Local Cutaneous Necrosis Secondary to a Prolonged Peripheral Infusion of Methylene Blue in Vasodilatory Shock

Dumbarton, Tristan C.; Gorman, Sean K; Minor, Samuel; Loubani, Osama; White, Fletcher A.; Green, Robert C.

doi:10.1345/aph.1q560

Cited by 30 publications

(22 citation statements)

References 26 publications

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“…Furthermore, oxidization of methylene blue into deaminized oxide free radicals may cause independent cytotoxic cellular injury. 38 Topical organic nitrates may be a therapeutic option for the reversal of methylene blueinduced vasospasm because they increase nitric oxide tone. Animal studies indicate that methylene blue may also produce a downstream release of norepinephrine through effects independent of its activity on cGMP.…”

Section: Methylene Blue (Methylthioninium Chloride)mentioning

confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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Extravasations are common manifestations of iatrogenic injury that occur in patients requiring intravenous delivery of known vesicants. These injuries can contribute substantially to patient morbidity, cost of therapy, and length of stay. Many different mechanisms are behind the tissue damage during extravasation injuries. In general, extravasations consist of four different subtypes of tissue injury: vasoconstriction, osmotic, pH related, and cytotoxic. Recognition of high-risk patients, appropriate cannulation technique, and monitoring of higher risk materials remain the standard of care for the prevention of extravasation injury. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. The best therapeutic agent for treatment of vasopressor extravasation is intradermal phentolamine. Topical vasodilators and intradermal terbutaline may provide relief. Intradermal hyaluronidase has been effective for hyperosmotic extravasations, although its use largely depends on the risk of tissue injury and the severity of extravasation. Among the hyperosmotic agents, calcium extravasation is distinctive because it may present as an acute tissue injury or may possess delayed clinical manifestations. Extravasation of acidic or basic materials can produce significant tissue damage. Phenytoin is the prototypical basic drug that causes a clinical manifestation known as purple glove syndrome (PGS). This syndrome is largely managed through preventive and conservative treatment measures. Promethazine is acidic and can cause a devastating extravasation, particularly if administered inadvertently through the arteriolar route. Systemic heparin therapy remains the accepted treatment option for intraarteriolar administration of promethazine. Overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. More research is needed to improve knowledge of patient risk, prompt recognition of the extravasation, and time course for tissue injury, and to develop prevention and treatment strategies for extravasation injuries.

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Section: Methylene Blue (Methylthioninium Chloride)mentioning

confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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“…One recent adjustment we have made in our coordinated surgical protocol with our oncologic surgeons is to rely solely an radionucleotide and discourage the use of methylene blue in the identification of sentinel nodes, because the use of methylene blue has been associated with a higher risk of wound skin edge necrosis, [31][32][33][34] and this indeed played a role in our series.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Safety, Predictability, and Aesthetics in Direct to Implant Immediate Breast Reconstruction

Kalus

Swartz

Metzger

2016

Annals of Plastic Surgery

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Direct to implant reconstruction can be technically more demanding and exacting than 2-stage expander/implant reconstructions. A review of this single surgeon series confirms that despite a learning curve with a higher complication rate early in the series, in the setting of proper patient selection DTI immediate reconstruction is both safe and reliable, and can potentially have clinical, psychological, and aesthetic advantages for patients when compared with a 2-stage expander/implant reconstruction, with 40% of patients having 1 operation only. The use of a patented 2-D template has reduced complications and the rate of reoperation.

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“…Ideally, it should be administered via central venous access as tissue necrosis may occur on extravasation 36. The use of methylene blue is particularly treacherous in patients with glucose-6-phosphate dehydrogenase deficiency as, in this population, it confers an increased risk of haemolytic anaemia 13.…”

Section: Discussionmentioning

confidence: 99%

A severe case of vasoplegic shock following metformin overdose successfully treated with methylene blue as a last line therapy

Graham¹,

Cartner

Winearls

2015

BMJ Case Reports

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A 44-year-old man presented to hospital 24 h after an intentional overdose of metformin and gliclazide. He had a critical metabolic acidosis on presentation with a pH of 6.88, and very rapidly deteriorated into distributive shock refractory to large volume fluid resuscitation and massive doses of vasopressors. We introduced a methylene blue infusion as a rescue therapy in an attempt to improve the patient's haemodynamics, which was successful. The patient made a full recovery with no long-term sequelae.

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Local Cutaneous Necrosis Secondary to a Prolonged Peripheral Infusion of Methylene Blue in Vasodilatory Shock

Cited by 30 publications

References 26 publications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Optimizing Safety, Predictability, and Aesthetics in Direct to Implant Immediate Breast Reconstruction

A severe case of vasoplegic shock following metformin overdose successfully treated with methylene blue as a last line therapy

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