Tags

Type your tag names separated by a space and hit enter

Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver transplantation: a narrative review of cases and potential biochemical mechanisms.

Abstract

PURPOSE

Hydroxocobalamin, or vitamin B12 (V-B12), is frequently used to treat smoke inhalation and cyanide poisoning. Recent reports have also described its use to treat vasoplegia in cardiac surgery and liver transplantation. This narrative review discusses this "off-label" indication for V-B12, focusing on the potential biochemical mechanisms of its actions.

SOURCE

PubMed, Cochrane, and Web of Science databases were searched for clinical reports on the use of V-B12 for vasoplegia in cardiac surgery and liver transplantation, with the biochemical mechanisms discussed being based on a survey of the related biochemistry literature.

PRINCIPAL FINDINGS

Forty-four patients have been treated with V-B12 for vasoplegia in various isolated case reports and one series. Although 75% of patients have increased blood pressure in response to V-B12, there were some "non-responders". The true efficacy remains unknown because clinical trials have not been performed, and significant reporting bias likely exists. Plausible biochemical explanations exist for the potential beneficial effects of V-B12 in treating vasoplegia, including binding nitric oxide and other gasotransmitters. Additional research is required to clarify if and how these mechanisms are causally involved in effective clinical responders and non-responders.

CONCLUSIONS

Although anecdotal reports utilizing V-B12 for vasoplegia are available, no higher-level evidence exists. Future work is necessary to further understand the dosing, timing, adverse events, and biochemical mechanisms of V-B12 compared with other therapies such as methylene blue.

Authors+Show Affiliations

Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA.Department of Chemistry, Center for Catalysis and Florida Center for Heterocyclic Compounds, University of Florida, Gainesville, FL, USA.Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA.Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA. bspiess@anest.ufl.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31346957

Citation

Charles, Fritz-Gerald, et al. "Vitamin B12 for the Treatment of Vasoplegia in Cardiac Surgery and Liver Transplantation: a Narrative Review of Cases and Potential Biochemical Mechanisms." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 2019.
Charles FG, Murray LJ, Giordano C, et al. Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver transplantation: a narrative review of cases and potential biochemical mechanisms. Can J Anaesth. 2019.
Charles, F. G., Murray, L. J., Giordano, C., & Spiess, B. D. (2019). Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver transplantation: a narrative review of cases and potential biochemical mechanisms. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, doi:10.1007/s12630-019-01449-x.
Charles FG, et al. Vitamin B12 for the Treatment of Vasoplegia in Cardiac Surgery and Liver Transplantation: a Narrative Review of Cases and Potential Biochemical Mechanisms. Can J Anaesth. 2019 Jul 25; PubMed PMID: 31346957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver transplantation: a narrative review of cases and potential biochemical mechanisms. AU - Charles,Fritz-Gerald, AU - Murray,Leslie J, AU - Giordano,Christopher, AU - Spiess,Bruce D, Y1 - 2019/07/25/ PY - 2018/06/19/received PY - 2019/05/14/accepted PY - 2019/05/14/revised PY - 2019/7/27/entrez JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth N2 - PURPOSE: Hydroxocobalamin, or vitamin B12 (V-B12), is frequently used to treat smoke inhalation and cyanide poisoning. Recent reports have also described its use to treat vasoplegia in cardiac surgery and liver transplantation. This narrative review discusses this "off-label" indication for V-B12, focusing on the potential biochemical mechanisms of its actions. SOURCE: PubMed, Cochrane, and Web of Science databases were searched for clinical reports on the use of V-B12 for vasoplegia in cardiac surgery and liver transplantation, with the biochemical mechanisms discussed being based on a survey of the related biochemistry literature. PRINCIPAL FINDINGS: Forty-four patients have been treated with V-B12 for vasoplegia in various isolated case reports and one series. Although 75% of patients have increased blood pressure in response to V-B12, there were some "non-responders". The true efficacy remains unknown because clinical trials have not been performed, and significant reporting bias likely exists. Plausible biochemical explanations exist for the potential beneficial effects of V-B12 in treating vasoplegia, including binding nitric oxide and other gasotransmitters. Additional research is required to clarify if and how these mechanisms are causally involved in effective clinical responders and non-responders. CONCLUSIONS: Although anecdotal reports utilizing V-B12 for vasoplegia are available, no higher-level evidence exists. Future work is necessary to further understand the dosing, timing, adverse events, and biochemical mechanisms of V-B12 compared with other therapies such as methylene blue. SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/31346957/Vitamin_B12_for_the_treatment_of_vasoplegia_in_cardiac_surgery_and_liver_transplantation:_a_narrative_review_of_cases_and_potential_biochemical_mechanisms L2 - https://dx.doi.org/10.1007/s12630-019-01449-x DB - PRIME DP - Unbound Medicine ER -