Key result
The authors suggest that administering methylene blue prior to cardiopulmonary bypass, rather than after stabilization, may be more logical to prevent hypotension and reduce postoperative morbidity.
Why the study?
Does administering methylene blue prior to cardiopulmonary bypass reduce postoperative morbidity compared to administration after stabilization?
This letter suggests that prophylactic administration of methylene blue before cardiopulmonary bypass may be more effective at preventing hypotension-related morbidity than reactive administration.
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. Dr. K. Valchanov, MD Dr. F. Falter, MD Department of Anaesthesia Papworth Hospital Cambridge CB3 8RE, UK [email protected]
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Valchanov et al. (2007) conducted a letter in Hypotension during cardiopulmonary bypass. Methylene blue was evaluated. The authors suggest that administering methylene blue prior to cardiopulmonary bypass, rather than after stabilization, may be more logical to prevent hypotension and reduce postoperative morbidity.
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