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Patent blue sentinel node mapping in cervical cancer patients may lead to decreased pulse oximeter readings and positive methaemoglobin results

Published online by Cambridge University Press:  01 May 2008

H. Kieckbusch ,
S. M. Coldewey ,
J. Hollenhorst ,
G. Haeseler ,
P. Hillemanns  and
H. Hertel
H. Kieckbusch
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
S. M. Coldewey
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
J. Hollenhorst
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
G. Haeseler*
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
P. Hillemanns
Affiliation:
Hannover Medical School, Department of Obstetrics and Gynecology, Hannover, Germany
H. Hertel
Affiliation:
Hannover Medical School, Department of Obstetrics and Gynecology, Hannover, Germany
*
Correspondence to: Gertrud Haeseler, Department of Anesthesiology; OE8050, Hannover Medical School, D-30623 Hannover, Germany. E-mail: Haeseler.Gertrud@MH-Hannover.de; Tel: +49 511 532 6873; Fax: +49 511 532 3642
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Summary

Background and objective

Patent blue (4-[(4-diethylaminophenyl)-(4-diethylazaniumylidencyclohexa-2,5-dienyliden) methyl]-6-hydroxy-3-sulfo-benzolsulfonate, sodium salt) is a contrast dye used for the intraoperative detection of the primary lymphatic nodes draining the area of tumour infiltration. The dye is known to interact with pulse oximeter readings. However, the degree of alteration seems to be moderate and predictable when patent blue is injected into the perimammilar region during breast surgery.

Methods

Here we report severe interference with the anaesthetic monitoring when patent blue was injected into the cervix prior to laparoscopy-assisted radical vaginal hysterectomy for cervical cancer.

Results

Injection of patent blue into the cervix induced a rapid (within 14 ± 9 min after the injection) and severe (from ⩾98% to 89 ± 2%) decrease in pulse oximeter readings, accompanied by positive methaemoglobin values of 7.3 ± 2.5% (arterial co-oximetry, Bayer Rapidlab 865 blood gas analyser; Bayer, Fernwald, Germany). Control of these values by a different device (Radiometer ABL co-oximeter blood gas analyser; Radiometer, Willich, Germany) yielded negative methaemoglobin results (<1.7%, mean 0.9 ± 0.6%). The arterial PO2 was normal in all patients throughout the procedure.

Conclusion

Injection of patent blue into the cervix uteri interferes dramatically with pulse oximeter readings. This situation is further complicated by device-dependent arterial co-oximetry methaemoglobin results. For the time being it is recommendable to monitor adequate oxygenation of the patient in the presence of patent blue by regular control of the arterial PO2. Clearly, the unresolved issue of reliable methaemoglobin determination in the presence of patent blue remains a matter of clinical concern for anaesthetists.

Keywords

OXIMETRY, pulse oximeter, arterial bloodSENTINEL LYMPH NODE BIOPSYPATENT BLUE VIOLETMETHAEMOGLOBIN
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 5 , May 2008 , pp. 365 - 368
Copyright
Copyright © European Society of Anaesthesiology 2008

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