| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;77:496-499
© 2004 The Society of Thoracic Surgeons
a Division of Cardiovascular Surgery, Navy Hospital, French Hospital, Swiss-Argentine Clinic, Argentine Institute of Diagnosis and Saint Elizabeth Clinic, Buenos Aires, Argentina
Accepted for publication August 1, 2003.
* Address reprint requests to Dr Levin, Postoperatory Cardiovascular Critical Care Navy Hospital, Migueletes 1203 2do 16, Buenos Aires 1426 Argentina
e-mail: rllevin{at}intramed.net.ar
BACKGROUND: 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.
This article has been cited by other articles:
|
|
 |
|
  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. J. C. Mittnacht, G. W. Fischer, and D. L. Reich Methylene Blue Administration Is Associated with Decreased Cerebral Oximetry Values Anesth. Analg., August 1, 2007; 105(2): 549 - 550. [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. S. H. Kwok and D. Howes Use of Methylene Blue in Sepsis: A Systematic Review J Intensive Care Med, December 1, 2006; 21(6): 359 - 363. [Abstract] [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? Interactive CardioVascular and Thoracic Surgery, 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]
|
|
|
|
 |
|
 M. Westerberg, J. Gabel, A. Bengtsson, J. Sellgren, O. Eidem, and A. Jeppsson Hemodynamic effects of cardiotomy suction blood J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1352 - 1357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. R. B. Evora and A. J. Rodrigues Methylene blue revised J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 250 - 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
S. I. Sersar, M. F. Ismaeil, Y. F. Elghoneimi, and M. A. F. Elgamal Vasomotor dysfunction after cardiac surgery; another look Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 529 - 529. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
