Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery.
10.4097/kjae.2012.63.2.142
- Author:
Jin Sun CHO
1
;
Jong Wook SONG
;
Sungwon NA
;
Joo Hwa MOON
;
Young Lan KWAK
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ylkwak@yuhs.ac
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Cardiopulmonary bypass;
Infective endocarditis;
Methylene blue;
Vasoplegia
- MeSH:
Adult;
Blood Platelets;
Cardiopulmonary Bypass;
Endocarditis;
Erythrocytes;
Hemodynamics;
Humans;
Hypotension;
Methylene Blue;
Nitric Oxide;
Norepinephrine;
Plasma;
Thoracic Surgery;
Vasoplegia;
Vasopressins;
Weaning
- From:Korean Journal of Anesthesiology
2012;63(2):142-148
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The accentuated nitric oxide (NO) release that is induced by the systemic inflammatory response associated with infective endocarditis (IE) and cardiopulmonary bypass (CPB) may result in catecholamine refractory hypotension (vasoplegia) and increased transfusion requirement due to platelet inhibition. Methylene blue (MB) is an inhibitory drug of inducible NO. We aimed to evaluate the effect of prophylactic MB administration before CPB on vasopressor and transfusion requirements in patients with IE undergoing valvular heart surgery (VHS). METHODS: Forty-two adult patients were randomly assigned to receive 2 mg/kg of MB (MB group, n = 21) or saline (control group, n = 21) for 20 min before the initiation of CPB. The primary end points were comparisons of vasopressor requirements serially assessed after weaning from CPB and hemodynamic parameters serially recorded before and after CPB. The secondary endpoint was the comparison of transfusion requirements. RESULTS: Two patients in the control group received MB after weaning from CPB due to norepinephrine and vasopressin refractory vasoplegia and were thus excluded. There were no significant differences in vasopressor requirements and hemodynamic parameters between the two groups. The mean number of units of packed erythrocytes transfused per transfused patient was significantly less in the MB group. The numbers of patients transfused with fresh frozen plasma and platelet concentrates were less in the MB group. CONCLUSIONS: In IE patients undergoing VHS, prophylactic MB administration before CPB did not confer significant benefits in terms of vasopressor requirements and hemodynamic parameters, but it was associated with a significant reduction in transfusion requirement.
