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All you ever (never?) wanted to know about indigo carmine & methylene blue .

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…….

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All you ever (never?) wanted to know about indigo carmine & methylene blue .

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  1. All you ever (never?) wanted to know about indigo carmine & methylene blue. Yee l. kwan, rn, ccrn Dunap, class of 2013 April 9th, 2012

  2. all about the blue stuff… • By the end of this presentation you should be able to……. • List the indications for use of indigo carmine (IC) and methylene blue (MB) • Identify risks associated with the use of these drugs • Discuss some off-label uses for these drugs

  3. 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

  4. CASE STUDIES • Hypertensive crisis • Anaphylactoid reaction • Bradycardia • Cardiac arrest

  5. 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

  6. Case studies • Encephalopathy • Serotonin toxicity • Vasoplegic syndrome • Alternative to lidocaine • Cure for Alzheimers?

  7. In summary….. • More studies needed • There is no such thing as a benign drug • A wise man once said…”Titrate, titrate, titrate.”

  8. 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?

  9. 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 canadiend'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

  10. 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 cardio-thoracic 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

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