Levosimendan administration is not associated with increased risk of bleeding and blood transfusion requirement in patients undergoing off-pump coronary artery bypass grafting: a retrospective study from single center.

BACKGROUND: Levosimendan (LEVO) is a positive inotropic drug which could increase myocardial contractility and reduce the mortality rate in cardiac surgical patients. However, Whether LEVO is associated with postoperative bleeding and blood transfusion in cardiac surgical patients is controversial. Therefore, the current study was designed to investigate the impact of LEVO administration on bleeding and blood transfusion requirement in off-pump coronary artery bypass grafting (OPCAB) patients. METHODS: In a retrospective analysis, a total of 292 patients, aged 40-87 years, undergoing elective OPCAB between January 2019 and July 2019, were divided into LEVO group (n = 151) and Control group (n = 141). Patients in LEVO group continuously received LEVO at a rate of 0.1-0.2 µg kg-1 min-1 after anesthesia induction until 24 hours after OPCAB or patients in Control group received no LEVO. The primary outcome was postoperative chest drainage volume. The secondary outcomes were reoperation for postoperative bleeding, transfusion requirement of red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrate (PC), etc. Comparisons of two groups were performed with the Student's t-test or Wilcoxon-Mann-Whitney test. RESULTS: There was no significant difference with respect to chest drainage volume ((956.29 ± 555.45) ml vs (1003.19 ± 572.25) ml, p = 0.478) and the incidence of reoperation for postoperative bleeding (1.32% vs 1.42%, p = 0.945) between LEVO group and Control group. The transfusion incidence and volume of allogeneic RBCs, FFP, and PC were comparable between two groups. CONCLUSIONS: LEVO administration was neither associated with more postoperative blood loss nor increased allogeneic blood transfusion requirement in OPCAB patients.

Combined spinal and epidural anaesthesia with chloroprocaine for hysterectomy.

1. The aim of the present study was to determine the clinical efficacy and safety of chloroprocaine (CP) for gynaecological surgery. 2. One hundred and twenty gynaecological patients scheduled for hysterectomy were divided randomly into four groups: Group A (n = 30), 2.5% CP 1.0 mL; Group B (n = 30), 2.5% CP 1.2 mL; Group C (n = 30), 2.5% CP 1.4 mL; and Group D (n = 30), 2.5% CP 1.6 mL. The dose of CP used in each group was mixed with 1 mL vehicle containing 5% glucose and 1.5% ephedrine. Spinal anaesthesia was achieved by lumbar puncture in the L2-3 interspace and injection of the mixture. Wherever necessary, CP (2.5%) was used for epidural anaesthesia. 3. Although the times to onset and peak effect, as well as the grade of motor block of the lower limbs (Bromage scale), were similar among the four groups, the level of the highest sensory nerve block increased gradually, from T7 (+/- 1), T6 (+/- 1), T4 (+/- 1) to T3 (+/- 1) in Groups A, B, C and D, respectively. The rate of unsatisfactory spinal anaesthesia was 80 and 16.7% in Groups A and B, respectively, and consequently epidural anaesthesia was superimposed in those patients for surgery to start. Spinal anaesthesia was very satisfactory for surgery in Groups C and D. In contrast, the incidence of hypotension in Groups B, C and D was 6.7, 16.7 and 67.7%, respectively; however, respiratory depression only occurred in Group D in nine cases (30%). No other adverse events or neurologic deficits were found. 4. The present results suggest that 30-35 mg CP in a total volume of 2.2-2.4 mL used for spinal anaesthesia in hysterectomy is safe and efficient. The combination of spinal and epidural anaesthesia with 2.5% CP can achieve 100% satisfactory anaesthesia for this type of surgery.