UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstracts for References 84-86

of 'Anaphylaxis: Emergency treatment'

84
TI
The level of evidence 5 blues: investigating medicine when experience trumps equipoise.
AU
Puttgen HA, Mirski MA
SO
Crit Care Med. 2013 Jan;41(1):359-61.
 
AD
PMID
85
TI
Methylene Blue: Magic Bullet for Vasoplegia?
AU
Hosseinian L, Weiner M, Levin MA, Fischer GW
SO
Anesth Analg. 2016 Jan;122(1):194-201.
 
Methylene blue (MB) has received much attention in the perioperative and critical care literature because of its ability to antagonize the profound vasodilation seen in distributive (also referred to as vasodilatory or vasoplegic) shock states. This review will discuss the pharmacologic properties of MB and review the critical care, liver transplantation, and cardiac anesthesia literature with respect to the efficacy and safety of MB for the treatment of shock. Although improved blood pressure has consistently been demonstrated with the use of MB in small trials and case reports, better oxygen delivery or decreased mortality with MB use has not been demonstrated. Large randomized controlled trials are still necessary to identify the role of MB in hemodynamic resuscitation of the critically ill.
AD
From the *Department of Anesthesiology, and†Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
PMID
86
TI
Methylene blue for the treatment of refractory anaphylaxis without hypotension.
AU
Bauer CS, Vadas P, Kelly KJ
SO
Am J Emerg Med. 2013 Jan;31(1):264.e3-5. Epub 2012 May 23.
 
Anaphylaxis is a life-threatening reaction treated primarily with epinephrine. Methylene blue, a competitive inhibitor of guanylate cyclase, interferes with the vasodilatory actions of nitric oxide. It has recently been proposed by the Joint Taskforce on Practice Parameters as an alternative treatment for anaphylaxis with hypotension that is not responsive to classical therapy. Little evidence supports its use in normotensive patients with refractory anaphylaxis. We present the case of a 43-year-old woman with severe anaphylaxis unresponsive to epinephrine. Physical examination revealed marked respiratory distress, raised oral lesions, and altered mental status but lacked hypotension. After infusion of methylene blue, symptom resolution occurred almost immediately, and intubation was spared. Side effects were minimal. We propose methylene blue as a safe treatment option for refractory anaphylaxis, whether with or without hypotension.
AD
Department of Pediatrics, Division of Allergy and Clinical Immunology, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. csbauer@mcw.edu
PMID