Methylene-Blue–Associated Encephalopathy

Intraoperative adjuncts in surgery for primary hyperparathyroidism

“…There is currently growing clinical and experimental evidence that MB can be associated with significant morbidity, in particular toxic encephalopathy [110][111][112][113][114][115][116][117][118][119][120][121][122][123]. MB appears to have additive or synergistic effects with anesthetic agents and may cause transient neurological dysfunction in the postoperative period [117], particularly in patients taking serotonin reuptake inhibitors (antidepressants) [107].…”

A Case of a Retroesophageal Parathyroid Adenoma with an Aberrant Right Subclavian Artery: A Potential Surgical Pitfall

“…9) Some studies reported symptoms of severe mental symptoms leading to encephalopathy because of increased central serotonin transmission and nitric oxide inhibition by the methylene blue. [10][11][12] Careful monitoring is needed to use it. In this case, we could complete the resection owing to the accurate localization of the adenoma and the anatomical knowledge of the esophagus and ARSA using preoperative 3D-CT. We previously used 3D-CT to provide an accurate anatomical location of the abnormal artery, which was useful in planning our surgical approach.…”

Methylene Blue and Dialysis-Related Hypotension

“…Encephalopathy has been noted in one series that included five patients that received preoperative intravenous MB (3-5 mg/kg in 500 mL saline) for parathyroid adenoma localization. All five cases of encephalopathy occurred in female patients taking serotonin-metabolism modifying agents [58]. In the neonatal and pediatric populations, enteral MB administration of >2 mg/kg has been associated with severe methemoglobinemia, hemolytic anemia, Heinz body anemia, and hyperbilirubinemia [53].…”