Utilización de azul de metileno en el tratamiento del síndrome vasopléjico del postoperatorio de cirugía cardíaca
J.M. Mora-Ordóñez; F. Sánchez-Llorente;
J.L. Galeas-López; B. Hernandez Sierra;
Unidad de Cuidados Intensivos. Hospital Regional Universitario Carlos Haya. Málaga. España
La vasoplejía es una complicación frecuente
en el postoperatorio de cirugía cardíaca y determina un importante aumento
en la morbi-mortalidad.
Plasma nitric oxide (NO) levels have been found to be high in haemodialysis (HD) patients, especially in those prone to hypotension in dialysis. The aim of the study was to prevent dialysis hypotension episodes by i.v. administration of methylene blue (MB), an inhibitor of NO activity and/or production.
methylene blue (MB),was given i.v. in 18 stable HD patients with hypotensive episodes during almost every dialysis, in 18 HD patients without hypotension during dialyses, and in five healthy controls. MB was given as a bolus of 1 mg/kg bodyweight followed by a constant infusion of 0.1 mg/kg bodyweight lasting 210 min until the end of the dialysis session and only as a bolus on a non-dialysis day. Systolic and diastolic blood pressures (BP) were measured at 10-min intervals during HD sessions with or without MB and on a non-dialysis day with MB.
Conclusions. MB is an efficient therapy in the prevention of dialysis hypotension.
Levin RL. Degrange MA. Bruno GF. Del Mazo CD. Taborda DJ.
Griotti JJ. Boullon FJ. Methylene
mortality and morbidity
in vasoplegic patients
Trial. Journal Article. Multicenter Study. Randomized Controlled Trial]
Annals of Thoracic Surgery.
77(2):496-9, 2004 Feb.
The discovery of nitric oxide as mediator in cardiac postoperative vasoplegia encourages the use of inhibitory drugs such as methylene blue. This drug has been used with favorable results in isolated cases. The purpose of this article is to analyze the incidence of the postoperative vasoplegic syndrome, to consider its prognosis, and to evaluate the effect of intravenous methylene blue on mortality. METHODS: Cardiac surgery patients were consecutively included. Vasoplegic syndrome was defined by the presence of the following five criteria: (1) hypotension, (2) low filling pressures, (3) high or normal cardiac index, (4) low peripheral resistance, and (5) vasopressor requirements. Those with vasoplegia were randomized to receive 1.5 mg/Kg of methylene blue or a placebo. A p value less than 0.05 was considered significant. RESULTS: Six hundred thirty eight cardiac surgery patients were consecutively included in this study. Fifty-six of these patients fulfilled vasoplegia criteria (8.8%) resulting in higher mortality (10.7% or 6 of 56 patients vs 3.6% or 21 of 582 patients; p value = 0.02). Those treated with methylene blue showed morbidity and mortality reductions (0% versus 21.4% or 6 of 28 patients; p value = 0.01). The duration of the vasoplegic syndrome was shorter in those patients treated with the drug, lasting less than 6 hours in all patients. Patients in the control group showed a slower recovery, lasting more than 48 hours in 8 patients (p value = 0.0007). CONCLUSIONS: Vasoplegic postoperative syndrome was seen in 8.8% of all patients. Outcome in patients with vasoplegia was worse with increased morbidity and mortality. The use of methylene blue reduced the high mortality in this population.
2006; 21; 359 J Intensive Care Med
Edmund S. H. Kwok and Daniel Howes
The EMBASE (1980-2005 week 27) was searched using the keywords methylene blue and septic shock or sepsis or septicemia. The Cochrane Central Register of Controlled Trials (3rd quarter 2005) was searched using the keywords methylene blue and septic shock or sepsis or septicemia. References from the included articles were searched for relevant citations.
Two studies were randomized, controlled trials, one involving 20 patients and the other 30 patients (Table 1). In the study by Kirov et al , 20 patients with septic shock were randomized 1:1 to receive either isotonic saline or MB as an intravenous bolus injection (2 mg/kg), followed 2 hours later by an infusion at increasing rates of 0.25, 0.5, 1, and 2 mg/kg/h, each maintained for 1 hour.
Memis and colleagues’  prospective, randomized, controlled trial had a slightly larger patient population. Thirty patients with sepsis were randomized 1:1 to receive isotonic saline or an infusion of MB (0.5 mg/kg/h) for 6 hours.
Conclusions The use of MB in patients with septic shock results in increased systemic vascular resistance and mean arterial pressure, but its effect on oxygen delivery and mortality is unknown. Further randomized, controlled trials are needed to better define the role of this drug in septic shock
Methylene Blue Administration Is Associated with Decreased Cerebral Oximetry Values
[Letters to the Editor]
Mittnacht, Alexander J. C. MD; Fischer, Gregory W. MD; Reich, David L. MD
Section Editor(s): Saidman, Lawrence
Department of Anesthesiology; Mount Sinai Medical Center; New York, New York; firstname.lastname@example.org
As described in a recent publication, we administered methylene blue as an IV loading dose (2 mg/kg over 20 min), followed by continuous infusion (0.5 mg · kg-1 · h-1) when the attending cardiac anesthesiologist determined that a refractory case of vasoplegia is present (1). Concomitant with the initiation of the methylene blue loading dose, we noted that cerebral oximetry values (INVOS®, Somanetics, Troy, MI) declined markedly in all patients despite significant improvement in systemic perfusion pressure. The image below illustrates this phenomenon in two patients by replicating the INVOS monitor display.
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