Methylene blue administration in refractory distributive shock

Introduction: Methylene blue is receiving special interest in perioperative and intensive care of patients with distributive shock due to its ability to block the action of nitric oxide and to antagonize deep vasodilation. Objective: The objective is to illustrate the use of the methylene blue, summarizing the perioperative management of a case with secondary vasoplegic syndrome due to a norepinephrine refractory septic shock and the response to methylene blue, reviewing the latest evidence of this therapeutic alternative. In practice:We describe the case of a 60-year-old man, paraplegic, with septic shock due to a long evolution decubitus pressure ulcer. After two hours of surgery, the patient remained with hemodynamic deterioration despite high doses of vasopressin (3 IU/hour) and norepinephrine (2 µg/kg /min), therefore methylene blue was administered with two intravenous bolus doses of 50 mg without adverse effects. After half an hour hemodynamic improvement was evidenced, allowing to decrease norepinephrine infusion and normalizing blood pressure. Finally, debridement of necrotic tissue, amputation and disarticulation of left coxofemoral joint was performed with subsequent transfer to the ICU and discharge to the spinal cord injury ward twenty eight days later. Conclusions: As it has been demonstrated in our patient, methylene blue is a therapeutic alternative to manage patients with persistent hypotension despite the use of various vasopressors during the management of vasoplegic syndrome secondary to septic shock.

Download Full-text

Methylene Blue Does Not Have to Be Considered Only as Rescue Therapy for Distributive Shock

Journal of Medical Toxicology ◽

10.1007/s13181-013-0333-8 ◽

2013 ◽

Vol 9 (4) ◽

pp. 426-426 ◽

Cited By ~ 5

Author(s):

Paulo Roberto Barbosa Evora

Keyword(s):

Methylene Blue ◽

Rescue Therapy ◽

Distributive Shock

Download Full-text

Response to Methylene Blue Does Not Have to Be Considered Only as Rescue Therapy for Distributive Shock

Journal of Medical Toxicology ◽

10.1007/s13181-013-0332-9 ◽

2013 ◽

Vol 9 (4) ◽

pp. 427-427

Author(s):

David H. Jang ◽

Lewis S. Nelson ◽

Robert S. Hoffman

Keyword(s):

Methylene Blue ◽

Rescue Therapy ◽

Distributive Shock

Download Full-text

Methylene blue in the management of severe distributive shock in calcium channel blocker overdose

Case Reports International ◽

10.5348/100082z06ab2020cr ◽

2020 ◽

Vol 9 ◽

pp. 1

Author(s):

Annica Bester ◽

Margareta ARoeck

Keyword(s):

Methylene Blue ◽

Calcium Channel ◽

Calcium Channel Blocker ◽

Channel Blocker ◽

Distributive Shock

Download Full-text

Methylene Blue for Distributive Shock: A Potential New Use of an Old Antidote

Journal of Medical Toxicology ◽

10.1007/s13181-013-0298-7 ◽

2013 ◽

Vol 9 (3) ◽

pp. 242-249 ◽

Cited By ~ 49

Author(s):

David H. Jang ◽

Lewis S. Nelson ◽

Robert S. Hoffman

Keyword(s):

Methylene Blue ◽

Distributive Shock

Download Full-text

A SEM and Light Microscope Study of the Epidermal Leaf Structures of the Carnivorous Plant, Sarracenia purpurea, L.

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100065833 ◽

1971 ◽

Vol 29 ◽

pp. 358-359

Author(s):

B. J. Panessa ◽

J. F. Gennaro

Keyword(s):

Methylene Blue ◽

Toluidine Blue ◽

Outer Surface ◽

Microscope Study ◽

Light Microscope ◽

Carnivorous Plant ◽

Sarracenia Purpurea ◽

Inner Surface

Tissue from the hood and sarcophagus regions were fixed in 6% glutaraldehyde in 1 M.cacodylate buffer and washed in buffer. Tissue for SEM was partially dried, attached to aluminium targets with silver conducting paint, carbon-gold coated(100-500Å), and examined in a Kent Cambridge Stereoscan S4. Tissue for the light microscope was post fixed in 1% aqueous OsO4, dehydrated in acetone (4°C), embedded in Epon 812 and sectioned at ½u on a Sorvall MT 2 ultramicrotome. Cross and longitudinal sections were cut and stained with PAS, 0.5% toluidine blue and 1% azure II-methylene blue. Measurements were made from both SEM and Light micrographs.The tissue had two structurally distinct surfaces, an outer surface with small (225-500 µ) pubescent hairs (12/mm2), numerous stoma (77/mm2), and nectar glands(8/mm2); and an inner surface with large (784-1000 µ)stiff hairs(4/mm2), fewer stoma (46/mm2) and larger, more complex glands(16/mm2), presumably of a digestive nature.

Download Full-text