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Michael Mazzeffi1, Benjamin Hammer2, Edward Chen3, Mark Caridi-Scheible4, James Ramsay5, Christopher Paciullo6
1 Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
2 Department of Pharmacy, Children's National Medical Center, Washington, DC 20010, USA
3 Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
4 Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, USA
5 Department of Anesthesiology, University of California, San Francisco School of Medicine, San Francisco, CA 94131, USA
6 Department of Pharmacy, Emory University School of Medicine, Atlanta, GA 30322, USA
Correspondence Address:
Michael Mazzeffi
Department of Anesthesiology, University of Maryland School of Medicine, 22 South Greene Street S11C00, Baltimore, MD 21201
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aca.ACA_237_16
Background: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. Aims: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. Setting and Design: This was conducted in a tertiary care medical center; this study was a retrospective cohort study. Materials and Methods: Adult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP) and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response. Results: Eighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004), and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02). A positive response had no correlation with in-hospital mortality (P = 0.09). Conclusions: MB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response.
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