HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Rainer G. Leyh Christian Hagl Axel Haverich Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Leyh, R. G. Articles by Haverich, A. Search for Related Content PubMed PubMed Citation Articles by Leyh, R. G. Articles by Haverich, A. Related Collections Cardiac - pharmacology Extracorporeal circulation

J Thorac Cardiovasc Surg 2003;125:1426-1431
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Methylene blue: The drug of choice for catecholamine-refractory vasoplegia after cardiopulmonary bypass?

From the Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

Received for publication Feb 1, 2002. Revisions requested June 13, 2002; revisions received Aug 1, 2002. Accepted for publication Aug 15, 2002. Address for reprints: Rainer G. Leyh, MD, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg St 1, 30623, Hannover, Germany (E-mail: leyh{at}thg.mh-hannover.de).

Objectives: Vasoplegia is a frequent complication after cardiopulmonary bypass that often requires the application of norepinephrine. In a number of cases, however, vasoplegia is refractory to norepinephrine. The guanylate cyclase inhibitor methylene blue could be an attractive treatment alternative in such cases. This study examines the results of methylene blue therapy for norepinephrine-refractory vasoplegia after cardiopulmonary bypass.
Methods: A total of 54 patients with norepinephrine-refractory vasoplegia after cardiopulmonary bypass were treated with methylene blue (2 mg/kg) administered intravenously through a period of 20 minutes. The effects on hemodynamics, norepinephrine dosage, and clinical outcome were evaluated.
Results: Three patients (5.6%) died during the hospital stay. A clinically relevant increase in systemic vascular resistance and a decrease in norepinephrine dosage were observed in 51 patients within 1 hour after methylene blue infusion. Four patients (7.4%) had no response to methylene blue. No adverse effects related to methylene blue were observed.
Conclusions: A single dose of methylene blue seems to be a potent approach to norepinephrine-refractory vasoplegia after cardiopulmonary bypass for most patients, with no obvious side effects. Guanylate cyclase inhibitors could be a novel class of agents for the treatment of norepinephrine-refractory vasoplegia after cardiopulmonary bypass. A controlled clinical trial is now needed to evaluate the role of methylene blue in this situation.

This article has been cited by other articles:

				K. A. Kortekaas, J. H. N. Lindeman, M. E. J. Reinders, M. Palmen, R. J. M. Klautz, P. G. de Groot, and M. Roest Pre-existing endothelial cell activation predicts vasoplegia after mitral valve surgery Interact CardioVasc Thorac Surg, June 4, 2013; (2013) ivt243v1. [Abstract] [Full Text] [PDF]

				J. Hajj-Chahine, C. Jayle, and P. Corbi Methylene blue in patients with severe pulmonary hypertension J. Thorac. Cardiovasc. Surg., March 1, 2013; 145(3): 898 - 898. [Full Text] [PDF]

				K. J. Grubb, J. L. W. Kennedy, J. D. Bergin, D. S. Groves, and J. A. Kern The role of methylene blue in serotonin syndrome following cardiac transplantation: A case report and review of the literature J. Thorac. Cardiovasc. Surg., November 1, 2012; 144(5): e113 - e116. [Full Text] [PDF]

				T. Bhalla, A. Sawardekar, H. Russell, and J. D. Tobias The Role of Methylene Blue in the Pediatric Patient With Vasoplegic Syndrome World Journal for Pediatric and Congenital Heart Surgery, October 1, 2011; 2(4): 652 - 655. [Abstract] [Full Text] [PDF]

				M. A. Levin, H.-M. Lin, J. G. Castillo, D. H. Adams, D. L. Reich, and G. W. Fischer Early On-Cardiopulmonary Bypass Hypotension and Other Factors Associated With Vasoplegic Syndrome Circulation, October 27, 2009; 120(17): 1664 - 1671. [Abstract] [Full Text] [PDF]

				X. Sun, L. Zhang, P. C. Hill, R. Lowery, A. T. Lee, R. E. Molyneaux, P. J. Corso, and S. W. Boyce Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery? Eur J Cardiothorac Surg, October 1, 2008; 34(4): 820 - 825. [Abstract] [Full Text] [PDF]

				A. D. Maslow, C. S. Schwartz, G. Stearns, P. Batula, J. Gough, and A. K. Singh Methylene Blue for CPB Anesth. Analg., May 1, 2007; 104(5): 1296 - 1297. [Full Text] [PDF]

				M. Egi, R. Bellomo, C. Langenberg, M. Haase, A. Haase, L. Doolan, G. Matalanis, S. Seevenayagam, and B. Buxton Selecting a Vasopressor Drug for Vasoplegic Shock After Adult Cardiac Surgery: A Systematic Literature Review Ann. Thorac. Surg., February 1, 2007; 83(2): 715 - 723. [Abstract] [Full Text] [PDF]

				E. G. Leite, A. Ronald, A. J. Rodrigues, and P. R. B. Evora Is methylene blue of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome during cardiac surgery? Interact CardioVasc Thorac Surg, December 1, 2006; 5(6): 774 - 778. [Abstract] [Full Text] [PDF]

				A. D. Maslow, G. Stearns, P. Batula, C. S. Schwartz, J. Gough, and A. K. Singh The Hemodynamic Effects of Methylene Blue When Administered at the Onset of Cardiopulmonary Bypass Anesth. Analg., July 1, 2006; 103(1): 2 - 8. [Abstract] [Full Text] [PDF]

				K. Taylor Reply to the Editor J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 251 - 251. [Full Text] [PDF]

				G. Shanmugam Vasoplegic syndrome--the role of methylene blue Eur J Cardiothorac Surg, November 1, 2005; 28(5): 705 - 710. [Abstract] [Full Text] [PDF]

				S. Hamanaka, K. Tanemoto, E. Inagaki, T. Yamasawa, K. Yoshida, S. Mochizuki, M. Goto, T. Miyasaka, F. Kajiya, and N. Tanaka Direct Measurement of Nitric Oxide during Experimental Cardiopulmonary Bypass Journal of International Medical Research, May 1, 2005; 33(3): 295 - 300. [Abstract] [PDF]

				E. Ozal, E. Kuralay, V. Yildirim, S. Kilic, C. Bolcal, N. Kucukarslan, C. Gunay, U. Demirkilic, and H. Tatar Preoperative Methylene Blue Administration in Patients at High Risk for Vasoplegic Syndrome During Cardiac Surgery Ann. Thorac. Surg., May 1, 2005; 79(5): 1615 - 1619. [Abstract] [Full Text] [PDF]

				M. Ruel, T. A. Khan, P. Voisine, C. Bianchi, and F. W. Sellke Vasomotor dysfunction after cardiac surgery Eur J Cardiothorac Surg, November 1, 2004; 26(5): 1002 - 1014. [Abstract] [Full Text] [PDF]

				P. R. B. Evora and R. L. Levin Methylene blue as drug of choice for catecholamine-refractory vasoplegia after cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 895 - 896. [Full Text] [PDF]