What is “Vasoplegia Syndrome” and how to manage it ???

The development of systemic inflammatory response during cardiopulmonary bypass may cause severe generalized vasodilation , known as “Vasoplegia syndrome”, which can result in increased early mortality , especially in heart transplant reciopients.
This syndrome is associated with prolonged cardiopulmonary bypass time , orthotropic heart transplantation , and LV assist devices insertion and is characterized by sever persistent hypotension , metabolic acidosis , decreased SVR and low intracardiac filling pressures , with normal or elevated CO.
Perioperative Risk factors include preoperative ACE inhibitor , CCB or IV heparin use and Poor LV function .
development of Vasoplegia syndrome may be related to the release of Vasodilatory inflammatory mediators , extensive complement activation or vasoactive substance depletion , such as vasopressin .
Although catecholamine therapy is often ineffective , methylene blue (through a nitric oxide- inhibition mechanism ) and vasopressin have been shown to improve outcome . 
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