Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery
BackgroundThe 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...
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Korean Society of Anesthesiologists
2012-08-01
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| Series: | Korean Journal of Anesthesiology |
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| Online Access: | http://ekja.org/upload/pdf/kjae-63-142.pdf |
| _version_ | 1818276963868999680 |
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| author | Jin Sun Cho Jong Wook Song Sungwon Na Joo-Hwa Moon Young Lan Kwak |
| author_facet | Jin Sun Cho Jong Wook Song Sungwon Na Joo-Hwa Moon Young Lan Kwak |
| author_sort | Jin Sun Cho |
| collection | DOAJ |
| description | BackgroundThe 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).MethodsForty-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.ResultsTwo 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.ConclusionsIn 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. |
| first_indexed | 2024-12-12T22:54:00Z |
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| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-12-12T22:54:00Z |
| publishDate | 2012-08-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-e49cdb11604b45a89871673d6efe5b232022-12-22T00:08:59ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632012-08-0163214214810.4097/kjae.2012.63.2.1427388Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgeryJin Sun Cho0Jong Wook Song1Sungwon Na2Joo-Hwa Moon3Young Lan Kwak4Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.BackgroundThe 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).MethodsForty-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.ResultsTwo 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.ConclusionsIn 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.http://ekja.org/upload/pdf/kjae-63-142.pdfcardiopulmonary bypassinfective endocarditismethylene bluevasoplegia |
| spellingShingle | Jin Sun Cho Jong Wook Song Sungwon Na Joo-Hwa Moon Young Lan Kwak Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery Korean Journal of Anesthesiology cardiopulmonary bypass infective endocarditis methylene blue vasoplegia |
| title | Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery |
| title_full | Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery |
| title_fullStr | Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery |
| title_full_unstemmed | Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery |
| title_short | Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery |
| title_sort | effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery |
| topic | cardiopulmonary bypass infective endocarditis methylene blue vasoplegia |
| url | http://ekja.org/upload/pdf/kjae-63-142.pdf |
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