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Ann Thorac Surg 2005;79:1615-1619
© 2005 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

Preoperative Methylene Blue Administration in Patients at High Risk for Vasoplegic Syndrome During Cardiac Surgery

Erturul Özal, MD^a, Erkan Kuralay, MD^a,_*, Vedat Yildirim, MD^b, Selim Kilic, MD^c, Cengiz Bolcal, MD^a, Nezihi Kücükarslan, MD^a, Celalettin Günay, MD^a, Ufuk Demirkilic, MD^a, Harun Tatar, MD^a

^a Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey
^b Department of Anesthesiology, Gülhane Military Medical Academy, Ankara, Turkey
^c Department of Public Health and Epidemiology, Gülhane Military Medical Academy, Gülhane Military Medical Academy, Ankara, Turkey

Accepted for publication October 20, 2004.

^_* Address reprint requests to Dr Kuralay, Yazanlar Sokak No. 31/11, Asagi Ayranci, Ankara, 06540 Turkey (E-mail: ekural{at}gata.edu.tr).

BACKGROUND: Angiotensin-converting enzyme inhibitors, calcium channel blockers, and preoperative intravenous heparin use are independent risk factors for vasoplegic syndrome after cardiac surgery. We prospectively studied whether preoperative methylene blue administration would prevent the vasoplegic syndrome in these high-risk patients.

METHODS: One hundred patients scheduled for coronary artery bypass graft surgery who were at high risk for vasoplegia because they were preoperatively using angiotensin-converting enzyme inhibitors, calcium channel blockers, and heparin were randomly assigned to either receive preoperative methylene blue (group 1, n = 50) or not receive it (group 2, controls, n = 50). Methylene blue (1% solution) was administered intravenously at a dose of 2 mg/kg for more than 30 minutes, beginning in the intensive care unit 1 hour before surgery.

RESULTS: Although similar in terms of all demographic and operative variables, the two groups differed significantly in terms of vasoplegic syndrome incidence (0% in group 1[0 of 50] vs 26% in group 2 [13 of 50]; p < 0.001). In 6 patients, the vasoplegic syndrome was refractory to norepinephrine. Four of these patients survived; the other 2 had vasoplegic syndromes that were refractory to aggressive vasopressor therapy, and they ultimately died of multiorgan failure. Stroke occurred in 1 patient. The two study groups also differed significantly in terms of average intensive care unit stay (1.2 ± 0.5 days in group 1 vs 2.1 ± 1.2 days in group 2; p < 0.001) and average hospital stay (6.1 ± 1.7 days in group 1 vs 8.4 ± 2.0 days in group 2; p < 0.001).

CONCLUSIONS: Our results suggest that preoperative methylene blue administration reduces the incidence and severity of vasoplegic syndrome in high-risk patients, thus ensuring adequate systemic vascular resistance in both operative and postoperative periods and shortening both intensive care unit and hospital stays.

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