Methylene Blue for Vasopressor-Resistant Vasoplegia Syndrome During Liver Transplantation

Fischer, Gregory W.; Bengtsson, Ylva; Scarola, S; Cohen, Edmond

doi:10.1053/j.jvca.2008.07.015

Cited by 40 publications

(27 citation statements)

References 19 publications

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“…This is similar to the effect of methylene blue on patients in septic shock [4]. However, when methylene blue was administered after reperfusion to a patient in vasoplegic shock, an increase in BP was correlated to an increase in SVR [6].…”

Section: Discussionsupporting

confidence: 68%

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The response to methylene blue in patients with severe hypotension during liver transplantation

Berman

Merritt

Hendrickse

et al. 2012

Journal of Clinical Anesthesia

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Section: Discussionsupporting

confidence: 68%

“…Recent clinical reports have focused on its use in vasoplegic shock, in the setting of postcardiopulmonary bypass [2], sepsis [3,4], acute liver failure [5], and liver transplantation [6,7].…”

Section: Discussionmentioning

confidence: 99%

The response to methylene blue in patients with severe hypotension during liver transplantation

Berman

Merritt

Hendrickse

et al. 2012

Journal of Clinical Anesthesia

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“…The pretreatment of patients with vasopressin or terlipressin before reperfusion would be interesting in light of the observation of a relative vasopressin deficiency in this patient population and several case reports of successful stabilization of catecholamine‐refractory hypotension during LT with these agents . Methylene blue, an inhibitor of inducible nitric oxide synthase and a nitric oxide scavenger, has been shown to attenuate reperfusion hypotension in several case reports, and its effect involves guanylate cyclase inhibition . However, this finding has been challenged recently by Fukazawa et al in a retrospective, propensity‐matching comparison study showing that the administration of methylene blue at 1 to 1.5 mg/kg immediately before reperfusion did not prevent postreperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

et al. 2013

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Liver transplantation (LT) is one of the highest risk noncardiac surgeries. We reviewed the incidence, etiologies, and outcomes of intraoperative cardiac arrest (ICA) during LT. Adult cadaveric LT recipients from January 1, 2001 through December 31, 2009 were reviewed. ICA was defined as an event requiring either closed chest compression or open cardiac massage. Cardiac arrest patients who recovered with only pharmacological interventions were excluded. Data included etiologies and outcomes of ICA, intraoperative deaths (IDs) and hospital deaths (HDs), and potential ICA risk factors. ICA occurred in 68 of 1238 LT recipients (5.5%). It occurred most frequently during the neohepatic phase (60 cases or 90%), and 39 of these cases (65.0%) experienced ICA within 5 minutes after graft reperfusion. The causes of ICA included postreperfusion syndrome (PRS; 26 cases or 38.2%) and pulmonary thromboembolism (PTE; 24 cases or 35.3%). A higher Model for End-Stage Liver Disease (MELD) score was found to be the most significant risk factor for ICA. The ID rate after ICA was 29.4% (20 cases), and the HD rate was 50.0% (34 cases). The 30-day patient survival rate after ICA was 55.9%, and the 1-year survival rate was 45.6%: these rates were significantly lower (P < 0.001) than those for non-ICA patients (97.4% and 85.1%, respectively). In conclusion, the incidence of ICA in adult cadaveric LT was 5.5% with an intraoperative mortality rate of 29.4%. ICA most frequently occurred within 5 minutes after reperfusion and resulted mainly from PRS and PTE. A higher MELD score was identified as a risk factor.

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“…In liver failure vasopressin analogues (terlipressin or ornipressin) are able to reverse hepatorenal syndrome and restore renal function (7, 8) similar to the effect of vasopressin in septic shock (9). Methylene blue has also been suggested as treatment for vasopressor resistant vasoplegia syndrome in liver transplantation (10) but should probably be reserved only for situations where other vasopressors failed to maintain adequate perfusion pressure.…”

Section: Introductionmentioning

confidence: 99%

Vasopressin Deficiency and Vasodilatory State in End-Stage Liver Disease

Wagener

Kovalevskaya

Minhaz

et al. 2011

Journal of Cardiothoracic and Vascular Anesthesia

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Abstract1. Objectives-Relative vasopressin deficiency, a contributor to vasodilatory septic shock may also be a cause of the vasodilatory state in liver disease. This study assesses endogenous vasopressin levels in patients with liver disease and their hemodynamic response to exogenous vasopressin.2. Design-Prospective, observational study 3. Setting-Single center, tertiary hospital 4. Participants-Human subjects undergoing liver transplantation or major surgery 5. Interventions-Vasopressin levels were measured in 28 patients with liver disease undergoing liver transplantation and 7 control patients with normal liver function. Additionally intravenous vasopressin was given to 20 liver transplant recipients and the hemodynamic response was observed. Measurements and MainResults-Patients with liver disease had significantly lower baseline vasopressin levels than controls (19.3 +/− 27.1 pg/mL versus 50.9 +/− 36.7 pg/mL, p=0.015). Patients with low vasopressin levels (• 20 pg/mL) were more likely to have low baseline mean blood pressure (• 80 mm Hg) than patients with high vasopressin levels (11 of 16 vs. 0 of 4, p=0.013). Systemic vascular resistance increased by 33% three minutes after intravenous vasopressin. Thirteen of 16 patients with low vasopressin levels compared to one of four patients

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Methylene Blue for Vasopressor-Resistant Vasoplegia Syndrome During Liver Transplantation

Cited by 40 publications

References 19 publications

The response to methylene blue in patients with severe hypotension during liver transplantation

The response to methylene blue in patients with severe hypotension during liver transplantation

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

Vasopressin Deficiency and Vasodilatory State in End-Stage Liver Disease

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