Effects of indigo carmine intravenous injection on noninvasive and continuous total hemoglobin measurement

Abstract

The effects of an intravenous injection of indigo carmine on noninvasive and continuous total hemoglobin (SpHb) measurement were retrospectively evaluated. The subjects were 21 patients who underwent elective gynecologic surgery under general anesthesia. During surgery, 5 mL of 0.4 % indigo carmine was intravenously injected, and subsequent changes in SpHb concentrations were evaluated. The results demonstrate that the pre-injection SpHb level was 10 g/dL, and the minimum post-injection SpHb level was 8.3 g/dL. The amount of decrease was 1.8 g/dL. The time to reach the minimum value was 4 min, and the time to return to the pre-injection value was 15 min. The decrease in SpHb was greater in the group with a perfusion index (PI) < 1.4 than in the group with a PI > 1.4. The assessment of SpHb after an intravenous injection of indigo carmine necessitates caution.

Impact of Increased End-Tidal Carbon Dioxide on Continuous Noninvasive Hemoglobin Monitoring during Laparoscopic Gastrectomy: A Randomized Controlled Study

“…Similarly, the accuracy of pulse CO-Oximetry has been evaluated using the SpHb and tHb values. In there, SpHb has shown clinical usefulness but was affected by various factors [7][8][9][10][11][12]. In previous studies, altered PaCO 2 levels affected the accuracy and reliability of oxygen saturation in pulse oximetry [13].…”

“…Twenty-five SpHb measurements (7.8%, 13 in the low CO 2 group and 12 in the high CO 2 group) were excluded because the PI was <1.0. The mean PI values for the remaining SpHb measurements were 3.9 ± 2.0 [1-8.2]% in the low CO 2 group and 4.2 ± 2.5 [1][2][3][4][5][6][7][8][9][10][11][12]% in the high CO 2 group (Table 1). Finally, 295 paired measurements of SpHb and tHb were analyzed (92.2%, 147 in the low CO 2 group and 148 in the high CO 2 group).…”

“…Several clinical studies have investigated the accuracy, precision, and trending ability of SpHb in various conditions including indigo carmine, anemia, cardiopulmonary bypass, transplantation, trauma, dark-skinned and hemodilution [7][8][9][10][11][12]. In a previous study, altered arterial CO 2 pressure (PaCO 2 ) impaired the agreement between oxygen saturation calculated from arterial blood analyzers and that measured with pulse oximetry [13].…”

Indigo Carmine: Between Necessity and Concern

“…Indigo carmine is mainly excreted by the kidneys [ 101 , 102 ]; it quickly reaches the urine, and due to the small size of the particles, it allows them to be easily filtered by the kidneys without tubular resorption [ 103 , 104 ]. It has been observed that indigo carmine does not affect renal function and is cleared from the circulation in the bladder within 5–7 min [ 103 ].…”

“…Indigo carmine is used in gynecological and urological surgeries in combination with cystoscopy to evaluate urethral conditions and urine production during genitourinary surgeries [ 98 , 100 , 104 , 110 , 111 , 112 ]. It is administered intravenously, and the recommended dye concentration is 0.4% [ 104 , 112 ]. Indigo carmine is often used in gynecology because, unlike methylene blue, it has not been reported to induce teratogenic changes [ 113 ].…”