Vasoplegic syndrome–the role of methylene blue

Shanmugam, Ganesh
November 2005
European Journal of Cardio-Thoracic Surgery;Nov2005, Vol. 28 Issue 5, p705
Academic Journal
Summary: 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.


Related Articles

  • The impact of subchronic cadmium poisoning on the vascular effect of nitric oxide in rats. Skoczynska, A.; Martynowicz, H. // Human & Experimental Toxicology;Jul2005, Vol. 24 Issue 7, p353 

    The aim of this study was to evaluate the impact of poisoning with cadmium in hypertensive doses (50 or 200 ppm in drinking water for three months) on the basal and stimulated release NO effect in the isolated and perfused rat mesenteric bed. Mesenteric artery preparation preconstricted by...

  • ANDROGEN DEPRIVATION THERAPY. Raj, Ganesh V.; Eastham, James // Contemporary Urology;Dec2005, Vol. 17 Issue 12, p8 

    This article presents information on how to prevent and treat the complications of androgen deprivation therapy (ADT). Many patients undergoing ADT experience hot flashes. It is typically described as a perception of intense warmth and cooling by cutaneous vasodilation. ADT is also associated...

  • Rosacea: Cause, Triggers and Treatment. Goldstein, Mindy S. // Cosmetics & Toiletries;Sep2008, Vol. 123 Issue 9, p44 

    The article offers information on rosacea. It is a skin condition described by broken blood vessels on the face, flushing and blushing of facial skin and by acne-like bumps on cheeks, chin and nose. It is stated that heat exercise, consumption of wine and sunlight are the stimuli that cause very...

  • Suppression of Niacin-induced Vasodilation with an Antagonist to Prostaglandin D2 Receptor Subtype 1. Lai, E.; De Lepeleire, I.; Crumley, T. M.; Liu, F.; Wenning, L. A.; Michiels, N.; Vets, E.; O'Neill, G.; Wagner, J. A.; Gottesdiener, K. // Clinical Pharmacology & Therapeutics;Jun2007, Vol. 81 Issue 6, p849 

    Niacin (nicotinic acid) reduces cardiovascular events in patients with dyslipidemia. However, symptoms associated with niacin-induced vasodilation (e.g., flushing) have limited its use. Laropiprant is a selective antagonist of the prostaglandin D2 receptor subtype 1 (DP1), which may mediate...

  • A COMPLEX SITUATION IN CARDIAC SURGERY: VASOPLEGIC SYNDROME. G�lmen, Senol; Okutan, H�seyin; Kuralay, Erkan // Anatolian Journal of Clinical Investigation;2011, Vol. 5 Issue 1, p65 

    Vasodilatory Shock or Vasoplegic Syndrome following heart surgery using cardiopulmonary bypass has been recently recognized and implicated in life-threatening complications of the peripheral circulation. The underlying mechanism of vasoplegic syndrome that characterized by profound...

  • Perspectives for core and skin surface temperature guided extubation in patients after normothermic cardiopulmonary bypass. Pezawas, Thomas; Rajek, Angela; Skolka, Michael; Schneider, Barbara; Plöchl, Walter; Plöchl, Walter // Intensive Care Medicine;Aug2004, Vol. 30 Issue 8, p1676 

    Objective: To investigate the relationship between changes in core and skin surface temperature and extubation time in patients following normothermic cardiopulmonary bypass (CPB).Design: Prospective observational study.Setting: Intensive care unit (ICU) of...

  • Treatment of Complications of Peripheral Obstructive Arterial Disease with Prostaglandin E. Killion, Dennis D.; Ambrus, Julian L. // Angiology;Jul1987, Vol. 38 Issue 7, p507 

    Forty-one subjects diagnosed with complications of peripheral obstructive arterial disease were treated with continuous infusions of Prostaglandin E, (PGE1) over a three-week period during 1981–1982 in an open-label, uncontrolled study under ward conditions. Ischemic rest pain and ulcers...

  • Local Heparin, Superficial Vein Thrombosis. Cesarone, Maria Rosaria; Belcaro, Gianni; Corsi, M.; Ippolito, Edmondo; Errichi, Silvia; Di Renzo, Andrea; Ledda, Andrea; Fano, Filiberto; Cacchio, Marisa; Adovasio, Roberto // Angiology;Apr/May2007 Supplement, Vol. 58, p36S 

    Local, topical effects of heparins on the skin still need deeper investigations. The lack of evidence is mainly due to the lack of large investments in this field. Three main local actions of heparin on the skin can be defined: (1) the anticoagulant action, (2) the microcirculatory-modulatory...

  • TREATMENT OF COLD FEET AND LEGS AFTER POLIOMYELITIS. Stenport, Kurt // Angiology;Oct1951, Vol. 2 Issue 5, p345 

    Cold blue feet and legs are often the consequence of poliomyelitis. This is due to poor blood circulation. To improve this, a series of treatments was begun with a substance for dilating the blood vessels (vasodil) with evident effect on a few hundred acute poliomyelitis cases. The pain in the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics