Intra-operative Dyes

Question 1

Which of the dyes do we try to use most often due to its lack of issues compared to the other dyes?

Answer 1

Fluorescein dye

Question 2

Which of the dyes will temporarily cause a drop in SpO2? (only according to the pulse ox though)

Answer 2

Methylene blue

Question 3

Fluorescein Dye dose (conc.):

Onset:

Answer 3

Dose: dependent upon practitioners
50-100 mg IV

(100 mg/cc)

Onset: usually works within 5 mins

Question 4

Indigo Carmine dose (conc.):

Answer 4

5 mL
(8 mg/cc)

Question 5

Symptoms of severe serotonin toxicity:

Answer 5

CNS excitation –> rigidity, respiratory failure
Mental state –> confusion, coma
Autonomic excitation –> severe hyperthermia

Question 6

Fluorescein Dye precautions:

Answer 6

bronchial asthma

avoid extravasation

Question 7

Indigo Carmine (uses):

Answer 7

Inactive blue dye routinely given IV during urologic and gynecologic procedures to localize the ureteral orifices

Question 8

Methylene Blue precautions:

Answer 8

Can induce severe, potentially fatal serotonin toxicity syndrome

careful with BLUE ARM syndrome

Question 9

Fluorescein Dye (uses):

Answer 9

Used to visualize ureters during cystoscopy
intraoperative urologic dye marker

Question 10

Methylene Blue MOA:

Answer 10

Potent Monoamine oxidase inhibitor (MOAI)

Interacts with serotonin reuptake inhibitors ( selective and nonselective) and

SSI/SSRI and SNRI (serotonin-norepinephrine) –> can induce severe, potentially fatal serotonin toxicity

Question 11

Indigo Carmine s/e:

Answer 11

Can see hypertension due to increased PVR with increased HR

Can see increased BP with reflex decrease in HR

On rare occasion can see hypotension, cardiac arrest, and cerebral ischemia