Adverse events associated with the intraoperative injection of isosulfan blue

Daley, M. Denise; Norman, Peter H.; Leak, Jessie A.; Nguyen, Dy Tien; Bui, Thao Phuong; Kowalski, Alicia M.; Srejic, Una; Popat, Keyuri; Arens, James F.; Gershenwald, Jeffrey E.; Hunt, Kelly K.; Kuerer, Henry Mark

doi:10.1016/j.jclinane.2003.09.013

Cited by 23 publications

(17 citation statements)

References 26 publications

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“…We have also reported potential risk factors for the development of an adverse event after lymphatic mapping in a variety of malignancies. 35 Although there was a trend towards an increased incidence of adverse events with isosulfan blue dye injection in the breast (compared with other sites), this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 88%

Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis

Raut

Hunt

Akins

et al. 2005

Cancer

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BACKGROUNDSevere anaphylactoid reactions to isosulfan blue dye requiring resuscitation are reported to occur in 1.1% of patients with breast carcinoma undergoing sentinel lymphadenectomy. In December 2001, the authors began administering a prophylactic regimen before dye injection to determine whether prophylaxis reduced the incidence of life‐threatening reactions.METHODSAll patients were mapped with technetium‐99m–labeled sulfur colloid. Those also receiving isosulfan blue dye were administered a glucocorticoid, diphenhydramine, and famotidine intravenously just before or at induction of anesthesia. Adverse reactions at the time of surgery were analyzed.RESULTSBetween December 2001 and July 2003, 1013 consecutive patients underwent sentinel lymphadenectomy for breast carcinoma. Six hundred sixty‐seven patients (65.8%) received prophylaxis and isosulfan blue dye, 33 (3.3%) received prophylaxis but no dye, 12 (1.2%) received dye but no prophylaxis, and 301 (29.7%) received no prophylaxis or dye. Blue urticaria and facial edema were observed in 3 (0.5%) of 667 patients receiving prophylaxis and dye and in 1 (8.3%) of 12 patients receiving dye but no prophylaxis. There were no episodes of hypotension, and no patients required vasopressors, ventilatory support, or intensive care observation. Adverse reactions to agents other than blue dye were observed in 2 (0.3%) of 667 patients receiving prophylaxis and dye and in 3 (1.0%) of 301 receiving no prophylaxis and no dye (P = 0.1773).CONCLUSIONSPreoperative prophylaxis was found to reduce the severity, but not the overall incidence, of adverse reactions to isosulfan blue dye. No life‐threatening reactions were noted in patients treated with preoperative prophylaxis. Based on these results, the authors now routinely recommend administration of prophylaxis to patients receiving isosulfan blue for lymphatic mapping and sentinel lymph node biopsy. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 88%

Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis

Raut

Hunt

Akins

et al. 2005

Cancer

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“…The other similar large-scale retrospective analysis done in the USA for 1835 patients undergoing 1852 procedures involving isosulphan blue dye injections showed a similar incidence of adverse events in 28 patients (1.5%) of which 0.75% were classified as major or having hypotension. [2] The time of onset for adverse events was 42.2–53.9 min (median, 17.5; range 1–180 min) after isosulphan blue injection, and was significantly longer for minor reactions compared with major events ( P <0.015). In yet another analysis involving 637 patients,[13] preoperative prophylaxis with chlorpheniramine, hydrocortisone, and famotidine was found to reduce the severity, but not the overall incidence, of adverse reactions to isosulphan blue dye.…”

Section: Discussionmentioning

confidence: 99%

“…[12] Sodium or calcium salt of diethylammonium hydroxide inner salt, it is a Food and Drug Administration approved substance having ubiquitous application in textile and paper industry, agriculture and cosmetics.…”

Section: Introductionmentioning

confidence: 99%

Adverse drug reaction, patent blue V dye and anaesthesia

Tripathy

Nair

2012

Indian J Anaesth

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Background and Aim:Patent blue vital (PBV) dye is used for varied perioperative indications, and has a potential for causing life-threatening allergic reactions. In this retrospective case series study, at a tertiary level neurosciences centre, we analysed the nature, management and outcome of adverse drug reaction to the preoperative use of PBV for marking vertebral level prior to back surgeries.Methods:Patients were identified from the theatre and radiology database. Data were collected from the patients’ notes retrieved from the medical records division.Results:Eleven of 1247 (0.88%) patients experienced adverse reactions: 6 (0.48%) patients had minor grade I reactions (urticaria, blue hives, pruritis or generalised rash), 4 (0.32%) had grade II reactions (transient hypotension/bronchospasm/laryngospasm) and grade III reaction (hypotension requiring prolonged vasopressor support) was noted in 1 (0.08%) patient. No mortality was seen. The time of onset (range 10–45 min) frequently coincided with induction of anaesthesia or prone positioning of patient. Seven (63.6%) cases were cancelled or postponed (range 2–63 days). Treatment varied independent of the grade of reaction. Allergy workup (often incomplete) was done for 6 (54%) patients.Conclusion:An awareness of the time of onset and infrequency of life-threatening reactions to patent blue dye may result in better management, less postponement, more complete workup and referral of these events.

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“…Furthermore, this procedure is associated with very few complications. The most commonly reported adverse effects are skin reactions 30, 31 and hypotension 32; however, the incidence of adverse effects is reported to be only 0.9–2.0%. Furthermore, Stadelmann et al experienced very faint residual blue hue at the injection sites, which is not considered permanent 17.…”

Section: Discussionmentioning

confidence: 99%