| The hemodynamic effects of methylene blue when administered at the onset of cardiopulmonary bypass. | |
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MedLine Citation:
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PMID: 16790616 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Andrew D Maslow; Gary Stearns; Parag Butala; Parag Batula; Carl S Schwartz; Jeffrey Gough; Arun K Singh |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 103 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2006 Jul |
Date Detail:
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Created Date: 2006-06-22 Completed Date: 2006-08-16 Revised Date: 2007-05-24 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 2-8, table of contents Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, Rhode Island Hospital, Providence Rhode Island, USA. amaslow@rcn.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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:
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Anesth Analg. 2007 May;104(5):1296; author reply 1296-7
[PMID:
17456696
]
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Erratum In:
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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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