Table 1.

Pharmacologic options for the treatment of post-CPB vasoplegia.

	Class	Drug	Cautions
Treatment	Vasopressor	Catecholamines	Well studied and familiar, however, clear risks (end-organ damage) exist with prolonged infusion.
		Vasopressin	Second line for vasoplegia. Risk for mesenteric malperfusion.
		Angiotensin II	Newest agent for high-output shock. Yet to be studied in the cardiac surgery population.
	Non-vasopressor	Corticosteroids	Extensively studied in septic shock, less so in cardiac surgery. May result in hyperglycemia, GI bleeding.
		Ascorbic acid	Dearth of high-quality evidence for its use both in septic shock and cardiac surgery.
		Methylene blue	May decrease norepinephrine requirement but can increase PVR. Monoamine oxidase inhibitory effects represent a contraindication in patients taking selective serotonin reuptake inhibitors or other serotonergic medications.
		Hydroxocobalamin	Under investigation for post-CPB vasoplegia. May cause dialysis alarms due to chromaturia.

GI: gastrointestinal; PVR: pulmonary vascular resistance.