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A A Pract. 2018 Feb 1;10(3):57-60. doi: 10.1213/XAA.0000000000000630.

Methylene Blue to Treat Refractory Latex-Induced Anaphylactic Shock: A Case Report.

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From the Anesthesiology Service, Regional Hospital Alto Vale, Rio do Sul, Santa Catarina, Brazil.


Anaphylaxis occurs in 1/5000-1/20,000 of anesthesia cases and may evolve with shock and cardiovascular collapse in up to 54% of cases. Mortality varies from 3% to 10%. Latex is the second leading cause of anaphylaxis during the perioperative period. We report a case of latex-induced anaphylactic shock refractory to the usual catecholamine treatment that was reversed with the aid of methylene blue. Exaggerated activation of the nitric oxide-cyclic guanosine monophosphate pathway is observed in refractory shock. Methylene blue selectively inhibits this pathway.

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