Utilização do azul de metileno no tratamento da síndrome vasoplégica após cirurgia cardíaca

Andrade, José Carlos S; Filho, Mário Lúcio Batista; Évora, Paulo Roberto Barbosa; Tavares, José Roberto; Buffolo, Ênio; Ribeiro, Expedito E.; Silva, Lélio A; Teles, Carlos Alberto; Petrizzo, Antônia; Filho, Vitor V Barata; R, Duprat

doi:10.1590/s0102-76381996000200009

Cited by 16 publications

(13 citation statements)

References 10 publications

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“…This finding agrees with data from clinical experiments in which MB was used to treat vasoplegic syndrome after cardiopulmonary bypass 7 , systemic inflammatory response syndrome-SIRS [7][8][9][10][11][15][16][17][18][19][20] and anaphylaxis [12][13][14] . These results are not unexpected since, as in healthy subjects, hemodynamics is only fine tuned and not fully under control of NO.…”

Section: Discussionsupporting

confidence: 87%

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Estudos hemodinâmicos e da função endotelial em porcas saudáveis após injeção em bolus endovenoso de azul de metileno

Menardi¹,

Viaro²,

Vicente³

et al. 2006

Arq. Bras. Cardiol.

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objective: Clinical benefit of methylene blue (MB) treating NO-induced vasoplegia has been reported in sepsis, systemic inflammatory response syndrome (SIRS) in cardiac surgery and anaphylactic shock, but its safety is sometimes questioned, mainly regarding its hemodynamic effects and the possibility of causing endothelium dysfunction. To examine the nitric oxide plasma levels and cardiovascular effects of the infusion of MB in vivo and its effects on endothelium-dependent and endothelium-independent in vitro vascular relaxation. Methods:The study protocol included two experimental groups of female pigs: Group I (Control) -the animals (n=6) did not receive MB; Group II (MB) -the animals received 3 mg/kg of MB intravenous bolus infusion. After fifteen minutes of hemodynamic parameter recording the animals were sacrificed by exsanguination, and in vitro studies were conducted using segments of coronary, hepatic, superior mesenteric and renal arteries, to determine the effect of MB on the arterial endothelium function with regard to NO release. Nitric oxide plasma levels (NOx) were measured in each of the experimental groups. results:The results obtained in the present investigation were: 1) intravenous infusion of MB (3.0 mg/kg) caused no hemodynamic changes; 2) absolute and percent plasma NOx values did not differ between the experimental groups; and 3) in vitro study of vascular relaxation showed no significant difference between groups. These results show that MB intravenous infusion seems to be safe. This finding agrees with data from clinical experiments where MB was used to treat vasoplegic syndrome after cardiopulmonary bypass, systemic inflammatory response syndrome (SIRS) and anaphylaxis. These results were not unexpected because, as in healthy subjects, hemodynamics is only fine tuned and not fully under NO control; therefore, MB inhibiting guanylyl cyclase is not expected to do anything.conclusion: Intravenous use of MB, at the investigated dose, did not cause any abnormal hemodynamic responses or impairment of endothelium-dependent relaxation.

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Section: Discussionsupporting

confidence: 87%

“…Clinical benefit of methylene blue (MB) treatment of nitric oxide (NO) vasoplegia has been reported in sepsis [1][2][3][4][5][6] , systemic inflammatory response syndrome (SIRS) in cardiac surgery [7][8][9][10][11] , and anaphylactic shock [12][13][14] .…”

mentioning

confidence: 99%

Estudos hemodinâmicos e da função endotelial em porcas saudáveis após injeção em bolus endovenoso de azul de metileno

Menardi¹,

Viaro²,

Vicente³

et al. 2006

Arq. Bras. Cardiol.

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“…Ten years ago, we successfully used MB to restore both systemic arterial pressure and vascular resistance in a 72 years-old diabetic woman who presented with severe bradycardia and vasoplegic hypotension not responsive to high dose amine infusion had appeared early after an uneventful surgical myocardial revascularization. After this first bedside observation, Andrade et al reported a similar experience with six cardiac surgery patients operated on with or without cardiopulmonary bypass [15]. All these patients presented with tachycardia, oliguria, good peripheral perfusion and important systemic arterial hypotension not responsible to high dose amine infusion in the immediate postoperative period.…”

Section: Mb and Vasoplegic Syndrome In Cardiac Surgerymentioning

confidence: 95%

“…On the basis of our experience with MB treatment for SIRS vasoplegia in cardiac surgery [15,16] and anaphylactic shock [17], and Hochman review [13], we suggest that MB would be a therapeutic alternative to MI associated to SIRS. This treatment option reversed a circulatory shock in a patient who came to the emergency room in acute lung edema, and after an urgent left anterior descending PTCA was directed to the operating room in cardiac arrest.…”

