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J Thorac Cardiovasc Surg 2004;127:592-593
© 2004 The American Association for Thoracic Surgery

Brief communication

Methylene blue for lithium-induced refractory hypotension in off-pump coronary artery bypass graft: report of two cases

Donatella Sparicio, MDa,*, Giovanni Landoni, MDa, Federico Pappalardo, MDa, Martina Crivellari, MDa, Elisa Cerchierini, MDa, Giovanni Marino, MDa, Alberto Zangrillo, MDa

a Department of Cardiovascular Anesthesia, Vita-Salute University of Milan, IRCCS San Raffaele Hospital, Milan, Italy

Received for publication June 16, 2003; accepted for publication September 12, 2003.

* Address for reprints: Donatella Sparicio, MD, Via Olgettina 60, 20132 Milano, Italy
Sparicio.donatella@hsr.it

The first 20% of the full text of this article appears below.

Off-pump surgery is gaining popularity for coronary artery bypass grafting (CABG). We report the perioperative management of 2 patients who self-assumed lithium and had refractory hypotension during beating heart surgery. Both patients had a dramatic hemodynamic improvement after receiving methylene blue.

Clinical summary

Two men (57 and 68 years, each weighing 72 kg, height 180 and 186 cm) with coronary artery disease and ejection fraction greater than 50% were scheduled for elective off-pump CABG. Medical history included depression on treatment with benzodiazepines and lithium carbonate (300 mg every 8 hours). They were both on treatment with beta-blockers (atenolol and carvedilol), calcium antagonist (amlodipine), nitrates, and aspirin; patient A also used an angiotensin-converting enzyme inhibitor. Both patients had an unnoticed . . . [Full Text of this Article]




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