Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver transplantation: a narrative review of cases and potential biochemical mechanisms

Charles, F.Kelley St.; Murray, Leslie J.; Giordano, Christopher; Spiess, Bruce D.

doi:10.1007/s12630-019-01449-x

Cited by 18 publications

(12 citation statements)

References 60 publications

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“…Our institutional guideline suggests the initiation of VS treatment at MAP <65 mmHg via arterial catheter and/or SVR <500 dynes/s/cm ‐ 5 (Box). SVR <500 dynes/s/cm ‐ 5 is lower than the normal range of values for SVR (800–1200 dynes/s/cm ‐ 5 ) 1,35,36 . Since hyperdynamic circulation with decreased SVR and increased cardiac output commonly occurs in patients in ESLD, the threshold of SVR <500 dynes/s/cm −5 is designed to administer B12 to patients with severe VS. An et al 18 .…”

Section: Discussionmentioning

confidence: 99%

“…SVR <500 dynes/s/cm -5 is lower than the normal range of values for SVR (800-1200 dynes/s/cm -5 ). 1,35,36 Since hyperdynamic circulation with decreased SVR and increased cardiac output commonly occurs in patients in ESLD, the threshold of SVR <500 dynes/s/cm −5 is designed to administer B12 to patients with severe VS. An et al 18 described a treatment strategy for intraoperative VS that was similar to our institutional guideline, with MB (approximately 1.5-2 mg/kg) as the first-line medication and then B12 (total of 5 g) as the rescue medication. Other case reports and case series described doses ranging from 750 mg to 5 g via incremental boluses and/or continual infusion.…”

Section: B12 (Nmentioning

confidence: 99%

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Use of hydroxocobalamin to treat intraoperative vasoplegic syndrome refractory to vasopressors and methylene blue during liver transplantation

Pai,

Torp,

Insignares

et al. 2024

Clinical Transplantation

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IntroductionFor patients with catecholamine‐resistant vasoplegic syndrome (VS) during liver transplantation (LT), treatment with methylene blue (MB) and/or hydroxocobalamin (B12) has been an acceptable therapy. However, data on the effectiveness of B12 is limited to case reports and case series.MethodsWe retrospectively reviewed records of patients undergoing LT from January 2016 through March 2022. We identified patients with VS treated with vasopressors and MB, and abstracted hemodynamic parameters, vasopressor requirements, and B12 administration from the records. The primary aim was to describe the treatment efficacy of B12 for VS refractory to vasopressors and MB, measured as no vasopressor requirement at the conclusion of the surgery.ResultsOne hundred one patients received intraoperative VS treatment. For the 35 (34.7%) patients with successful VS treatment, 14 received MB only and 21 received both MB and B12. Of the 21 patients with VS resolution after receiving both MB and B12, 17 (89.5%) showed immediate, but transient, hemodynamic improvements at the time of MB administration and later showed sustained response to B12.ConclusionImmediate but transient hemodynamic response to MB in VS patients during LT supports the diagnosis of VS and should prompt B12 administration for sustained treatment response.

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Section: Discussionmentioning

confidence: 99%

Section: B12 (Nmentioning

confidence: 99%

Use of hydroxocobalamin to treat intraoperative vasoplegic syndrome refractory to vasopressors and methylene blue during liver transplantation

Pai,

Torp,

Insignares

et al. 2024

Clinical Transplantation

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“…Currently, there are several clinical trials combining chemotherapeutic agents with pan-NOS inhibitors. 75 Another method is to use NO scavengers, such as cobalamin, 76 to locally tune NO levels. Reducing NO can limit nitrosative signaling while preserving critical physiological functions including vasodilation and can improve tumor infiltration of immune cells.…”

Section: Development Of No Technologies Formentioning

confidence: 99%

Nitric Oxide and Cancer: When to Give and When to Take Away?

et al. 2021

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The mechanistic roles of nitric oxide (NO) during cancer progression have been important considerations since its discovery as an endogenously generated free radical. Nonetheless, the impacts of this signaling molecule can be seemingly contradictory, being both pro-and antitumorigenic, which complicates the development of cancer treatments based on the modulation of NO fluxes in tumors. At a fundamental level, low levels of NO drive oncogenic pathways, immunosuppression, metastasis, and angiogenesis, while higher levels lead to apoptosis and reduced hypoxia and also sensitize tumors to conventional therapies. However, clinical outcome depends on the type and stage of the tumor as well as the tumor microenvironment. In this Viewpoint, the current understanding of the concentration, spatial, and temporal dependence of responses to NO is correlated with potential treatment and prevention technologies and strategies.

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“…We and others have reported the utility of hydroxocobalamin in several cases of vasoplegia including patients undergoing cardiac surgery or liver transplantation [4] , [5] , [6] . A recent review analyzed the published cases and reported a total of 44 patients who received hydroxocobalamin in these settings [7] . The authors identified that 33 patients (75 %) who were “responders” to the medication as an indicated by clinically meaningful increases in arterial pressure.…”

Section: Introductionmentioning

confidence: 99%

Hydroxocobalamin for treatment of catecholamine-resistant vasoplegia during liver transplantation: A single-center series of 20 cases

Boettcher

Woehlck

Makker

et al. 2022

International Journal of Surgery Case Reports

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Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver transplantation: a narrative review of cases and potential biochemical mechanisms

Cited by 18 publications

References 60 publications

Use of hydroxocobalamin to treat intraoperative vasoplegic syndrome refractory to vasopressors and methylene blue during liver transplantation

Use of hydroxocobalamin to treat intraoperative vasoplegic syndrome refractory to vasopressors and methylene blue during liver transplantation

Nitric Oxide and Cancer: When to Give and When to Take Away?

Hydroxocobalamin for treatment of catecholamine-resistant vasoplegia during liver transplantation: A single-center series of 20 cases

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