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Methylene Blue: Magic Bullet for Vasoplegia?

Hosseinian, Leila MD*; Weiner, Menachem MD*; Levin, Matthew A. MD*; Fischer, Gregory W. MD*†

doi: 10.1213/ANE.0000000000001045
Critical Care, Trauma, and Resuscitation: Review Article
Continuing Medical Education

Methylene blue (MB) has received much attention in the perioperative and critical care literature because of its ability to antagonize the profound vasodilation seen in distributive (also referred to as vasodilatory or vasoplegic) shock states. This review will discuss the pharmacologic properties of MB and review the critical care, liver transplantation, and cardiac anesthesia literature with respect to the efficacy and safety of MB for the treatment of shock. Although improved blood pressure has consistently been demonstrated with the use of MB in small trials and case reports, better oxygen delivery or decreased mortality with MB use has not been demonstrated. Large randomized controlled trials are still necessary to identify the role of MB in hemodynamic resuscitation of the critically ill.

From the *Department of Anesthesiology, and Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.

Accepted for publication August 31, 2015.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Leila Hosseinian, MD, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1010, New York, NY 10029. Address e-mail to

© 2016 International Anesthesia Research Society