Methylene blue: potential use of an antique molecule in vasoplegic syndrome during cardiac surgery

Abstract

Vasoplegic syndrome is a common complication of cardiopulmonary bypass, appearing with an incidence ranging between 5 and 25%. It is characterized by significant hypotension, high or normal cardiac output and low systemic vascular resistance. This syndrome is hypothesized to be caused by the inflammation-mediated dysregulation of endothelial homeostasis and subsequent endothelial dysfunction. In vasoplegic syndrome, the inhibition of the nitric oxide/cyclic guanosine monophosphate pathway with concomitant administration with traditional ionotropes may represent a promising therapeutic option. Methylene blue, an inhibitor of nitric oxide synthase and guanylate cyclase, may contribute to the improvement of refractory hypotension associated with endothelial dysfunction in vasoplegia. In this article, we will update evidence on the potential therapeutic use of methylene blue in vasoplegic syndrome.

Keywords::

• cardiac surgery
• cardiopulmonary bypass
• guanylate cyclase
• methylene blue
• nitric oxide synthase
• vasoplegia

Financial & competing interests disclosure

This research was funded by EU FP7, AtheroRemo (grant no. 201668) to F Mach. This work was also supported by the Swiss National Science Foundation grants to F Mach (grant nos 310030-118245) and F Montecucco (grant nos 32002B-134963/1). This work was also funded by a grant from the Swiss Heart Foundation and Novartis Foundation to F Mach, as well as by the ‘Sir Jules Thorn Trust Reg’ fund and Gustave and Simone Prévot fund to F Montecucco. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Data taken from [7].