Methylene Blue for Vasoplegic Syndrome
Keywords:Methylene Blue, Vasoplegia
Vasoplegic syndrome is a form of vasodilatory shock that occurs frequently in patients who undergo cardiac surgery requiring cardiopulmonary bypass (CBP). Treatment often demands high doses of vasopressors over sustained periods for hypotension that can be refractory to standard vasoactive medications. Furthermore, the development of vasoplegia greatly contributes to morbidity and mortality following cardiac surgery. Methylene blue (MB) has become a popular therapy for cardiac vasoplegia despite a paucity of prospective data to direct its use. Therefore, the aim of this study was to review available data regarding mechanisms, dosing strategies, and side effects of MB, with a focus on its applications for vasoplegia in cardiac surgery.
Andrade JCS, Batista ML, Evora PRB, et al. 1996. Methylene blue administration in the treatment of the vasoplegic syndrome after cardiac surgery. Rev Bras Cir Cardiovasc 11:107-14.
Cremer J, Martin M, Redl H, et al. 1996. Systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg 61:1714-20.
Evora PR, Ribeiro PJ, Andrade JC. 1997. Methylene blue administration in SIRS after cardiac operations. Ann Thorac Surg 63:1212-13.
Evora PR. 2000. Should MB be the drug of choice to treat vasoplegias caused by cardiopulmonary bypass and anaphylactic shock? J Thorac Cardiovasc Surg 119: 632-4.
Evora PRB, Rodrigues AJ, Celotto AC. 2014. Methylene blue should be relegated to rescue use and not as first-line therapy. J Cardiothorac Vasc Anesth 28: 11-12.
Gillman PK. 2011. CNS toxicity involving methylene blue: the exemplar for understanding and predicting drug interactions that precipitate serotonin toxicity. J Psychopharmacol 25:429-36.
Gomes WJ, Carvalho AC, Palma JH, Gonçalves I Jr, Buffolo E. 1994. Vasoplegic syndrome: a new dilemma. J Thorac Cardiovasc Surg 107:942-3.
Grubb KJ, Kennedy JL, Bergin JD, Groves DS, Kern JA. 2012. The role of methylene blue in serotonin syndrome following cardiac transplantation: a case report and review of the literature. J Thorac Cardiovasc Surg 144:e113-6.
Hajjar, Vincent JL, Galas FRBG, et al. 2017. Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: the VANCS randomized controlled trial. Anesth 126:85-93.
Hanna ER, Clark JA. 2014. Serotonin syndrome after cardiopulmonary bypass: a case demonstrating the interaction between methylene blue and selective serotonin reuptake inhibitors. A A Case Rep 2:113-4.
Hencken L, To L, Ly N, Morgan JA. 2016. Serotonin syndrome following methylene blue administration for vasoplegic syndrome. J Card Surg 31:208-10.
Kofidis T, Strüber M, Wilhelmi M, et al. 2001. Reversal of severe vasoplegia with single-dose methylene blue after heart transplantation. J Thorac Cardiovasc Surg 122:823-4.
Lavigne D. 2010. Vasopressin and methylene blue: alternate therapies in vasodilatory shock. Semin Cardiothorac Vasc Anesth 14:186-9.
Levin RL, Degrange MA, Bruno GF, et al. 2004. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Annals Thorac Surg 77: 496-9.
Leyh RG, Kofidis T, Strüber M, et al. 2003. Methylene blue: the drug of choice for catecholamine refractory vasoplegia after cardiopulmonary bypass? J Thorac Cardiovasc Surg 125:1426-31.
Manghelli J, Brown L, Tadros HB, Munfakh NA. 2015. A reminder of methylene blue’s effectiveness in treating vasoplegic syndrome after on-pump cardiac surgery. Tex Heart Institute J 42:491-4.
Maslow AD, Stearns G, Butala P, Schwartz CS, Gough J, Singh AK. 2006. The hemodynamic effects of methylene blue when administered at the onset of cardiopulmonary bypass. Anesth Analg 103:2-8.
Mehaffey JH, Johnston LE, Hawkins RB, et al. 2017. Methylene blue for vasoplegic syndrome after cardiac operation: early administration improves survival. Ann Thorac Surg 104:36-41.
Myles PS, Leong CK, Currey J. 1997. Endogenous nitric oxide and low vascular resistance after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 11:571-4.
Omar S, Zedan A, Nugent K. 2015. Cardiac vasoplegia syndrome: pathophysiology, risk factors, and treatment. Am J Med Sci 349:80-8.
Ozal E, Kuralay E, Yildirim V, et al. 2005. Preoperative methylene blue administration in patients at high risk for vasoplegic syndrome during cardiac surgery. Ann Thorac Surg 79:1615-9.
Patarroyo M, Simbaqueba C, Shrestha K, et al. 2012. Pre-operative risk factors and clinical outcomes associated with vasoplegia in recipients of orthotopic heart transplant in the contemporary era. J Heart Lung Transpl 31:282-7.
Preiser JC, Lejeune P, Roman A, et al. 1995. Methylene blue administration in septic shock: a clinical trial. Crit Care Med 23:259-64.
Raja SG, Dreyfus GD. 2004. Vasoplegic syndrome after off-pump coronary artery bypass surgery. Tex Heart Inst J 31:421-4.
Riha H, Augoustides JGT. 2011. Pro: Methylene blue as a rescue therapy for vasoplegia after cardiac surgery. J Cardiothorac Vasc Anesth 25:736-8.
Roderique JD, VanDyck K Holman B, et al. 2014. The use of high-dose hydroxocobalamin for vasoplegic syndrome. Ann Thorac Surg 97:1785-6.
Strüber M, Cremer J, Gohrbandt B, Haverich A. 1999. Humoral cytokine response to coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg 68:1330-5.
Weiner MM, Lin H, Danforth D, Rao S, Hosseinian L, Fischer GW. 2013. Methylene blue is associated with poor outcomes in vasoplegic shock. J Cardiothorac Vasc Anesth 27:1233-8.
Yiu P, Robin J, Pattison CW. 1999. Reversal of refractory hypotension with single-dose methylene blue after coronary bypass surgery. J Thorac Cardiovasc Surg 118:195-6.
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