Methylene blue: potential use of an antique molecule in vasoplegic syndrome during cardiac surgery

Expert Rev Cardiovasc Ther. 2011 Dec;9(12):1519-25. doi: 10.1586/erc.11.160.

Abstract

Vasoplegic syndrome is a common complication of cardiopulmonary bypass, appearing with an incidence ranging between 5 and 25%. It is characterized by significant hypotension, high or normal cardiac output and low systemic vascular resistance. This syndrome is hypothesized to be caused by the inflammation-mediated dysregulation of endothelial homeostasis and subsequent endothelial dysfunction. In vasoplegic syndrome, the inhibition of the nitric oxide/cyclic guanosine monophosphate pathway with concomitant administration with traditional ionotropes may represent a promising therapeutic option. Methylene blue, an inhibitor of nitric oxide synthase and guanylate cyclase, may contribute to the improvement of refractory hypotension associated with endothelial dysfunction in vasoplegia. In this article, we will update evidence on the potential therapeutic use of methylene blue in vasoplegic syndrome.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cardiac Surgical Procedures
  • Cardiopulmonary Bypass / adverse effects*
  • Cardiotonic Agents / administration & dosage
  • Cardiotonic Agents / adverse effects
  • Cardiotonic Agents / therapeutic use
  • Drug Therapy, Combination / adverse effects
  • Enzyme Inhibitors / administration & dosage
  • Enzyme Inhibitors / adverse effects
  • Enzyme Inhibitors / therapeutic use
  • Guanylate Cyclase / antagonists & inhibitors*
  • Humans
  • Intraoperative Complications / drug therapy*
  • Intraoperative Complications / etiology
  • Intraoperative Complications / prevention & control
  • Methylene Blue / administration & dosage
  • Methylene Blue / adverse effects
  • Methylene Blue / therapeutic use*
  • Nitric Oxide Synthase / antagonists & inhibitors*
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Salvage Therapy
  • Vasoplegia / drug therapy*
  • Vasoplegia / etiology
  • Vasoplegia / prevention & control

Substances

  • Cardiotonic Agents
  • Enzyme Inhibitors
  • Nitric Oxide Synthase
  • Guanylate Cyclase
  • Methylene Blue