Use of intravenous methylene blue for catecholamine‐refractory vasoplegia during liver transplantation. Issue 1 (15th May 2015)

• Record Type: Journal Article
• Authors: Arachchige, Nimali Lochanie Puwackwaththa; Abayadeera, Anuja; Abrew, Gitanjalee
• Is Part Of: Anaesthesia cases. Volume 3:Issue 1(2015)
• Page Start: 53
• Page End: 57
• Publication Date: 2015-05-15
• Subjects: 617.9605
• DOI: 10.21466/ac.UOIMBFC.2015
• Languages: English
• ISSNs: 2396-8397

Abstract

Summary: We report a patient with catecholamine‐refractory vasoplegia who was successfully managed with intravenous methylene blue. A 22‐yr‐old female with primary hyperoxaluria underwent orthotopic liver transplantation. During the early dissection phase she remained haemodynamically stable. Towards the latter part of the dissection phase, her blood pressure decreased to around 60/25 mmHg and she became unresponsive to fluid therapy, conventional vasopressors and inotropes. However, she demonstrated a remarkable response to a bolus of intravenous methylene blue, 2 mg.kg ‐1 administered over 20 min. She remained haemodynamically stable for the remainder of the procedure and was transferred to ICU with an intravenous methylene blue infusion running and minimal vasopressor requirements. Intravenous methylene blue seems a promising rescue treatment for refractory vasoplegia during liver transplantation. It competitively inhibits guanylase cyclase, thus responsiveness of cyclic guanosine monophosphate (cGMP)‐mediated vasodilators such as nitric oxide (NO) is reduced, leading to improved vasomotor tone.