Vasoplegic syndrome after off pump coronary artery bypass grafting surgery

Authors

  • Swaminathan Vaidyanathan Department of Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India
  • Kumar Chidambaram Department of Anaesthesiology, Madras Medical Mission, Chennai, Tamil Nadu, India
  • Anbarasu Mohanraj Department of Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20174011

Keywords:

Cardiac surgery, CABG, Cardiopulmonary bypass, OPCAB, Vasoplegia, Vasopressin

Abstract

We report a case of 48-years-old man who developed nor-epinephrine resistant vasoplegic syndrome after elective off pump coronary artery bypass grafting surgery. The failure of norepinephrine to improve the patients’ hemodynamics promted us to start treatment with vasopressin. Within an hour, the hemodynamics begin to improve. After 4 hours, patient was stable enough to be weaned from vasopressin, extubated at the end of 24 hrs and shifted to ward at the end of 48 hours. Vasoplegic syndrome can occur commonly after cardiopulmonary bypass and incidence can go up to 10%. This case was reported to insist upon the fact that vasoplegic syndrome can occur even after off pump surgeries. Herein we discuss the aetiology, risk factors, pathophysiology and prophylactic measures to be taken, for the prevention of vasoplegic syndrome.

Author Biographies

Swaminathan Vaidyanathan, Department of Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India

Department Of Cardiac Surgery

Kumar Chidambaram, Department of Anaesthesiology, Madras Medical Mission, Chennai, Tamil Nadu, India

Department Of Anesthesiology

Anbarasu Mohanraj, Department of Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India

Department Of Cardiac Surgery

References

Gomes WJ, Erlichman MR, Batista-Filho ML, Knobel M, Almeida DR, Carvalho AC, et al. Vasoplegic syndrome after off pump coronary artery bypass surgery. Eur J Cardiothorac Surg. 2003;23:165-9.

Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use a novel pressor agent. J Thorac Cardio-vasc Surg. 1998;116:973-80.

Levin RL, Degrange MA, Bruno GF, Del Mazo CD, Taborda DJ, Griotti JJ, et al. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Ann Thoracic Surg. 2004;77(2):496-9.

Papodopoulos G, Sintou E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E. Perioperative infusion of low dose vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-a double blind-randomized study. J Cardiothorac Surg. 2010;5:17-28.

Gomes WJ, Carvalho AC, Palma JH, Teles CA, Branco JN, Silas MG, Buffolo E. Vasoplegic syndrome after open heart surgery. J Cardiovasc Surg. 1998;39:619-23.

Mekontso-Dessap A, Hauel R, Soustelle C, Kirsch M, Thebert D, Loisance DY. Risk factors for post cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function. Ann Thorac Surg. 2001;71(5):1428-32.

Ohri SK, Becket J, Brannan J, Keogh BE, Taylor KM. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilization and intra-mucosal Ph. Ann Thorac Surg. 1994;57:1198-9.

Tuman KJ, McCarthy RJ, O'connor CJ, Holm WE, Ivankovich AD. Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypass. Anesthesia Analgesia. 1995;80(3):473-9.

Mehaffey JH, Johnston LE, Hawkins RB, Charles EJ, Yarboro L, Kern JA, et al. Methylene blue for vasoplegic syndrome after cardiac operation: early administration improves survival. Ann Thoracic Surg. 2017;20(2):178-81.

Downloads

Published

2017-08-26

How to Cite

Vaidyanathan, S., Chidambaram, K., & Mohanraj, A. (2017). Vasoplegic syndrome after off pump coronary artery bypass grafting surgery. International Journal of Research in Medical Sciences, 5(9), 4191–4194. https://doi.org/10.18203/2320-6012.ijrms20174011

Issue

Section

Case Reports