Updates in the Management of Perioperative Vasoplegic Syndrome

Brennan, Kaitlyn A.; Bhutiani, Monica; Kingeter, Meredith A.; McEvoy, Matthew D.

doi:10.1016/j.aan.2022.07.010

Cited by 1 publication

(1 citation statement)

References 126 publications

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“…A well-known complication following cardiac surgery, either with or without cardiopulmonary bypass (CPB), is vasoplegic syndrome (VS), which carries a high risk of perioperative morbidity and death. Its occurrence range in cardiac surgery patients following CPB has been reported by some authors to be between 9% and 44% in the subset of patients with predisposing characteristics [ 1 , 2 ]. VS is manifested by significant systemic hypotension associated with continuously high cardiac output and low systemic vascular resistance, yet poor quality organ perfusion, although vasopressors are needed to sustain the blood pressure for end-organ perfusion [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiotoxic Effects Produced by Omeprazole and Methylene Blue in an Animal Model of Cardiac Ischemia and Reperfusion and Potential Implications for the Pharmacological Strategy for Vasoplegic Syndrome

de Araújo,

Tallo,

Oliveira

et al. 2024

Biomedicines

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Defined as systemic hypotension caused by intense vasodilation due to the loss of systemic vascular resistance, vasoplegic syndrome (VS) is associated with elevated morbidity and mortality in humans. Although vasopressors such as norepinephrine and vasopressin are the first-choice drugs for VS treatment, several other drugs such as methylene blue (MB) can be used as adjuvant therapy including rescue therapy. To develop new pharmacological strategies to reduce the risk of VS, we investigated the effects of treatments with MB (2 mg/kg/IV), omeprazole (OME, 10 mg/kg/IV), and their combination in an animal model of cardiac ischemia–reperfusion (CIR). The ventricular arrhythmia (VA), atrioventricular block (AVB), and lethality (LET) incidence rates caused by CIR (evaluated via ECG) and serum levels of the cardiac lesion biomarkers creatine kinase–MB (CK-MB) and troponin I (TnI) in adult rats pretreated with saline solution 0.9% and submitted to CIR (SS + CIR group) were compared to those pretreated with MB (MB + CIR group), OME (OME + CIR group), or the MB + OME combination (MB + OME + CIR group). The AVB and LET incidence rates in the MB + CIR (100%), OME + CIR (100%), and MB + OME + CIR (100%) groups were significantly higher compared to the SS + CIR group (60%). The serum level of CK-MB in these groups were also significantly higher compared to the SS + CIR group, demonstrating that the treatments before CIR with MB, OME, and MB + OME produced similar effects in relation to cardiac function and the occurrence of lesions. These results demonstrate that the treatment of animals subjected to the CIR protocol with OME produced the same effects promoted by the treatment with MB, which may suggest the possibility of using OME alone or in combination with MB in medical clinics in treatment of VS.

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