Answer 9

The TEE at the end of bypass shows persistent left ventricular dysfunction. This patient is likely to need the best possible inotropic support, and continued vasopressor therapy for vasoplegia. Although there is not a single answer to this problem, choices 1-3 are all vasodilators, and choice 4, dopamine, is probably not an adequate inotrope for this situation. Answer 5 is most appropriate. Since the patient is already on norepinephrine during bypass for vasoplegia, we would suggest adding milrinone to improve inotropy. Additional vasoconstrictors may also be needed to maintain coronary perfusion pressure.