The effect of hydroxocobalamin and methylene blue for vasoplegic syndromes: A systematic review
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Wahyu Mananda 1 2 , Dian Anggraini Permatasari Musalim 3 , Puguh Oktavian 3 , David Setyo Budi 3 , Chaq El Chaq Zamzam Multazam 4 , Citrawati Dyah Kencono Wungu 5 6 *
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1 Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, INDONESIA2 Department of Anesthesiology and Reanimation, Dr. Soetomo General Academic Hospital, Surabaya, INDONESIA3 Faculty of Medicine, Universitas Airlangga, Surabaya, INDONESIA4 National Heart and Lung Institute, Imperial College London, London, UK5 Department of Physiology and Medical Biochemistry, Universitas Airlangga, Surabaya, INDONESIA6 Institute of Tropical Disease, Universitas Airlangga, Surabaya, INDONESIA* Corresponding Author

Abstract

Background: The role of methylene blue (MB) and hydroxocobalamin (B12) in treating patients with vasoplegic syndromes remains uncertain.
Objective: This systematic review aimed to assess the effects of MB and hydroxocobalamin on patients with vasoplegic syndromes following surgery.
Methods: A systematic search was conducted for articles reporting the use of MB and hydroxocobalamin in vasoplegic syndromes. The databases PubMed, ScienceDirect, Cochrane Library, Springer, Scopus, and medRxiv were systematically searched up to 9 June 2024. Clinical outcomes, hemodynamic outcomes, length of stay (LOS), mortality, and adverse events were extracted from each study.
Results: This review included five studies. The findings from these studies suggested that hydroxocobalamin, with or without MB, effectively reduced vasopressor requirements and improved MAP mainly at 1-hour post-administration. The LOS and mortality did not differ between the two groups. The most common reported side effects for MB include serotonin syndrome. Meanwhile, chromaturia affects the hydroxocobalamin group.
Conclusion: Hydroxocobalamin could lower the need for vasopressors and increase MAP better than MB only. Hydroxocobalamin can also cause temporary chromaturia, which resolves itself. Given the side effects, the choice between MB or hydroxocobalamin for treating vasoplegic syndrome should be based on the patient’s condition. Further studies are required to confirm its findings.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Review Article

ELECTRON J GEN MED, Volume 22, Issue 1, February 2025, Article No: em622

https://doi.org/10.29333/ejgm/15850

Publication date: 13 Jan 2025

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Article Downloads: 59

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