Role of Non-catecholamines Vasopressors in the Management of Vasoplegic Syndrome after Cardiopulmonary Bypass: A Scoping Review.

Amarjeet Kumar, Athira Jayan, Poonam Kumari, Kunal Singh, Aakanksha Hiremath

Journal: Annals of cardiac anaesthesia 2026;29(1):4-12

PMID: 41543401

Abstract

Vasoplegic syndrome is a life-threatening condition characterized by uncontrolled peripheral vasodilation, leading to profound arterial hypotension. Treatments include catecholamines, vasopressin, methylene blue (MB), hydroxocobalamin, angiotensin II, and ascorbic acid. We developed a scoping review protocol according to the Joanna Briggs Institute methodology and searched PubMed, PubMed Central, Scopus, and Cochrane Library electronic databases. A total of 23 records were included in this scoping review, out of which 13 were original research studies, seven were reviews, and three were case studies. In these studies, vasopressin, MB, hydroxocobalamin, angiotensin II, and ascorbic acid were used for vasoplegic syndrome. Vasopressin, MB, hydroxocobalamin, angiotensin II, and ascorbic acid showed rapid restoration of hemodynamics and decreased vasopressor requirement. Non-catecholamine drugs such as vasopressin, angiotensin II, MB, and hydroxocobalamin appear to be promising drugs for the treatment of patients with post-cardiac surgery vasoplegic syndrome. It is demonstrated to be effective in raising blood pressure in such patients, but these agents should be used cautiously due to their associated adverse effects.

Address: Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India.; Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.

DOI: 10.4103/aca.aca_86_25

MeSH Terms: Humans, Vasoplegia, Vasoconstrictor Agents, Cardiopulmonary Bypass, Postoperative Complications, Methylene Blue, Vasopressins, Hydroxocobalamin, Ascorbic Acid, Angiotensin II