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EnglishOBJECTIVES: Methylene blue commonly is used as a dye or an antidote, but also can be used off label as a vasopressor. Serotonin toxicity is a potentially lethal and often misdiagnosed condition that can result from drug interaction. Mild serotonin toxicity previously was reported in settings in which methylene blue was used as a dye. The authors report 3 cases of life-threatening serotonin toxicity in patients undergoing chronic selective serotonin reuptake inhibitor (SSRI) therapy who also underwent cardiac surgery and received methylene blue to treat vasoplegic syndrome. DESIGN: An observational study. SETTING: A cardiothoracic intensive care unit (ICU) in a teaching hospital. PARTICIPANTS: Three patients who received methylene blue after cardiac surgery, later discovered to be undergoing chronic SSRI therapy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All 3 patients received high doses of fentanyl during general anesthesia. They all developed vasoplegic syndrome and consequently were given methylene blue in the ICU. All 3 patients developed serotonin toxicity, including coma, after this administration and diagnostic tests were negative for acute intracranial pathology. Coma lasted between 1 and 5 days. Two patients were discharged from the ICU shortly after awakening, whereas the third patient experienced a complicated postoperative course for concomitant refractory low-cardiac-output syndrome. CONCLUSIONS: Patients undergoing chronic SSRI therapy should not be administered methylene blue to treat vasoplegic syndrome.
The Blue Coma: The Role of Methylene Blue in Unexplained Coma After Cardiac Surgery / Martino, Ea; Winterton, D; Nardelli, P; Pasin, L; Calabrò, Mg; Bove, T; Fanelli, G; Zangrillo, A; Landoni, G. - In: JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA. - ISSN 1053-0770. - 30:2(2016), pp. 423-427.
| Titolo: | The Blue Coma: The Role of Methylene Blue in Unexplained Coma After Cardiac Surgery |
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| Data di pubblicazione: | 2016 |
| Rivista: | |
| Citazione: | The Blue Coma: The Role of Methylene Blue in Unexplained Coma After Cardiac Surgery / Martino, Ea; Winterton, D; Nardelli, P; Pasin, L; Calabrò, Mg; Bove, T; Fanelli, G; Zangrillo, A; Landoni, G. - In: JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA. - ISSN 1053-0770. - 30:2(2016), pp. 423-427. |
| Handle: | http://hdl.handle.net/11390/1122950 |
| Appare nelle tipologie: | 1.1 Articolo in rivista |
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| 2016 The Blue Coma.pdf | Versione Editoriale (PDF) | Non pubblico | Accesso ristretto Richiedi una copia |
http://hdl.handle.net/11390/1122950
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