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Hyperpyrexia and prolonged postoperative disorientation following methylene blue infusion during parathyroidectomy
Author(s) -
Mathew S.,
Linhartova L.,
Raghuraman G.
Publication year - 2006
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2006.04619.x
Subject(s) - medicine , methylene blue , parathyroidectomy , anesthesia , surgery , hyperparathyroidism , shivering , parathyroid hormone , calcium , biochemistry , chemistry , photocatalysis , catalysis
Summary A 65‐year‐old man underwent parathyroidectomy for hyperparathyroidism secondary to renal failure. Intra‐operatively he received methylene blue infusion (7.5 mg.kg −1 , a total of 650 mg in 500 ml 0.9% sodium chloride) for visualisation of parathyroid glands. At the end of surgery, following extubation he developed agitation, intense shivering and hyperpyrexia, and his level of consciousness decreased to a Glasgow Coma score of 7. The differential diagnoses included methylene blue toxicity or malignant hyperpyrexia. His lungs were ventilated, and intravenous dantrolene was administered to control hyperpyrexia. Haemodialysis was started to remove the methylene blue dye. We review the literature on the pharmacological actions of methylene blue, and discuss the differential diagnosis and management of this patient.