Resumen

SANCHEZ SUEN, Kwok Ho; SALAZAR VARGAS, Carlos  y  DOBLES RAMIREZ, Carlos. Experiencia preliminar en el tratamiento de la vasoplejia post-circulación extracorpórea con azul de metileno. Rev. costarric. cardiol [online]. 2003, vol.5, n.3, pp.15-18. ISSN 1409-4142.

Background: Coronary disease, valvulopathys and congenital cardiopathys constitute a major problem in public health worldwide. Many times, surgical procedures are required. The success of this type of procedures was obtained until the development of extracorporeal circulation (ECC), even though it could produce a severe systemic inflammatory reaction syndrome (SIRS) with vasoplegia. When this condition appears, it is associated with a high morbi-mortality. As far as it is known there are no studies published in Costa Rican literature related to the use of blue methylene for the management of post-ECC vasoplegia. Objective: Report a consecutive series of the first five cases of post- ECC vasoplegia in the Cardiac Surgery Service of the Hospital Calderon Guardia managed with blue methylene. Materials and methods: Patients with post ECC vasoplegia refractory to epinephrine were treated with blue methylene (2mg/kg IV administered in 20 minutes). Hemodynamic effects and clinical results were evaluated. Results: Between March and august 2003, 52 cardiac surgeries with ECC were completed. 5 patients developed severe SIRS with vasoplegia refractory to high doses of epinephrine. A clinically relevant increase in the systemic vascular resistance was observed in 4 out of 5 patients within 30 and 120 minutes after the infusion with blue methylene (increase of 4.6% and 40% respectively compared to basal digits). No adverse effects related to the infusion of the drug were observed. Two of the five patients died (one of them had no response to the blue methylene). Conclusions: In accordance to the literature, the administration of blue methylene could provide a useful, safe and economic alternative in the management of post ECC vasoplegia refractory to epinephrine. The inhibitors of the guanilate cyclasa such as blue methylene represent a new kind of drug for the treatment of vasoplegia. Future studies are required where more patients can participate in order to make a definite recommendation regarding this subject.

Palabras clave : Cirugía cardíaca; circulación extracorpórea; vasoplejia; azul de metileno; hemodinamia.