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.
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.
Authors: Isabella Werner; Fengwei Guo; Ulrich A Stock; Michèle Lupinski; Patrick Meybohm; Anton Moritz; Andres Beiras-Fernandez Journal: Inflamm Res Date: 2014-05-03 Impact factor: 4.575
Authors: J Hunter Mehaffey; Lily E Johnston; Robert B Hawkins; Eric J Charles; Leora Yarboro; John A Kern; Gorav Ailawadi; Irving L Kron; Ravi K Ghanta Journal: Ann Thorac Surg Date: 2017-05-24 Impact factor: 4.330
Authors: Paulo Roberto Barbosa Evora; Lafaiete Alves Junior; Cesar Augusto Ferreira; Antônio Carlos Menardi; Solange Bassetto; Alfredo José Rodrigues; Adilson Scorzoni Filho; Walter Vilella de Andrade Vicente Journal: Rev Bras Cir Cardiovasc Date: 2015 Jan-Mar
Authors: Paulo Roberto B Evora; Julio Nather; Paulo Victor Tubino; Agnes Afrodite S Albuquerque; Andrea Carla Celotto; Alfredo J Rodrigues Journal: Int J Inflam Date: 2013-05-30
Authors: Isabella Werner; Fengwei Guo; Nicolai V Bogert; Ulrich A Stock; Patrick Meybohm; Anton Moritz; Andres Beiras-Fernandez Journal: PLoS One Date: 2013-12-10 Impact factor: 3.240