Vazoplegický syndrom po kardiochirurgické operaci s použitím mimotělního oběhu je závažnou komplikací s vysokou morbiditou i mortalitou. Bez adekvátní terapie tento syndrom progreduje až do šokového stavu s rozvojem multiorgánového selhání. Základní hemodynamické charakteristiky vazoplegického syndromu zahrnují nízkou systémovou cévní rezistenci s těžkou hypotenzí, tachykardii, normální nebo zvýšený srdeční výdej a nízké plnící tlaky. V terapii se používá noradrenalin a vazopresin nebo jeho analoga. Další léčebnou možnost představuje metylenová modř. Popisujeme konkrétní případ úspěšného použití metylenové modři při léčbě vazoplegického syndromu.
Vasoplegic syndrome after cardiac surgery with cardiopulmonary bypass is severe complication with high morbidity and mortality. Without appropriate therapy the syndrome advances to the shock state with subsequent multiorgan failure. Basic haemodynamic parameters of vasoplegic syndrome include low systemic vascular resistance with severe hypotension, tachycardia, and normal or increased cardiac output and low filling pressures. In therapy norepinephrine and vasopressin or its analogues are used. Methylene blue is other therapeutic option. The case of successful application of methylene blue for the treatment of vasoplegic syndrome is presented.
- MeSH
- Hypotension etiology therapy MeSH
- Cardiac Surgical Procedures MeSH
- Humans MeSH
- Methylene Blue administration & dosage therapeutic use MeSH
- Extracorporeal Circulation adverse effects MeSH
- Norepinephrine therapeutic use MeSH
- Systemic Inflammatory Response Syndrome etiology therapy MeSH
- Vasopressins therapeutic use MeSH
- Vasomotor System physiopathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Case Reports MeSH
Methylenová modř je syntetická látka používaná v medicíně již více než 120 let. Tento článek shrnuje její základní farmakologické vlastnosti a oblast použití jako léčiva i zdravotnického prostředku. Jsou osvětleny mechanismy působení methylenové modři, a to jak specifické, tedy ovlivnění enzymů a zapojení do přenosu elektronů v dýchacím řetězci, tak i nespecifické, dané fyzikálně chemickým působením i vlastnostmi předurčujícími látku k antioxidačním účinkům. Dále jsou zmíněny farmakokinetické parametry, interakce, nežádoucí účinky a toxicita; schválené indikace a oblast použití zdravotnických prostředků.
Methylene blue is a synthetic substance used in medicine for more than 120 years. This review summarizes its basic pharmacological properties and its use as a drug and a medical device. Mechanisms of action of methylene blue are presented, both specific, i.e. enzyme inhibition and involvement in electron transfer in the respiratory chain, as well as non specific mechanisms which are based on physico chemical characteristics, predetermining its antioxidant properties. In addition, pharmacokinetic parameters, pharmacokinetic interactions, adverse effects and toxicity plus approved indications and use related to medical devices are reviewed.
- MeSH
- Alzheimer Disease drug therapy MeSH
- Staining and Labeling methods utilization MeSH
- Endoscopy, Digestive System methods utilization MeSH
- Pharmacologic Actions MeSH
- Drug Evaluation * methods utilization MeSH
- Ifosfamide poisoning toxicity MeSH
- Skin Diseases, Infectious drug therapy MeSH
- Humans MeSH
- Malaria drug therapy MeSH
- Methemoglobinemia drug therapy MeSH
- Methylene Blue * administration & dosage adverse effects therapeutic use MeSH
- Drug Approval methods legislation & jurisprudence MeSH
- Statistics as Topic MeSH
- Therapeutic Uses * MeSH
- Vasoplegia drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Refrakterní distributivní šok představuje u kriticky nemocných stav s excesivní smrtností. Neadrenergní vasopresory, mezi které patří i methylenová modř, získávají stále na významu jako tzv. záchranná léčba u vazoparalytických stavů. V tomto přehledového článku shrnujeme dosavadní literární evidenci použití methylenové modři v indikaci refrakterního šoku u kriticky nemocných pacientů.
Refractory distributive shock is associated with excessive mortality in critically ill patients. Non-adrenergic vasopressors, including methylene blue, are often considered as an adjuvant therapy to the usual, catecholamine-based vasopressor treatment. In this narrative review we summarize the current scientific evidence on the use of methylene blue in the treatment of refractory distributive shock in different clinical situations.
- Keywords
- distributivní šok, refrakterní šok, vaskulární hyporesponzivita,
- MeSH
- Humans MeSH
- Methylene Blue * therapeutic use MeSH
- Shock * drug therapy MeSH
- Vasoplegia MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Pituitary Gland, Anterior drug effects MeSH
- Endocrine Glands physiology MeSH
- Gonads MeSH
- Guanylate Cyclase metabolism MeSH
- Rats MeSH
- Methylene Blue metabolism MeSH
- Thyroid Gland drug effects MeSH
- Nitric Oxide Synthase antagonists & inhibitors metabolism MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
Methylene blue is a long-established drug with complex pharmacology and multiple clinical indications. Its diverse mechanisms of action are most likely responsible for the large variety of its clinical effects. Of interest to psychiatrists, methylene blue has antidepressant, anxiolytic, and neuroprotective properties documented by both animal and human studies. Its stabilizing effect on mitochondrial function and dose-dependent effect on the generation of reactive oxygen species are of significant heuristic value. For these reasons, methylene blue holds promise as a proof-of-concept treatment of organic/neurodegenerative disorders and as a neuroprotective agent in general. In psychiatry, methylene blue has been used for over a century. It was tried successfully in the treatment of psychotic and mood disorders and as a memory enhancer in fear-extinction training. Particularly promising results have been obtained in both short- and long-term treatment of bipolar disorder. In these studies, methylene blue produced an antidepressant and anxiolytic effect without risk of a switch into mania. Long-term use of methylene blue in bipolar disorder led to a better stabilization and a reduction in residual symptoms of the illness. It is usually well tolerated, but caution is needed in the light of its inhibitory effect on monoamine oxidase A.
- MeSH
- Antidepressive Agents therapeutic use MeSH
- Bipolar Disorder drug therapy MeSH
- Humans MeSH
- Methylene Blue therapeutic use MeSH
- Neuroprotective Agents therapeutic use MeSH
- Fear drug effects MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
