Wondering if anyone has seen alternative uses of methylene blue? Specifically I am asking about vasoplegic hypotensive syndrome or just vasoplegic syndrome. Last week we had a patient who had a consistent MAP of 40-50 after coming off a very long CPB run (>225 minutes). He was on large does of Phenylephrine, Norepinephrine, epinephrine, vasopressin and was receiving large amounts of volume based on TEE views of left ventricular filling. CI was high to normal, pt was normothermic. Still couldn't get his pressure up and anesthesia was asked by the surgeon to give methylene blue. Current literature suggests a dose of 1.5mg/kg over an hour (found this out post case after doing research). We gave the methylene blue and within 30 minutes his pressure had stabilized although we left the chest open. Within 2 hours the SICU was able to wean down some of his pressors and the next day he was brought back to have his chest closed and is doing well. Anybody used this drug in this fashion? Students - can you explain the mechanism of action? I learned something new and it was exciting, sent all of us off to research it. Wanted to share and get feedback from others. Thanks.