Transcript You Ever (Never?)

ALL YOU EVER (NEVER?)
WANTED TO KNOW
ABOUT INDIGO
CARMINE & METHYLENE
BLUE.
YEE L. KWAN, RN, CCRN
DUNAP, CLASS OF 2013
APRIL 9 TH , 2012
ALL ABOUT THE BLUE STUFF…
By the end of this presentation you should be
able to…….
1. List the indications for use of indigo
carmine (IC) and methylene blue (MB)
1. Identify risks associated with the use of
these drugs
2. Discuss some off-label uses for these
drugs
INDIGO CARMINE
• Dye
• Concentrated by kidneys, excreted in urine
• Diagnosis/visualization of urinary
fistulae/ureteral orifices during cysto
• Endoscopic examination of gastric CA
• Adjustments to catheters for chemo in
hepatic & oralmaxillo-facial tumors.
• Give undiluted IVP or intramuscularly
• 40-80mg (5-10ml) – 0.8% sol’n
• Generally considered pharmacologically
inert
CASE STUDIES
• Hypertensive crisis
• Anaphylactoid reaction
• Bradycardia
• Cardiac arrest
METHYLENE BLUE
• Dye
• 75% of dose excreted renally
• Diagnosis/visualization of urinary
fistulae/ureteral orifices during
cysto
• 1-2mg/kg IVP over several minutes
• Do NOT give SQ or IM
• Many interesting uses
CASE STUDIES
• Encephalopathy
• Serotonin toxicity
• Vasoplegic syndrome
• Alternative to lidocaine
• Cure for Alzheimers?
IN SUMMARY…..
1. More studies needed
2. There is no such thing as a
benign drug
3. A wise man once
said…”Titrate, titrate, titrate.”
QUESTIONS FOR
THOUGHT…..
• Will you think about this the next
time you go to give either of these
drugs?
• Would you give MB as a treatment
for vasoplegic syndrome?
• How about MB for pain of propofol
injection?
References:
Flewellen, E. H. (1980). Hazards of intravenous indigo carmine, fluorescein, and methylene blue. Texas medicine,
76(10), 49-51.
Gillman, P. K. (2011). CNS toxicity involving methylene blue: the exemplar for understanding and predicting drug
interactions that precipitate serotonin toxicity. [Review]. Journal of psychopharmacology, 25(3), 429-436. doi:
10.1177/0269881109359098
Gousse, A. E., Safir, M. H., Madjar, S., Ziadlourad, F., & Raz, S. (2000). Life-threatening anaphylactoid reaction
associated with indigo carmine intravenous injection. [Case Reports]. Urology, 56(3), 508.
Jeffords, D. L., Lange, P. H., & DeWolf, W. C. (1977). Severe hypertensive reaction to indigo carmine. [Case
Reports]. Urology, 9(2), 180-181.
McDonagh, D. L., McDaniel, M. R., & Monk, T. G. (2007). The effect of intravenous indigo carmine on near-infrared
cerebral oximetry. [Case Reports Research Support, Non-U.S. Gov't]. Anesthesia and analgesia, 105(3), 704-706.
doi: 10.1213/01.ane.0000271917.20429.50
Naitoh, J., & Fox, B. M. (1994). Severe hypotension, bronchospasm, and urticaria from intravenous indigo carmine.
[Case Reports]. Urology, 44(2), 271-272.
Parlow, J. L., & van Vlymen, J. M. (2008). [The methylene blues: anticipating adverse reactions to non-anesthetic
drugs]. [Comment
Editorial]. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 55(1), 1-5. doi: 10.1007/BF03017590
Salman, A. E., Salman, M. A., Saricaoglu, F., Akinci, S. B., & Aypar, U. (2011). Pain on injection of propofol: a
comparison of methylene blue and lidocaine. [Comparative Study
Randomized Controlled Trial]. Journal of clinical anesthesia, 23(4), 270-274. doi: 10.1016/j.jclinane.2010.09.008
Satoh, K., Sakamoto, N., Shinohe, Y., Satoh, M., & Joh, S. (2001). Indigo carmine-induced bradycardia in a patient
during general anesthesia. [Case Reports]. Anesthesia and analgesia, 92(1), 276-277.
Shanmugam, G. (2005). Vasoplegic syndrome--the role of methylene blue. [Review]. European journal of cardiothoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 28(5), 705-710. doi:
10.1016/j.ejcts.2005.07.011
Stanford, S. C., Stanford, B. J., & Gillman, P. K. (2010). Risk of severe serotonin toxicity following co-administration
of methylene blue and serotonin reuptake inhibitors: an update on a case report of post-operative delirium. [Case
Reports Review]. Journal of psychopharmacology, 24(10), 1433-1438. doi: 10.1177/0269881109105450
Sweet, G., & Standiford, S. B. (2007). Methylene-blue-associated encephalopathy. [Research Support, Non-U.S.
Gov’t Review]. Journal of the American College of Surgeons, 204(3), 454-458. doi:
10.1016/j.jamcollsurg.2006.12.030