Section: Endothelial Dysfunction and Cardiogenic Shockmentioning

confidence: 99%

The Guanylyl Cyclase Inhibition by MB as Vasoplegic Circulatory Shock Therapeutical Target

Évora

Viaro

2006

CDT

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There were strong evidences that NO has capital importance in the progressive vasodilatation that associates to the varied circulatory shock forms. The decreased systemic vascular resistance observed in irreversible hemorrhagic (hypovolemic) and septic shock may be due to the excess production of nitric oxide. Other forms of shock associated to anaphylaxis (anaphylactic shock, SIRS) and ischemia reperfusion injury (cardiogenic shock, organ transplants), may involve nitric oxide overproduction. In these situations, the nitric oxide-induced loss of vascular sensitivity to catecholamines and myocardial depression contributes to lethal hypotension. As NO vasodilatation is cyclic GMP-mediated, there were two therapeutical options: a) The unspecific NO synthesis inhibition by L-arginine analogs, iNOS-specific inhibition by corticoids and/or aminoguanidine and; b) Guanylyl cyclase inhibition by MB. As the NO synthesis inhibition is associated to tissue necrosis and adverse hemodynamic effects and its clinical use was associated with high mortality, the second option using MB is safer and more rational. The elaboration of this text was motivated to suggest the guanylyl cyclase inhibition by MB as vasoplegic circulatory shock therapeutical target.

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“…These data deserve attention when using MB in the clinical setting, because if this increase is not due to a right ventricular dysfunction, it can be consequence of an undesirable lung hypertension, which was not observed in heart surgery patients infused with MB to treat vasoplegic syndrome 29 .…”

mentioning

confidence: 99%

Methylene blue administration in the compound 48/80-induced anaphylactic shock: hemodynamic study in pigs

Menardi¹,

Capellini²,

Celotto³

et al. 2011

Acta Cir. Bras.

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PURPOSE: To verify if the methylene blue (MB) administration prevents and/or reverses the compound 48/80 (C48/80)-induced anaphylactic shock in pigs. METHODS: Female Dalland pigs were anesthetized and had the hemodynamic parameters recorded during the necessary time to administer some drugs and observe their effect. The animals were randomly assigned to one of the five groups: 1) control; 2) MB: the animals received a bolus injection of MB (2 mg/kg) followed by continuous infusion of MB (2.66 mg/Kg/h delivered by syringe infusion pump); 3) C48/80: the animals received a bolus injection of C48/80 (4 mg/kg); 4) C48/80+MB: the animals received a bolus injection of C48/80 (4 mg/kg) and 10 minutes after the C48/80 administration the animals received a bolus injection of MB (2 mg/kg) followed by continuous infusion of MB (2.66 mg/Kg/h delivered by syringe infusion pump); 5) MB+C48/80: the animals received a bolus injection of MB (2 mg/kg) and 3 minutes later they received a bolus injection of C48/80 (4 mg/kg). RESULTS: The intravenous infusion of MB alone caused no changes in the mean arterial pressure (MAP) showing that the administered MB dose was safe in this experimental model. The C48/80 was effective in producing experimental anaphylactic shock since it was observed a decrease in both MAP and cardiac output (CO) after its administration. The MB did not prevent or reverse the C48/80-induced anaphylactic shock in this model. In fact, the MAP of the animals with anaphylactic shock treated with MB decreased even more than the MAP of the animals from the C48/80 group. On the other hand, the C48/80-induced epidermal alterations disappeared after the MB infusion. CONCLUSION: Despite our data, the clinical manifestations improvement brings some optimism and does not allow excluding the MB as a possible therapeutic option in the anaphylactic shock.

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Utilização do azul de metileno no tratamento da síndrome vasoplégica após cirurgia cardíaca

Abstract: do azul de metileno no tratamento da síndrome vasoplégica após cirurgia cardíaca. Rev Bras Cir Cardiovasc 1996;11 (2): 107-14.

Cited by 16 publications

References 10 publications

Estudos hemodinâmicos e da função endotelial em porcas saudáveis após injeção em bolus endovenoso de azul de metileno

Estudos hemodinâmicos e da função endotelial em porcas saudáveis após injeção em bolus endovenoso de azul de metileno

The Guanylyl Cyclase Inhibition by MB as Vasoplegic Circulatory Shock Therapeutical Target

Methylene blue administration in the compound 48/80-induced anaphylactic shock: hemodynamic study in pigs

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