This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andrew Ronald Alfredo J. Rodrigues Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Leite, E. G. Articles by Evora, P. R. B. Search for Related Content PubMed PubMed Citation Articles by Leite, E. G. Articles by Evora, P. R. B. Related Collections Anesthesia Cardiac - pharmacology Extracorporeal circulation

Is methylene blue of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome during cardiac surgery?

^a Cardiovascular and Endothelium Function Laboratory from the Surgical Research Division, Ribeirão Preto Faculty of Medicine – University of São Paulo, Ribeirão Preto, São Paulo, Brazil
^b Department of Cardiac Anaesthesia, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK

*Corresponding author. Rua Rui Barbosa, 367, Apt. 15, 14015 120 - Ribeirao Preto, SP, Brazil. Tel./fax: +55-16-3602-2497.

E-mail address: prbevora{at}netsite.com.br (P.R.B. Evora).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether methylene blue (MB) is of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome (VPS) during cardiac surgery. Altogether 47 papers were found in Medline and 107 in Embase using the reported search. A further five papers were found by hand-searching reference lists. Four papers represented the best evidence on the subject and details of authors, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. In addition, a further 14 papers are referenced to aid the discussion. We conclude that MB may provide an interesting and novel therapeutic option for adult patients who develop catecholamine-resistant VPS during cardiac surgery. Whilst there is currently insufficient evidence to advocate its use as first-line therapy it should be considered as a possible ‘rescue therapy’ in catecholamine-resistant VPS and some work has suggested that it may have a prophylactic role in preventing VPS. However, further large well-controlled studies are required before its routine use can be recommended.

Key Words: Methylene blue; Vasoplegic syndrome; Cardiopulmonary bypass; cGMP; Guanylate cyclase