Methylene blue infusion for intraoperative identification of the parathyroid glands

Abstract

Identifying the parathyroid glands is of fundamental importance in thyroid and parathyroid surgery. We found that intravenous infusion of methylene blue was beneficial in intraoperative identification of the parathyroid glands in patients undergoing surgery for hyperparathyroidism as well as total and bilateral subtotal thyroidectomy. The technique is safe and easy to use, and it clearly reduces the operative time. We suggest that it be used routinely in thyroid and parathyroid surgery.

Intraoperative adjuncts in surgery for primary hyperparathyroidism

“…There are no prospective studies published on this topic. Many retrospective studies describe its use [90][91][92][93][94][95][96][97][98][99][100][101][102][103], five of them originating from the same center [104][105][106][107][108]. Two of them showed a small but significant reduction in the duration of surgery [107,109].…”

Methylene Blue-Associated Serotonin Syndrome: A ‘Green’ Encephalopathy After Parathyroidectomy

“…In vitro experiments also show that intravenous doses of MB inhibit monoamine oxidase (MAOI) [7] and may have direct hippocampal neuronal toxicity in rats [5]. The use of MB greatly aids visualization of the parathyroid glands during parathyroidectomy and is given as a preoperative infusion of 5-10 mg/ kg over 45-60 min [1,2,[8][9][10]. After intravenous infusion, it is rapidly accumulated in the parathyroid glands, and animal studies demonstrate rapid CNS accumulation after intravenous administration [11].…”

“…Ng et al [18] reviewed a total of eight cases of MB neurotoxicity (including their own patient) and all but one patient were on concomitant serotonin-modulating drugs. The signs and symptoms reported with MB encephalopathy (doses ranged from 1.75 mg/kg to 7.5 mg/kg [4,9,[19][20][21][22] include aphasia, confusion, agitation, decreased level of consciousness, nystagmus, dilated and non-reactive pupils, bilateral upgoing plantar reflexes, shivering, and pyrexia [6,15,19,21].…”

Vertical Restraints Facilitating Horizontal Collusion: ‘Stretching’ Agreements in a Comparative Approach

“…Miles 167 with forced arguments such as lack of evidence of 'agreement'. 168 However, after Legin, 169 they can be judged more 'on the merits'. 170 In the FTC challenge of MAPs under Section 5, 171 the five largest USA music distributors imposed simultaneously and openly a similar rigid MAP policy toward retailers that led to an increase in CD prices.…”

“…168 However, after Legin, 169 they can be judged more 'on the merits'. 170 In the FTC challenge of MAPs under Section 5, 171 the five largest USA music distributors imposed simultaneously and openly a similar rigid MAP policy toward retailers that led to an increase in CD prices. The main reason was that intense retail competition increased concentration in the industry, which might represent countervailing power to music distributors in the future.…”