the end of
`infusion. Statistical analysis was performed by ANOVA for repeated mea-
`surements, P ⬍ 0.05 was considered significant.
`Results: There were no significant differences in the demographic data.
`Haemodynamic results are shown in the table.
`
`Heart rate
`(beats/min)
`Mean arterial
`pressure (mmHg)
`Stroke volume (ml)
`
`Cardiac index
`(L min⫺1 m2)
`PCWP (mmHg)
`
`Gp
`I
`II
`I
`II
`I
`II
`I
`II
`I
`II
`
`T1
`T0
`78 ⫾ 1.8
`80 ⫾ 2
`89* ⫾ 2.0
`80 ⫾ 3
`76 ⫾ 3.8
`85 ⫾ 4
`65* ⫾ 5
`82 ⫾ 5
`57 ⫾ 4.2
`55 ⫾ 4
`59 ⫾ 7.1
`56 ⫾ 5.6
`2 ⫾ 0.6
`1.9 ⫾ 0.3
`1.9 ⫾ 0.6 2.2 ⫾ 0.7
`18 ⫾ 4
`12* ⫾ 3
`16 ⫾ 3
`11* ⫾ 2.5
`
`T4
`T3
`T2
`81 ⫾ 3
`84 ⫾ 3.2
`84 ⫾ 3
`88 ⫾ 3.8
`94* ⫾ 4
`93* ⫾ 4
`78 ⫾ 4.8
`78 ⫾ 5
`73 ⫾ 4
`74 ⫾ 3.2
`76 ⫾ 5
`73 ⫾ 5
`58 ⫾ 5.4
`60* ⫾ 5
`58 ⫾ 3.7
`59 ⫾ 7
`63* ⫾ 9.9
`60* ⫾ 8.5
`2.3* ⫾ 0.6 2.5* ⫾ 0.7 2.3* ⫾ 0.4
`2.4* ⫾ 0.7 2.6* ⫾ 0.8 2.3* ⫾ 0.8
`13* ⫾ 5
`13 * ⫾ 6
`12* ⫾ 4
`12* ⫾ 4
`12* ⫾ 5
`10* ⫾ 5
`
`*P ⬍ 0.05 in comparison to T0
`
`Conclusion: Both doses of levosimendan were effective, achieving a suc-
`cessful separation from CPB during the initial attempt. Levosimendan may
`offer an alternative inotropic therapy in patients following cardiac surgery.
`The effects of the drug were not abolished after terminating the infusion [2].
`References:
`1
`Follath F, Cleland JG, Just H, et al. Efficacy and safety of intravenous levosimendan
`compared with dobutamine in severe low-output heart failure (the LIDO study): a ran-
`domised double-blind trial. Lancet 2002; 360: 196–202.
`Lilleberg J, Nieminen MS, Akkila J, et al. Effects of a new calcium sensitizer, levosi-
`mendan, on haemodynamics, coronary blood flow and myocardial substrate utilization
`early after coronary artery bypass grafting. Eur Heart J 1998; 19: 660–668.
`
`2
`
`084
`Inhaled iloprost in the management of pulmonary
`hypertension in infants undergoing congenital
`heart surgery
`M. Mueller, C. Neuhaeuser, R. Noest, H. Akintuerk, I. Welters,
`G. Hempelmann
`Department of Anaesthesiology, Intensive Care, Pain Therapy, University
`Hospital Giessen, Giessen, Germany
`Introduction: Impaired endothelium-dependant pulmonary artery relaxation
`is present in children with high pulmonary flow and pressure which might be
`exacerbated by cardiopulmonary bypass (CPB) [1]. The use of aerosolized
`Iloprost has shown to be safe and effective in adults with pulmonary hyper-
`tension [2]. However, no data is available about the intra-operative use of
`inhaled iloprost in infants ⬍1 year with pulmonary hypertension undergoing
`cardiac surgery.
`
`© 2004 European Academy of Anaesthesiology, European Journal of Anaesthesiology 21 (Suppl. 33): 2–36
`
`WATSON LABORATORIES, INC. , IPR2017-01622, Ex. 1041, p. 1 of 1
`
`
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