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

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Taylor, K. Search for Related Content PubMed Articles by Taylor, K. Related Collections Anesthesia Cardiac - pharmacology Cardiac - other Valve disease Related Article

J Thorac Cardiovasc Surg 2006;131:251
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

former Fellow in Paediatric Anaesthesia, The Hospital for Sick Children, Department of Anaesthesia, 555 University Avenue, Toronto, Ontario M5G1X8, Canada

We thank Drs Evora and Rodrigues for their interest in our case report and their comments. The clinical improvement as described in the series by Leyh and associates ¹ and the case reports by Grayling, ² Sparicio, ³ and their colleagues, was not evident in our case. Those authors described dramatic improvements in mean arterial pressure with commencement of methylene blue (MB); our patient experienced no such benefit. Norepinephrine, epinephrine, and vasopressin requirements persisted for at least the first 24 hours after the operation in our case. Her treating intensivists believe that her postoperative course was not significantly shortened by the use of MB. The dose used (2 mg/kg at induction of anaesthesia, 2 mg/kg on initiation of CPB, and an infusion of 1 mg/kg per hour for a total of 4 hours) was based on the description by Grayling and Deakin, ² which is longer than that used by others. ^1,3

Nitric oxide vasodilation is implicated in both sepsis and the refractory vasoplegia associated with cardiopulmonary bypass (CPB). The different outcomes in the studies of MB in the septic group and our patient may be due to the different pathology and underlying heterogeneity of septic patients. ⁴ A case report of dramatic improvement after MB in a patient with infective endocarditis refutes this. ² Evora and Rodrigues describe the "random" efficacy of MB when used as a "last minute vasopressor." The evidence for use of MB as anything other than the "last minute vasopressor" in such situations does not exist for children. We, therefore, reiterate the need for clinical trials to answer this question.

	References

Top References

 

1. Leyh RG, Kofidis T, Struber M, Fischer S, Knobloch K, Wachsmann B, et al. Methylene blue. the drug of choice for catecholamine-refractory vasoplegia after cardiopulmonary bypass?. [see comment] J Thorac Cardiovasc Surg 2003;125:1426-1431.[Abstract/Free Full Text]
   
2. Grayling M, Deakin C. Methylene blue during cardiopulmonary bypass to treat refractory hypotension in septic endocarditis. J Thorac Cardiovasc Surg 2003;125:426-427.[Free Full Text]
   
3. Sparicio D, Landoni G, Pappalardo F, Crivellari M, Cerchierini E, Marino G, et al. Methylene blue for lithium induced refractory hypotension in off-pump coronary artery bypass graft. report of two cases. J Thorac Cardiovasc Surg 2004;127:592-593.[Free Full Text]
   
4. Faber P, Ronald A, Millar BW. Methylthioninium chloride. pharmacology and clinical applications with special emphasis on nitric oxide mediated vasodilatory shock during cardiopulmonary bypass. Anaesthesia 2005;60:575-587.[Medline]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Taylor, K. Search for Related Content PubMed Articles by Taylor, K. Related Collections Anesthesia Cardiac - pharmacology Cardiac - other Valve disease Related Article