Azul de metileno no tratamento da síndrome vasoplégica em cirurgia cardíaca. quinze anos de perguntas, respostas, dúvidas e certezas
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Data
2009-07-01
Autores
Evora, Paulo Roberto Barbosa
Ribeiro, Paulo José de Freitas
Vicente, Vilella de Andrade
dos Reis, Celso Luís
Rodrigues, Alfredo José
Menardi, Antonio Carlos
Alves Jr., Lafaiete
Evora, Patrícia Martinez [UNESP]
Bassetto, Solange
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Resumo
Objective: There is strong evidence that methylene blue (MB), an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS) treatment in heart surgery. The aim of this article is to review the MB's therapeutic function in the vasoplegic syndrome treatment. Methods: Fifteen years of literature review. Results: 1) Heparin and ACE inhibitors are risk factors; 2) In the recommended doses it is safe (the lethal dose is 40 mg/ kg); 3) The use of MB does not cause endothelial dysfunction; 4) The MB effect appears in cases of nitric oxide (NO) up-regulation; 5) MB is not a vasoconstrictor, by blocking of the GMPc system it releases the AMPc system, facilitating the norepinephrine vasoconstrictor effect; 6) The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasmatic concentrations strongly decays in the first 40 minutes; 7) There is a possible window of opportunity for the MB's effectiveness. Conclusions: Although there are no definitive multicentric studies, the MB used to treat heart surgery VS, at the present time, is the best, safest and cheapest option, being a Brazilian contribution for the heart surgery.
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Palavras-chave
Cardiovascular surgical procedures, Extracorporeal circulation, Methylene blue, Postoperative complications, Vascular diseases, Vascular resistance/drug effects, guanylate cyclase, methylene blue, dose response, drug antagonism, heart surgery, human, vasoplegia, Cardiac Surgical Procedures, Dose-Response Relationship, Drug, Guanylate Cyclase, Humans, Methylene Blue, Vasoplegia
Como citar
Brazilian Journal of Cardiovascular Surgery, v. 24, n. 3, p. 279-288, 2009.