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Journal of Case Reports
Methylene Blue for Treating Vasoplegic Syndrome During Liver Transplantation: A Bolus Dose or Continuous Infusion?
Ceren Gunt, Nedim Çekmen
Güven Hospital Department of Anesthesiology and Intensive Care, Ankara, Turkey.
Corresponding Author:
Dr. Ceren Gunt 
Email: guntceren@gmail.com
Received: 15-DEC-2018 Accepted: 11-MAY-2019 Published Online: 15-JUN-2019
DOI: http://dx.doi.org/10.17659/01.2019.0032
Background: Role of methylene blue in vasopressor-resistant hypotension during liver transplantation has limited literature. Case Report: A 60-year-old man who had vasoplegic syndrome during liver transplantation is discussed in this case report. His pre-operative evaluation was normal. While it was expected that arterial blood pressure would be in normal range at 190 min after portal vein reperfusion, severe hypotension recurred under the high dose vasopressor treatment. Observed hypotension along with hemodynamic findings suggested vasoplegic syndrome. Therefore, 2 mg/kg of methylene blue was administered. The arterial blood pressure showed improvement immediately after methylene blue administration. The vasopressors were gradually reduced, and the operation completed uneventfully, the patient was transferred to the intensive care unit. Five minutes after the admission, cardiac arrest was witnessed. The cause of  cardiac arrest was assumed that the previously infused methylene blue significantly decayed and per se vasopressor was ineffective in maintaining the hemodynamic stability of this patient. The patient was resuscitated successfully and discharged to the service on postoperative day 4. Conclusion: Infusion of methylene blue following a bolus dose could be beneficial in maintaining hemodynamic stability when vasoplegic syndrome develops in liver transplantation.
Keywords : Hypotension, Liver Transplantation, Methylene Blue, Portal Vein, Vasoconstrictor Agents.
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