Anesth Analg 2007;104:1296
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260369.82560.10
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Methylene Blue for CPB
Dr K. Valchanov, MD, and
Dr F. Falter, MD
Department of Anaesthesia, Papworth Hospital, Cambridge CB3 8RE, UK, kvalchanov{at}hotmail.com
To the Editor:
Maslow et al. (1) explored the beneficial effects of methylene blue on mean arterial pressure during and after cardiopulmonary bypass (CPB). We were intrigued, however, by the fact that methylene blue was administered after an initial period of stabilization on bypass (5 min). As shown in the past, hypotension during CBP is independently associated with postoperative morbidity (2) Hypotension is also an independent predictor of mortality for noncardiac surgery (3). It would be more logical to administer the hypotension-avoiding agent prior to the hypotensive insult, commencement of CPB in the present case. The logistics of infusing methylene blue prior to CPB would not be a problem as methylene blue infusions over 15 min durations have not been documented to cause hypotension (4). It would be interesting to know if a trial with methylene blue administered prior to CPB would also reduce postoperative morbidity.
REFERENCES
- Maslow AD, Stearns G, Parag B, et al. The hemodynamic effects of methylene blue when administered at the onset of cardiopulmonary bypass. Anesth Analg 2006;103:2–8.[Abstract/Free Full Text]
- Reich DL, Bodian CA, Krol M, et al. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg 1999;89:814–22.[Abstract/Free Full Text]
- Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after non-cardiac surgery. Anesth Analg 2005;100:4–10.[Abstract/Free Full Text]
- Kirov MY, Evgenov OV, Evgenova NV, et al. Infusion of methylene blue in human septic shock: a pilot, randomised, controlled study. Crit Care Med 2001;29:1860–7.[Web of Science][Medline]
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