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Parathyroid surgery and methylene blue: A review with guidelines for safe intraoperative use
Author(s) -
Pollack Geoffrey,
Pollack Aron,
Delfiner Joel,
Fernandez John
Publication year - 2009
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20581
Subject(s) - methylene blue , medicine , serotonin syndrome , serotonin , anesthesia , surgery , intensive care medicine , chemistry , biochemistry , receptor , photocatalysis , serotonergic , catalysis
Methylene blue has been used to help facilitate parathyroid surgery for over 30 years. Its use has been widely considered both safe and cost effective. Twenty‐six cases of a toxic metabolic encephalopathy, however, have been reported with its use. As a result, some surgeons have stopped using this technique altogether. It is now known that methylene blue is a monoamine oxidase inhibitor. When combined with drugs that increase central serotonin neurotransmission, serotonin toxicity results. This is the cause of the encephalopathy described in the literature. A case report, review of the literature, and guidelines as to its proper use are presented so as to allow for safe parathyroid surgery. Laryngoscope, 2009