Katekolaminlere Dirençli Şokta Non-Adrenerjik Yaklaşım: Metilen Mavisi ve Perfüzyon Güvenliği

Eda Gödekmerdan Katırcıoğlu; Mehmet Burak Coşkun; Mahmut Köylü; Mihriban Yalçın

doi:10.5281/zenodo.19238729

Authors

Eda Gödekmerdan Katırcıoğlu ordu devlet hastanesi https://orcid.org/0000-0003-0724-4051
Mehmet Burak Coşkun Sağlık Bakanlığı https://orcid.org/0000-0001-6748-575X
Mahmut Köylü Çukurova University https://orcid.org/0009-0004-2106-983X
Mihriban Yalçın Ordu State Hospital https://orcid.org/0000-0003-4767-0880

DOI:

https://doi.org/10.5281/zenodo.19238729

Keywords:

Vasoplegic Syndrome, Methylene Blue, Cardiopulmonary Bypass, Nitric Oxide, Perfusion Management

Abstract

Vasoplegic syndrome developing after cardiopulmonary bypass (CPB) is a clinical condition characterized by low systemic vascular resistance, normal or increased cardiac output, and unresponsiveness to high doses of catecholamines, with a high mortality rate (25%). This section examines the excessive activation of the Nitric Oxide (NO) and cyclic Guanosine Monophosphate (cGMP) pathway, which plays a role in the pathophysiology of vasoplegia, and the therapeutic role of Methylene Blue (MB), which targets this pathway. MM restores vascular tone through a mechanism independent of adrenergic receptors by inhibiting soluble guanylate cyclase (sGC) and inducible nitric oxide synthase (iNOS) enzymes.

The study also details the specific monitoring challenges created by MM use during the intraoperative period. The mechanism of the “pseudo-desaturation” (false drop) phenomenon observed in pulse oximeters (SpO2) and cerebral oximeters (NIRS) due to the drug's optical properties and its management in terms of perfusion safety are discussed. From a surgical perspective, preoperative risk factors (ACE inhibitor use, endocarditis), timing strategies (prophylactic vs. rescue), and absolute contraindications (G6PD deficiency, risk of Serotonin Syndrome) are addressed in light of the current literature. This section aims to establish a safe and effective clinical protocol for the management of refractory vasoplegia from the joint perspective of the cardiac surgeon, perfusionist, and pharmacologist.

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