Indocyanine green dye administration can cause oxygen desaturation

Abstract

Indocyanine green (ICG) video-angiography is used intraoperatively to visualize the vascular integrity during neurovascular surgical procedures [1]. Oxygen desaturation following ICG injection has not been described previously nor is it mentioned in the list of adverse effects of the dye by the manufacturer.We report here a 42-year-old female who underwent clipping of the basilar artery aneurysm. The ICG dye (Aurogreen TM , Aurolab, Madurai, India) was injected at the recommended dose of 0.25 mg/kg before clip application to visualize the vessels and their branches. After clipping, ICG was repeated to confirm correct clip placement and patency of parent and perforator vessels. On both occasions, there was reduction in the pulse-oximeter saturation reading (99-96 %), the decrease more after the second dose (94 %). We had a monitor (Radical-7 Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) where we observed that the methemoglobin level too increased during desaturation from 0.2 to 0.9 % and gradually returned to previous value in 8 min along with return of saturation to 99 %. The patient did not have any complications associated with these changes. This finding was reproducible and consistent in other patients as well. Decreased pulse-oximeter reading has been observed in dogs following ICG administration [2]. Therefore, though the change is insignificant and transient, it is desirable that this effect be listed by the manufacturer in the list of side effects. Caution should be exercised when repeat doses of ICG are administered especially within short periods of time.

Concerns and challenges during anesthetic management of aneurysmal subarachnoid hemorrhage

“…[ 26 ] However, ICG can cause transient oxygen desaturation. [ 27 ] IMD use confirms aneurysm isolation and patency of parent vessel and branching arteries. Hui et al .…”

The Influence of Flow Velocity in the Feeding Vessel on Flap Perfusion in Deep Inferior Epigastric Artery Perforator Flap

“…6 All ICG angiographic images were acquired in the arterial phase to ensure consistency in measurements. After intravenous ICG injection, the sound of the saturation monitor changed after 50 to 70 seconds of dwell time, which is when the oximetry desaturation occurs because of the ICG 15 or when ICG is believed to enter the systemic circulation during imaging. The contralateral flap perfusion was marked from the midline of the flap, and a photograph was taken using a digital camera and a scale.…”

Intravenous Injection of Indocyanine Green Results in an Artificial Transient Desaturation by Pulse Oximetry

“…The phenomenon was first described in humans as an anecdotal report in 2013. 8,9 Furthermore, inaccuracy in pulse oximetry measurement has been attributed to interference by several intravenous dyes including methylene blue, ICG, and indigo carmine, as well as placement over dark nail polish and under fluorescent and xenon arc surgical lamps. 10 Here, we present the first posited mechanism of artificial desaturation in children undergoing transpupillary thermotherapy using ICG for the treatment of retinoblastoma.…”