Neurological sequelae following methylene blue injection for parathyroidectomy

Martindale, Sarah J.; Stedeford, J. C.

doi:10.1046/j.1365-2044.2003.03415_23.x

Cited by 58 publications

(57 citation statements)

References 4 publications

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“…All of the patients experienced symptoms consistent with serotonin syndrome (or serotonin toxicity), including agitation, confusion, hypertonicity and clonus. [1][2][3][4][5][6][7] The most significant common feature of these cases is that five patients were concurrently taking a selective serotonin reuptake inhibitor (SSRI), or a serotonin norepinephrine reuptake inhibitor. One patient was receiving clomipramine, a tricyclic antidepressant with high serotonergic activity.…”

Section: Conclusion : Une Interaction Entre Le Bleu De Méthylène Et Lmentioning

confidence: 99%

Serotonin syndrome following methylene blue infusion during parathyroidectomy: A case report and literature review

Cameron

Liang

et al. 2008

Can J Anesth/J Can Anesth

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Section: Conclusion : Une Interaction Entre Le Bleu De Méthylène Et Lmentioning

confidence: 99%

Serotonin syndrome following methylene blue infusion during parathyroidectomy: A case report and literature review

Cameron

Liang

et al. 2008

Can J Anesth/J Can Anesth

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“…cases of transient neurological complications in relation to MB infusion have recently been reported in the medical literature [10][11][12][13][14][15][16][17][18]. Of note, no sensorimotor deficits have been reported and brain computed tomography (CT) scans were all unremarkable.…”

mentioning

confidence: 97%

“…Although considered to be safe, numerous adverse effects including nausea and vomiting, chest pain, hypertension or hypotension, dyspnoea, haemolysis and neuropsychological disturbances have been described after intravenous administration of MB in the dose range of 1-10 mg.kg )1 [1,7]. Following parathyroidectomy, 22cases of transient neurological complications in relation to MB infusion have recently been reported in the medical literature [10][11][12][13][14][15][16][17][18]. Of note, no sensorimotor deficits have been reported and brain computed tomography (CT) scans were all unremarkable.…”

mentioning

confidence: 99%

Effects of methylene blue on propofol requirement during anaesthesia induction and surgery

Licker

Diaper²,

Robert

et al. 2008

Anaesthesia

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SummaryDelayed emergence from anaesthesia and neurological disturbances have been reported in patients undergoing parathyroidectomy who received methylene blue (MB) pre-operatively. We hypothesised that MB would decrease propofol requirements. The Bispectral index (BIS) and a target-controlled infusion of propofol were used in two groups of 11 matched patients. Patients in one group were pretreated with MB. During induction, clinical sedation scores and BIS values were significantly lower at the predicted effect-site propofol concentration of 2 lg.ml )1 in the MB compared with the control group. Intra-operatively, although similar BIS values were achieved in the two groups, patients pretreated with MB required a mean 50% lower dose of propofol compared with controls. In view of these findings, care should be taken to ensure an adequate depth of anaesthesia by titrating the administration of anaesthetic agents whenever MB is infused peri-operatively. In addition to its use as an antidote for methaemoglobinaemia, the properties of methylthioninium chloride (methylene blue, MB) as a dye, antiseptic, vasopressor and psychotropic have extended its use for many medical applications [1,2]. In surgical practice, MB is often used for localisation of parathyroid adenoma, potentially preventing surgical nerve damage and reducing the operative time [3][4][5]. Moreover, by inhibiting the nitric oxide-cyclic guanylyl monophosphate (NO-cGMP) pathway, MB has also been advocated as a second line treatment for vasodilatory hypotension associated with cardiopulmonary bypass, liver transplantation, sepsis or the hepatopulmonary syndrome [6][7][8][9]. Although considered to be safe, numerous adverse effects including nausea and vomiting, chest pain, hypertension or hypotension, dyspnoea, haemolysis and neuropsychological disturbances have been described after intravenous administration of MB in the dose range of 1-10 mg.kg )1 [1,7]. Following parathyroidectomy, 22cases of transient neurological complications in relation to MB infusion have recently been reported in the medical literature [10][11][12][13][14][15][16][17][18]. Of note, no sensorimotor deficits have been reported and brain computed tomography (CT) scans were all unremarkable. The term 'MB-associated encephalopathy' has been coined to cover clinical manifestations, lasting from a few hours up to five days and ranging from disorientation to profound lethargy and coma with cardiorespiratory depression requiring tracheal re-intubation and resuscitation.In our clinical practice, we have witnessed several cases of delayed emergence from anaesthesia and prolonged confusional state after parathyroidectomy. We hypothesised that MB could potentiate the effects of general anaesthetic agents. Therefore, we compared propofol requirements during phases of anaesthesia induction and maintenance in two groups of patients, one of which received pretreatment with MB before undergoing parathyroid or thyroid surgery. In this case-controlled study general anaesthesia was conducted with a ta...

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“…In the four cases described, the mean surgical duration was 35 min (minimum 27 min, maximum 49 min). We went on to validate the success of this ultra-low CSE dose in a randomised, prospective trial in 44 normotensive, non-obese parturients undergoing elective Caesarean section, with only one failure in the ultra-low dose group [1]. The requirement to achieve a bilateral T6 sensory level within 10 min of induction of spinal anaesthesia in our study protocol dictated that some patients received epidural supplementation and were considered 'failures', despite the possibility that waiting longer may have allowed for adequate surgical anaesthesia to develop.…”

Section: A Replymentioning

confidence: 99%

A reply

Teoh¹,

Sia²

2006

Anaesthesia

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We thank Drs Verma and Agarwal for their interest in our report. We agree that 3 ml epidural lidocaine 1.5% is less than the volume of 10 ml reported to lead to a volume effect, but we had already described the multifactorial causes contributing to the success of this ultra-low CSE dose in providing adequate surgical anaesthesia. We acknowledge that the relatively short operating times in our institution may be another contributory factor. In the four cases described, the mean surgical duration was 35 min (minimum 27 min, maximum 49 min). We went on to validate the success of this ultra-low CSE dose in a randomised, prospective trial in 44 normotensive, non-obese parturients undergoing elective Caesarean section, with only one failure in the ultra-low dose group [1]. The requirement to achieve a bilateral T6 sensory level within 10 min of induction of spinal anaesthesia in our study protocol dictated that some patients received epidural supplementation and were considered 'failures', despite the possibility that waiting longer may have allowed for adequate surgical anaesthesia to develop. However, we believe that this 10-min timeframe is consistent with the realities of a busy operating suite and a high turnover rate. We conclude that this technique results in a significantly lower incidence of maternal hypotension, and has a role in high-risk parturients in whom maintenance of stable haemodynamics is imperative.

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Neurological sequelae following methylene blue injection for parathyroidectomy

Cited by 58 publications

References 4 publications

Serotonin syndrome following methylene blue infusion during parathyroidectomy: A case report and literature review

Serotonin syndrome following methylene blue infusion during parathyroidectomy: A case report and literature review

Effects of methylene blue on propofol requirement during anaesthesia induction and surgery

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