title: Hydroxocobalamin for Vasoplegic Syndrome in Liver Transplantation: Restoration of Blood Pressure Without Vasospasm.
abstract: Systemic vasoplegia is common in patients undergoing liver transplantation. In this report, we present a case in which treatment with conventional vasopressors caused peripheral arterial spasm, rendering arterial blood pressure monitoring impossible. Administration of methylene blue resolved the vasospasm; however, concern for toxic dose requirements limited its use. Hydroxocobalamin administration resolved the vasospasm and increased blood pressure without the potential adverse effects seen with methylene blue. This case represents the first report of hydroxocobalamin use in liver transplantation and may represent a new option for the treatment of vasoplegia and the potential vasospasm that may result from traditional vasopressors.
authors.affiliation: From the Departments of *Anesthesiology and †Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Woehlck
authors.forename: Brent T
authors.initials: BT
authors.lastname: Boettcher
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Lauer
authors.forename: David C
authors.initials: DC
authors.lastname: Cronin
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zimmerman
authors.forename: Joohyun
authors.initials: J
authors.lastname: Kim
authors.forename: Motaz
authors.initials: M
authors.lastname: Selim
mesh_terms: D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006801:Humans; D006879:Hydroxocobalamin / Q000008:administration & dosage / Q000627:therapeutic use*; D016031:Liver Transplantation; D008751:Methylene Blue / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D056987:Vasoplegia / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D006879:Hydroxocobalamin; D008751:Methylene Blue