Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties
OBJECTIVE: There is strong evidence that methylene blue (MB), an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS) treatment in heart surgery. The aim of this article is to review the MB's therapeutic function in the vasoplegic syndrome treatment. METHODS: Fifteen years of literature review. RESULTS: 1) Heparin and ACE inhibitors are risk factors; 2) In the recommended doses it is safe (the lethal dose is 40 mg/kg); 3) The use of MB does not cause endothelial dysfunction; 4) The MB effect appears in cases of nitric oxide (NO) up-regulation; 5) MB is not a vasoconstrictor, by blocking of the GMPc system it releases the AMPc system, facilitating the norepinephrine vasoconstrictor effect; 6) The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasmatic concentrations strongly decays in the first 40 minutes; 7) There is a possible "window of opportunity" for the MB's effectiveness. CONCLUSIONS: Although there are no definitive multicentric studies, the MB used to treat heart surgery VS, at the present time, is the best, safest and cheapest option, being a Brazilian contribution for the heart surgery
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Sociedade Brasileira de Cirurgia Cardiovascular
2009
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oai:scielo:S0102-763820090004000052009-12-08Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certaintiesEvora,Paulo Roberto BarbosaRibeiro,Paulo José de FreitasVicente,Walter Vilella de AndradeReis,Celso Luís dosRodrigues,Alfredo JoséMenardi,Antonio CarlosAlves Junior,LafaieteEvora,Patrícia MartinezBassetto,Solange Methylene blue Cardiovascular surgical procedures Extracorporeal circulation Vascular diseases Vascular resistance/drug effects Postoperative complications OBJECTIVE: There is strong evidence that methylene blue (MB), an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS) treatment in heart surgery. The aim of this article is to review the MB's therapeutic function in the vasoplegic syndrome treatment. METHODS: Fifteen years of literature review. RESULTS: 1) Heparin and ACE inhibitors are risk factors; 2) In the recommended doses it is safe (the lethal dose is 40 mg/kg); 3) The use of MB does not cause endothelial dysfunction; 4) The MB effect appears in cases of nitric oxide (NO) up-regulation; 5) MB is not a vasoconstrictor, by blocking of the GMPc system it releases the AMPc system, facilitating the norepinephrine vasoconstrictor effect; 6) The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasmatic concentrations strongly decays in the first 40 minutes; 7) There is a possible "window of opportunity" for the MB's effectiveness. CONCLUSIONS: Although there are no definitive multicentric studies, the MB used to treat heart surgery VS, at the present time, is the best, safest and cheapest option, being a Brazilian contribution for the heart surgeryinfo:eu-repo/semantics/openAccessSociedade Brasileira de Cirurgia CardiovascularBrazilian Journal of Cardiovascular Surgery v.24 n.3 20092009-09-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382009000400005en10.1590/S0102-76382009000400005 |
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Evora,Paulo Roberto Barbosa Ribeiro,Paulo José de Freitas Vicente,Walter Vilella de Andrade Reis,Celso Luís dos Rodrigues,Alfredo José Menardi,Antonio Carlos Alves Junior,Lafaiete Evora,Patrícia Martinez Bassetto,Solange |
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Evora,Paulo Roberto Barbosa Ribeiro,Paulo José de Freitas Vicente,Walter Vilella de Andrade Reis,Celso Luís dos Rodrigues,Alfredo José Menardi,Antonio Carlos Alves Junior,Lafaiete Evora,Patrícia Martinez Bassetto,Solange Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties |
author_facet |
Evora,Paulo Roberto Barbosa Ribeiro,Paulo José de Freitas Vicente,Walter Vilella de Andrade Reis,Celso Luís dos Rodrigues,Alfredo José Menardi,Antonio Carlos Alves Junior,Lafaiete Evora,Patrícia Martinez Bassetto,Solange |
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Evora,Paulo Roberto Barbosa |
title |
Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties |
title_short |
Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties |
title_full |
Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties |
title_fullStr |
Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties |
title_full_unstemmed |
Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties |
title_sort |
methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties |
description |
OBJECTIVE: There is strong evidence that methylene blue (MB), an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS) treatment in heart surgery. The aim of this article is to review the MB's therapeutic function in the vasoplegic syndrome treatment. METHODS: Fifteen years of literature review. RESULTS: 1) Heparin and ACE inhibitors are risk factors; 2) In the recommended doses it is safe (the lethal dose is 40 mg/kg); 3) The use of MB does not cause endothelial dysfunction; 4) The MB effect appears in cases of nitric oxide (NO) up-regulation; 5) MB is not a vasoconstrictor, by blocking of the GMPc system it releases the AMPc system, facilitating the norepinephrine vasoconstrictor effect; 6) The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasmatic concentrations strongly decays in the first 40 minutes; 7) There is a possible "window of opportunity" for the MB's effectiveness. CONCLUSIONS: Although there are no definitive multicentric studies, the MB used to treat heart surgery VS, at the present time, is the best, safest and cheapest option, being a Brazilian contribution for the heart surgery |
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Sociedade Brasileira de Cirurgia Cardiovascular |
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2009 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382009000400005 |
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