Methylene blue: the drug of choice for catecholamine-refractory vasoplegia after cardiopulmonary bypass

Abstract

A single dose of methylene blue seems to be a potent approach to norepinephrine-refractory vasoplegia after cardiopulmonary bypass for most patients, with no obvious side effects. Guanylate cyclase inhibitors could be a novel class of agents for the treatment of norepinephrine-refractory vasoplegia after cardiopulmonary bypass. A controlled clinical trial is now needed to evaluate the role of methylene blue in this situation.

Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties

“…Among the 60 papers that appear in the bibliography of this text, through a laborious and error subjected evaluation, the existence of varied types of publications is evidenced: 1) a first series (1.67%) of six non-randomized patients [5]; 2) a series (1.67%) of 60 patients submitted the CPB and randomized to study the inflammatory reaction [12]; 3) a series (1.67%) of 54 non-randomized patients [6,7]; 4) a series (1.67%) of 56 randomized patients in which 28 had received MB to treat VS in cardiac surgery´s postoperative [8][9][10] and; 5) a series (1.67%) of 100 patients with VS risk factors that had been randomized and 50 patients that received MB before the CPB [11]. Observing the other 55 studies we can find: 1) one study (1.67%) based on evidences through metanalysis of literature [13]; 2) seven review articles (11.67%) [4,14,23].…”

“…The largest series of prospective studies indicate an incidence of 8% to 12% [6,10,11] The mortality is high, ranging from 16 to 27% [6,10,11], and therefore has been the subject of several studies aimed on improving the outcomes of these patients. MB has been used as a therapeutic option in these situations.…”

“…Three studies involving a higher number of patients deserve particular citations: 1) In 2003, Leyh et al [6,7] reported, in Germany, 54 cases of cardiac surgery patients not carrying bacterial endocarditis who had been treated with MB, with over 90% of the patients responding to the treatment; 2) Levin et al [8][9][10], in Argentina, reported the incidence of 8.8% of VS in 638 patients. Among the 56 vasoplegic patients randomly receiving MB or placebo there was no mortality in the group treated with MB and it was possible to discontinue vasoconstrictors in a short period time, with less consequential morbidity and mortality.…”

Vasoplegic Syndrome after Oral Nimodipine Application in Patients with Subarachnoid Hemorrhage

“…These symptoms were found in our patients although we didn't have TEE to confirm normal cardiac output. Risk factors for developing VS include intravenous heparin, medication with long acting angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers [17][18][19] or systemic inflammatory response syndrome (SIRS) [20]. Also release of interleukines, which is seen after SAH, can lead to 4/5 vessel dilation by activation of cyclic guanosine monophosphate (cGMP) [21].…”

Intensive Care Management of Patients in the First 24 Hours After Cardiac Surgery

“…There were no sufficient data on the effectiveness that allow definitive conclusions regarding the use of antifibrinolytic agents in other situations. 61,62,63,64,65,66,67 While other review reports that aminocaproic acid and tranexamic acid are safe, it is noteworthy that the works included were smaller than the jobs studied aprotinin. Therefore, the authors say, the safety data are not reliable, especially with regard to thrombosis.…”