Use of Methylene Blue for Catecholamine-Refractory Vasoplegia from Protamine and Aprotinin

摘要: We present two cases of catecholamine-refractory and vasopressin-refractory vasoplegic syndrome associated with intraoperative anaphylaxis during cardiac surgery. One case was related to the administration protamine other aprotinin. Both were successfully managed using intravenous methylene blue. The use blue blocks accumulation cyclic guanosine monophosphate by competitively inhibiting enzyme guanylate cyclase. This results in reduced responsiveness vasculature monophosphate-mediated vasodilators, such as nitric oxide. report provides a description severe induced different agents, which significant clinical response.