Document Detail


The hemodynamic effects of methylene blue when administered at the onset of cardiopulmonary bypass.
MedLine Citation:
PMID:  16790616     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hypotension occurs during cardiopulmonary bypass (CPB), in part because of induction of the inflammatory response, for which nitric oxide and guanylate cyclase play a central role. In this study we examined the hemodynamic effects of methylene blue (MB), an inhibitor of guanylate cyclase, administered during cardiopulmonary bypass (CPB) to patients taking angiotensin-converting enzyme inhibitors. Thirty patients undergoing cardiac surgery were randomized to receive either MB (3 mg/kg) or saline (S) after institution of CPB and cardioplegic arrest. CPB was managed similarly for all study patients. Hemodynamic data were assessed before, during, and after CPB. The use of vasopressors was recorded. All study patients experienced a similar reduction in mean arterial blood pressure (MAP) and systemic vascular resistance (SVR) with the onset of CPB and cardioplegic arrest. MB increased MAP and SVR and this effect lasted for 40 minutes. The saline group demonstrated a persistently reduced MAP and SVR throughout CPB. The saline group received phenylephrine more frequently during CPB, and more norepinephrine after CPB to maintain a desirable MAP. The MB group recorded significantly lower serum lactate levels despite equal or greater MAP and SVR. In conclusion, administration of MB after institution of CPB for patients taking angiotensin-converting enzyme inhibitors increased MAP and SVR and reduced the need for vasopressors. Furthermore, serum lactate levels were lower in MB patients, suggesting more favorable tissue perfusion.
Authors:
Andrew D Maslow; Gary Stearns; Parag Butala; Parag Batula; Carl S Schwartz; Jeffrey Gough; Arun K Singh
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  103     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-22     Completed Date:  2006-08-16     Revised Date:  2007-05-24    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2-8, table of contents     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Rhode Island Hospital, Providence Rhode Island, USA. amaslow@rcn.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Blood Pressure / drug effects*
Cardiopulmonary Bypass*
Enzyme Inhibitors / administration & dosage*
Female
Guanylate Cyclase / antagonists & inhibitors*
Humans
Hypotension / etiology,  physiopathology,  prevention & control
Male
Methylene Blue / administration & dosage*
Vascular Resistance / drug effects*
Vasoconstrictor Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Enzyme Inhibitors; 0/Vasoconstrictor Agents; 61-73-4/Methylene Blue; EC 4.6.1.2/Guanylate Cyclase
Comments/Corrections
Comment In:
Anesth Analg. 2007 May;104(5):1296; author reply 1296-7   [PMID:  17456696 ]
Erratum In:
Anesth Analg. 2007 Jan;104(1):50
Note: Batula, Parag [corrected to Butala, Parag]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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