A Reminder of Methylene Blue's Effectiveness in Treating Vasoplegic Syndrome after On-Pump Cardiac Surgery.
The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. Indeed the hypotension consequent to on-pump cardiac surgery often necessitates vasopressor and intravenous fluid support. Methylene blue counteracts vasoplegic syndrome by inhibiting the formation of nitric oxide. We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. After the administration of methylene blue, his hypotension improved to the extent that he could be weaned from vasopressors. The use of methylene blue should be considered in patients who develop hypotension refractory to standard treatment after cardiac surgery.
Joshua
J
Manghelli
Lisa
L
Brown
Hany B
HB
Tadros
Nabil A
NA
Munfakh
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008751:Methylene Blue / Q000627:therapeutic use*; D008943:Mitral Valve / Q000601:surgery*; D009569:Nitric Oxide / Q000378:metabolism; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors* / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D056987:Vasoplegia / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology / Q000209:etiology / Q000503:physiopathology
D004791:Enzyme Inhibitors; D009569:Nitric Oxide; D019001:Nitric Oxide Synthase; D008751:Methylene Blue
Cardiopulmonary bypass/adverse effects; hemodynamics/drug effects; hypotension/drug therapy; methylene blue/administration & dosage/therapeutic use; nitric oxide/antagonists & inhibitors; shock, vasodilatory/physiopathology; vasoconstrictor agents/therapeutic use; vasodilation/physiology; vasoplegia/etiology/therapy; vasopressors/therapeutic use