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Levosimendan in perioperative and critical care patients

Salmenperä, Markku; Eriksson, Heidi

Current Opinion in Anesthesiology: August 2009 - Volume 22 - Issue 4 - p 496–501
doi: 10.1097/ACO.0b013e32832c5269
Drugs in anesthesia: Edited by Klaus T. Olkkola

Purpose of review To present recent experiences and studies on the pharmacologic profile of levosimendan in the context of surgery, anesthesia and critical care. Special emphasis is on the studies that could support the use of or create novel indications for levosimendan in these patients.

Recent findings Several controlled studies now suggest that levosimendan is efficacious in improving hemodynamics in patients after cardiac surgery. Its use as an adjunct to catecholamines instead of phosphodiesterase inhibitors can be recommended in patients with postcardiotomy heart failure and cardiogenic shock. Prophylactic administration before cardiopulmonary bypass in patients with compromised ventricular function may also be rational because levosimendan facilitates weaning from cardiopulmonary bypass without inotropes with higher myocardial oxygen cost of inotropy. This mode of administration also seems to attenuate troponin release and spares treatment resources such as duration of postoperative ventilation and ICU stay. The reported experience in patients with noncardiac surgery is meager but previous results obtained from nonsurgical patients should be largely applicable. The use of levosimendan in treating septic myocardial depression or sepsis syndrome is a promising option but remains investigational for today.

Summary New practice advisories and proposals for indications to treat and prevent low-output syndrome in patients at risk are warranted for patients undergoing cardiac surgery with cardiopulmonary bypass. Levosimendan should also be considered as an adjunct drug for the treatment of cardiogenic shock. Further experience and controlled studies are needed to support the use of levosimendan for other perturbations in critical care and perioperative medicine.

Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland

Correspondence to Salmenperä Markku, MD, Department of Anesthesiology and Intensive Care, PO Box 340, FIN-00029HUS Helsinki, Finland Tel: +358 50 4270607; e-mail: markku.salmenpera@hus.fi

© 2009 Lippincott Williams & Wilkins, Inc.