Vasoplegia after cardiac surgery

Vasoplegia following cardiac surgery, its definition, associated risks, and management strategies are discussed. Dr. Iqbal Ratnani, an intensivist at Houston Methodist Hospital, defines vasoplegia as a loss of vascular tone and highlights its association with increased mortality. Predisposing factors such as ACE inhibitors, renal insufficiency, and prolonged pump time during surgery are identified. Management focuses on ensuring adequate preload and cardiac output, with early use of vasopressin in combination with norepinephrine. Alternative treatments like hydroxycobalamin and angiotensin II are considered for refractory cases, while the use of methylene blue and vitamin C are approached with caution due to potential side effects and limited evidence of benefit, respectively. The importance of clinical judgment and physical examination is emphasized, advocating for individualized patient care over strict adherence to numerical targets.