HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ganesh Shanmugam Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shanmugam, G. Search for Related Content PubMed PubMed Citation Articles by Shanmugam, G. Related Collections Cardiac - pharmacology Cardiac - other

Eur J Cardiothorac Surg 2005;28:705-710
© 2005 Elsevier Science NL

Review

Vasoplegic syndrome—the role of methylene blue

Department of Cardiac Surgery, Royal Hospital for Sick Children, Dalnair Street, Glasgow G3 8SJ, UK

Received 15 May 2005; received in revised form 27 July 2005; accepted 29 July 2005.

^_* Tel.: +44 141 201 0264. (Email: sgunpat{at}hotmail.com).

Vasoplegic syndrome is a recognized complication following cardiac surgery using cardiopulmonary bypass and is associated with increased morbidity and mortality. In several patients profound post-operative vasodilatation does not respond to conventional vasoconstrictor therapy. Methylene blue has been advocated as an adjunct to conventional vasoconstrictors in such situations. There is limited data pertaining to the use of methylene blue and a number of reports have been anecdotal observations. This article reviews the incidence and problems associated with the vasoplegic syndrome, the mechanism of action of methylene blue, its effects and adverse reactions and the literature supporting its intra-operative and post-operative use.

In cases where first-line therapy fails, the use of methylene blue seems to be a potent approach to refractory vasoplegia. The early use of methylene blue may halt the progression of low systemic vascular resistance even in patients responsive to norepinephrine and mitigate the need for prolonged vasoconstrictor use. However, dosing regimens and protocols need to be clearly defined before widespread routine use. Whether methylene blue should be the first line of therapy in patients with vasoplegia is a matter of debate, and there is inadequate evidence to support its use as a first line drug. More scientific evidence is needed to define the role of MB in the treatment of catecholamine refractory vasoplegia.

Key Words: Vasoplegic syndrome • Cardiopulmonary bypass • Methylene blue

This article has been cited by other articles:

				Z. Cao, Y. Gao, and G. Tao Vasoplegic Syndrome During Liver Transplantation Anesth. Analg., June 1, 2009; 108(6): 1941 - 1943. [Abstract] [Full Text] [PDF]

				X. Sun, L. Zhang, P. C. Hill, R. Lowery, A. T. Lee, R. E. Molyneaux, P. J. Corso, and S. W. Boyce Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery? Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 820 - 825. [Abstract] [Full Text] [PDF]

				Z. I. Khalpey, R. B. Ganim, and J. D. Rawn Postoperative Care of Cardiac Surgery Patients Card. Surg. Adult, January 1, 2008; 3(2008): 465 - 486. [Full Text]

				E. G. Leite, A. Ronald, A. J. Rodrigues, and P. R. B. Evora Is methylene blue of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome during cardiac surgery? Interactive CardioVascular and Thoracic Surgery, December 1, 2006; 5(6): 774 - 778. [Abstract] [Full Text] [PDF]