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3235451 
Journal Article 
Vasoplegic syndrome - the rote of methylene blue 
Shanmugam, G 
2005 
Yes 
European Journal of Cardio-thoracic Surgery
ISSN: 1010-7940 
28 
5 
705-710 
WOS:000233377600006 
Vasoplegic syndrome is a recognized complication following
cardiac surgery using cardiopulmonary bypass and is associated with increased morbidity and
mortality. In several patients profound post-operative vasodilatation does not respond to
conventional vasoconstrictor therapy. Methylene blue has been advocated as an adjunct to
conventional vasoconstrictors; in such situations. There is limited data pertaining to the use of
methylene blue and a number of reports have been anecdotal observations. This article reviews the
incidence and problems associated with the vasoplegic syndrome, the mechanism of action of
methylene blue, its effects and adverse reactions and the literature supporting its
intraoperative and post-operative use. In cases where first-line therapy fails, the use of
methylene blue seems to be a potent approach to refractory vasoplegia. The early use of methylene
blue may halt the progression of tow systemic vascular resistance even in patients responsive to
norepinephrine and mitigate the need for prolonged vasoconstrictor use. However, dosing regimens
and protocols need to be clearly defined before widespread routine use. Whether methylene blue
should be the first line of therapy in patients with vasoplegia is a matter of debate, and there
is inadequate evidence to support its use as a first tine drug. More scientific evidence is
needed to define the role of MB in the treatment of catecholamine refractory vasoplegia. (c) 2005
Elsevier B.V. All rights reserved. 
vasoplegic syndrome; cardiopulmonary bypass; methytene blue