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Jornal Vascular Brasileiro

versão impressa ISSN 1677-5449


SANTOS, Mariana Raphaela Garcia de Araújo dos et al. Use of methylene blue in the reversal of vasoplegia refractory to the use of catecholamines after aortobifemoral bypass. J. vasc. bras. [online]. 2010, vol.9, n.1, pp.74-77.  Epub 30-Abr-2010. ISSN 1677-5449.

There is evidence that the nitric oxide plays an important role in the vasodilation associated with vasoplegic reactions. The objective of this case report is to document a case of catecholamine-refractory shock after aortobifemoral bypass treated with methylene blue. A 50-year-old woman was admitted for aortobifemoral bypass graft surgery. She did not present with any comorbidities. At the end of the surgery, she was breathing spontaneously, with palpable pedal pulses. Two hours later, the patient presented shock. Noradrenaline infusion was initiated and the causes of shock were investigated. She required increasing doses of amines and her parameters were stable. On the sixth day after surgery, methylene blue was administered due to the hypothesis of refractory vasoplegia. There was immediate response, with decrease in the catecholamine infusion levels until its withdrawal on the next day. Methylene blue inhibits the enzyme guanylate cyclase that produces GMPc. There might be a synergism between these two drugs, since their association allows the action of the AMPc system.

Palavras-chave : Methylene blue; vasoplegia; aortobifemoral bypass; nitric oxide.

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