2017
DOI: 10.4103/aca.aca_88_17
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The use of intravenous hydroxocobalamin as a rescue in methylene blue-resistant vasoplegic syndrome in cardiac surgery

Abstract: Vasoplegic syndrome is a well-recognized complication during cardiopulmonary bypass (CPB) and is associated with increased morbidity and mortality, especially when refractory to conventional vasoconstrictor therapy. This is the first reported case of vasoplegia on CPB unresponsive to methylene blue whereas responsive to hydroxocobalamin, which indicates that the effect of hydroxocobalamin outside of the nitric oxide system is significant or that the two drugs have a synergistic effect in one or multiple mechan… Show more

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Cited by 35 publications
(17 citation statements)
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“…Hydroxocobalamin, a highly bioavailable form of vitamin B12 that is approved for use in cyanide poisoning, is thought to act in a similar way to methylene blue on the NO system. Additionally, it is also thought to counteract hydrogen sulfide (H 2 S)–induced vasodilation by directly binding the H 2 S to be excreted ( 12 ). To date, there is no literature describing the use of hydroxocobalamin in nimodipine-induced vasoplegia.…”
Section: Discussionmentioning
confidence: 99%
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“…Hydroxocobalamin, a highly bioavailable form of vitamin B12 that is approved for use in cyanide poisoning, is thought to act in a similar way to methylene blue on the NO system. Additionally, it is also thought to counteract hydrogen sulfide (H 2 S)–induced vasodilation by directly binding the H 2 S to be excreted ( 12 ). To date, there is no literature describing the use of hydroxocobalamin in nimodipine-induced vasoplegia.…”
Section: Discussionmentioning
confidence: 99%
“…To date, there is no literature describing the use of hydroxocobalamin in nimodipine-induced vasoplegia. However, there are a number of reports of hydroxocobalamin used in refractory vasoplegia after cardiopulmonary bypass ( 12 14 ). Interestingly, Cai et al ( 12 ) describe such a case of vasoplegia in the setting of cardiac surgery, refractory to vasopressors, fluid boluses, and methylene blue, which responded to hydroxocobalamin, suggestive of potentially a different or secondary mechanism of vasoplegia than impaired NO metabolism.…”
Section: Discussionmentioning
confidence: 99%
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