Azul de metileno/Methylene blue

Azul de metileno en el tratamiento del shock vasodilatador refractario después de la implantación del dispositivo de asistencia cardiaca: reporte de cuatro casos consecutivos


Use of methylene blue in the treatment of refractory vasodilatory shock after cardiac assist device implantation: report of four consecutive cases.
Michel S, Weis F, Sodian R, Beiras-Fernandez A, Bigdeli AK, Kaczmarek I, Bruegger D.
Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany.
J Clin Med Res. 2012 Jun;4(3):212-5. doi: 10.4021/jocmr804w. Epub 2012 May 15.
Abstract
Vasodilatory shock frequently occurs after cardiac surgery, particularly after cardiac assist device implantation. This complication is often associated with high mortality, especially if refractory to conventional vasoconstrictor treatment. Methylene blue, a guanylate cyclase inhibitor, has been successfully used in the management of vasodilatory shock associated with cardiopulmonary bypass. We present four successive cases after implantation of cardiac assist devices suffering from norepinephrine and vasopressin refractory severe vasodilatory shock. In all patients, administration of a single dose of methylene blue (2 mg/kg body weight) resulted in an immediate and persistent decrease in vasoconstrictor dosages and serum lactate concentrations. Despite of this benefit, all patients deceased during hospital stay, however, this was not related to the methylene blue treatment. Methylene blue seems to be a promising therapeutical option in patients with otherwise resistant vasodilatory shock after cardiac assist device implantation. However, controlled clinical trials are necessary to substantiate safety and efficacy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376881/pdf/jocmr-04-212.pdf



Azul de metileno: revisión

Methylene blue: revisited.
Ginimuge PR, Jyothi SD.
Assistant Professor, Department of Anaesthesiology, Belgaum Institute of Medical Sciences, Belgaum, Karnataka, India.
Ginimuge PR, Jyothi S D. Methylene blue: Revisited.
J Anaesthesiol Clin Pharmacol [serial online] 2010 [cited 2013 Jun 18];26:517-20.
J Anaesthesiol Clin Pharmacol. 2010 Oct;26(4):517-20.
Methylene blue, an inhibitor of nitric oxide synthase and guanylate cyclase has many uses in medicine. It has been found to improve the hypotension associated with various clinical states. [1] It also improves hypoxia and hyper dynamic circulation in cirrhosis of liver and severe hepatopulmonary syndrome. [2] It also results in transient and reproducible improvement in blood pressure and cardiac function in septic shock
http://www.joacp.org/text.asp?2010/26/4/517/74599




Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org