title: Methylene blue to treat vasoplegia due to a severe protamine reaction: a case report.
abstract: Protamine sulfate is used during coronary artery bypass graft surgery to reverse the anticoagulating effects of heparin. Vasoplegic syndrome is a state of endothelial dysregulation that produces profound vasodilatation that is refractory to vasopressors. This syndrome leads to systemic hypoperfusion and may progress to death. Up to 27% of patients after cardiac bypass may experience vasoplegia. Symptoms of vasoplegia may also be present in many different clinical settings. This case report describes a 57-year-old woman who after cardiac bypass experienced a severe protamine reaction with profound hypotension, which was unresponsive to volume resuscitation and vasopressor therapy. A dramatic increase in blood pressure resulted almost immediately after administration of methylene blue. This patient had no prior risk factors for a protamine reaction other than her current cardiac surgery. A review of the pathophysiologic characteristics associated with vasoplegia and the pharmacodynamics of methylene blue will potentially enable anesthesia providers to utilize this lifesaving drug when needed.
authors: University of Kansas Medical Center, Kansas City, USA. dinalutjen@hotmail.com
authors: Dina L
authors: DL
authors: Lutjen
authors: Karri L
authors: KL
authors: Arndt
mesh_terms: D001026:Coronary Artery Bypass; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006494:Heparin Antagonists / Q000009:adverse effects; D006801:Humans; D008751:Methylene Blue / Q000627:therapeutic use*; D008875:Middle Aged; D009719:Nurse Anesthetists; D011479:Protamines / Q000009:adverse effects*; D012720:Severity of Illness Index; D056987:Vasoplegia / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D004791:Enzyme Inhibitors; D006494:Heparin Antagonists; D011479:Protamines; D008751:Methylene Blue