LAUSR

Vasoplegia continues to be a major challenge facing clinicians during the periprocedural care of cardiac surgical patients. The incidence of vasoplegia, particularly in the heart transplant from the left ventricular assist device population, maybe as high as approximately 50%.[1,2] The precise pathophysiology of vasoplegia is not known but is thought to be related to a combination of dysregulation of nitric oxide synthase and cyclic guanylate cyclase, as well as elevated levels of interleukins and other inflammatory molecules.[3‐5] Treatments have included high doses of vasoconstrictors such as norepinephrine and vasopressin, corticosteroids, and alternatives such as methylene blue, hydroxocobalamin, and angiotensin II.[6‐9] While these treatments have some efficacy, they have risks, and it may be time to approach the problem from a new perspective: prevention.