High-Dose Intravenous Hydroxocobalamin for Persistent Vasoplegic Syndrome after Cardiac Surgery

Ben-Omran Mohamed,Patel Vijay S,Bora Vaibhav,Huang Ellen,Glenn Taylor,Odo Nadine

doi:10.23937/2378-3656/1410335

Abstract

Vasoplegic syndrome is a vasodilatory shock characterized by significant hypotension, normal or high cardiac output, and increased requirement for intravenous fluid resuscitation and vasopressors. It is a relatively common complication following cardiac surgery. We describe the case of a 77-year-old man who developed prolonged vasoplegic syndrome which was refractory to high doses of conventional vasopressors following coronary artery bypass graft surgery. Given the possible increased risk of serotonin syndrome associated with concurrent administration of methylene blue and tramadol, we elected not to administer methylene blue in favor of hydroxocobalamin due to its favorable adverse effect profile.

Highlights

Vasoplegia is a well-recognized complication following cardiac surgery
The lowest and highest incidence are related to off-pump procedures and patients with orthotopic heart transplantation, respectively [1,2]. It is characterized by significant hypotension with a mean arterial pressure (MAP) < 50 mmHg, reduced systemic vascular resistance (SVR < 800 dynes-s/cm5), in a normal or high cardiac output setting, normal or decreased filling pressures, and increased requirement for intravenous fluid resuscitation and vasopressors [3]
Given the possible increased risk of serotonin syndrome associated with concurrent administration of methylene blue and tramadol, we favored administration of hydroxocobalamin over methylene blue for refractory vasoplegia

Summary

Introduction

Vasoplegia is a well-recognized complication following cardiac surgery. It is a relatively common syndrome, with an incidence of 5-45%. Hydroxocobalamin, Vitamin B12, Vasoplegia, Vesoplegic syndrome, Cardiac surgery, Serotonin toxicity, Serotonin syndrome, Methylene blue We report the successful administration of a high dose of intravenous hydroxocobalamin as a rescue agent to manage persistent refractory vasoplegic syndrome following cardiopulmonary bypass surgery.

Results

Conclusion