RESUMEN
Vasoplegic syndrome is a well-recognized complication during cardiopulmonary bypass (CPB) and is associated with increased morbidity and mortality, especially when refractory to conventional vasoconstrictor therapy. This is the first reported case of vasoplegia on CPB unresponsive to methylene blue whereas responsive to hydroxocobalamin, which indicates that the effect of hydroxocobalamin outside of the nitric oxide system is significant or that the two drugs have a synergistic effect in one or multiple mechanisms.
Asunto(s)
Antídotos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos/métodos , Hematínicos/administración & dosificación , Hematínicos/uso terapéutico , Hidroxocobalamina/administración & dosificación , Hidroxocobalamina/uso terapéutico , Azul de Metileno/uso terapéutico , Vasoplejía/tratamiento farmacológico , Resistencia a Medicamentos , Ecocardiografía , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Vasoplejía/diagnóstico por imagenAsunto(s)
Hidroxocobalamina/administración & dosificación , Complicaciones Intraoperatorias/tratamiento farmacológico , Trasplante de Hígado/efectos adversos , Vasoplejía/tratamiento farmacológico , Adulto , Anciano , Humanos , Infusiones Intravenosas , Complicaciones Intraoperatorias/diagnóstico por imagen , Complicaciones Intraoperatorias/etiología , Masculino , Resultado del Tratamiento , Vasoplejía/diagnóstico por imagen , Vasoplejía/etiología , Complejo Vitamínico B/administración & dosificaciónRESUMEN
PURPOSE: Loco-regional anesthesia, along with the neurosensitive inhibition causes arterial and venous vasodilatation, that could be of interest for vascular access surgery. We evaluated the long term vasoplegia persistence after brachial plexic block. METHODS: Five patients submitted to brachial plexus block for an orthopedic procedure have been observed. Both radial arteries, that of the blocked arm and the opposite as a control, were analyzed by ultrasound examination, at time 0 and 360 minutes after anesthesia induction. All patients were treated with the same anesthesiologic protocol: axillary approach, use of an electroneurostimulator, injection 10 ml of ropivacain 7.5% + 10 ml of mepivacain 2%. The parameters evaluated from the arterial ultrasound flowmetry were: peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI). RESULTS: No modification of the arterial flow were observed in the control arm at 0 and 360'after block induction. The blocked arm instead showed a significant decrease of the resistive index, stable at 360 minutes. CONCLUSIONS: The vasoplegia accompaning plexic block lasted 6 hours after anesthesia induction. Whereas this longstanding haemodynamic effect is beneficial for early patency of vascular access for hemodialysis, needs to be ascertained by further investigations.