Frangioni JV. Nitric oxide activates soluble guanylate cyclase to produce cyclic guanosine 3′,5′monophosphate (cGMP). Obstet Gynecol. Methylene blue is also well known to turn the urine greenish-blue [1,46]. Mortality after cardiac surgery was 24% in a series reported by Levin and colleagues [3] and 25% in a series reported by Gomes and colleagues [12], in which post-operative VS persisted for longer than 36–48 h. The duration of norepinephrine-refractory vasoplegia significantly influences outcome. Gioux S, Kianzad V, Ciocan R, Gupta S, Oketokoun R, Frangioni JV. It is not known whether the increased enzyme levels were related to the methylene blue, the associated norepinephrine, or both. If methemoglobin level remains >30% or if clinical symptoms persist, repeat dose up to 1 mg/kg 1 hr after the first dose, Treatment: 50 mg once or q4-8hr until symptoms resolve, Methemoglobinemia indication is approved under accelerated approval, Continued approval for this indication may be contingent upon verification of clinical benefit in subsequent trials, May cause serious or fatal serotonergic syndrome when coadministered with serotonergic drugs, Avoid coadministration with SSRIs, SNRIs, and MAOIs, Severe hypersensitivity reactions to methylene blue or any other thiazine dye, Patients with glucose-6-phosphate dehydrogenase deficiency (G6PD) due to the risk of hemolytic anemia, Hypersensitivity reactions (eg, anaphylaxis, angioedema, urticaria, bronchospasm) reported; monitor vital signs and ECG during treatment; if severe hypersensitivity occurs, discontinue drug and initiate supportive treatment (see Administration and Contraindications), Methemoglobinemia may not resolve or may rebound after response to treatment due to aryl amines (eg, aniline, sulfa drugs [dapsone]); monitor response to therapy with through resolution of methemoglobinemia, Patients with G6PD deficiency may not reduce methylene blue to its active form in vivo and thereby be ineffective (see Contraindications), Hemolysis can occur during treatment of methemoglobinemia with methylene blue and anemia may occur; hemolytic anemia may not be apparent until ≥1 day after, The presence of methylene blue in the blood may result in an underestimation of the oxygen saturation reading by pulse oximetry, A fall in the Bispectral Index (BIS) has been reported following administration of methylene blue class products; if methylene blue is administered during surgery, alternative methods for assessing the depth of anesthesia should be employed, May cause confusion, dizziness and disturbances in vision; patients should refrain from driving or engaging in hazardous occupations or activities, Methylene blue is a blue dye which passes freely into the urine and may interfere with the interpretation of any urine test which relies on a blue indicator (eg, dipstick test for leucocyte esterase), Methylene blue is extensively metabolized in the liver; monitor patients with any hepatic impairment for toxicities and potential drug interactions for an extended period of time following treatment, Approximately 40% of methylene blue is excreted by the kidneys; patients with any renal impairment should be monitored for toxicities and potential drug interactions for an extended period of time following treatment, May cause fetal harm when administered to a pregnant woman, Intra-amniotic injection of pregnant women with a methylene blue class product during the second trimester was associated with neonatal intestinal atresia and fetal death, There is no information regarding the presence of methylene blue in human milk, the effects on the breastfed infant, or the effects on milk production, Because of the potential for serious adverse reactions, including genotoxicity discontinue breastfeeding during and for up to 8 days after treatment. encoded search term (What is the role of f indigo carmine or methylene blue in the intraoperative workup of ureteral injury?) Meirow D, Moriel EZ, Zilberman M, Farkas A. The inducible synthase is produced in vascular smooth-muscle cells [25,26], cardiac myocytes [27], and by inflammatory mediators such as tumor necrosis factor alpha [28] and interferon gamma [29]. The development of mesenteric ischemia and peripheral ischemia of the upper and lower extremities, in such patients is a dreaded complication. Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine [Medline]. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. J Urol. 3rd ed. To view formulary information first create a list of plans. This drug is available at a higher level co-pay. Int Urogynecol J Pelvic Floor Dysfunct. [19] successfully used in MB for vasoplegia in a post-transplant patient. Transient and self-limiting increases in serum aspartate aminotransferase and alanine aminotransferase have been reported in some studies [1]. More work is needed to identify the optimal contrast agent and light wavelength with which it is most optimally visualized. Arrhythmias and angina have usually been transient and self-limiting. Miller EA. Gynecol Oncol. Palaniappa NC, Telem DA, Ranasinghe NE, Divino CM. Urology. Troyan SL, Kianzad V, Gibbs-Strauss SL, Gioux S, Matsui A, Oketokoun R, et al. Intraoperative Radiographic Determination of Ureteral Length as a Method of Determining Ideal Stent Length. 1997 Dec. 158(6):2078-82. By clicking send, you acknowledge that you have permission to email the recipient with this information. Procedures, 2002 Kuno K, Menzin A, Kauder HH, Sison C, Gal D. Prophylactic ureteral catheterization in gynecologic surgery. Kusaka J, Matsumoto S, Hagiwara S, Koga H, Noguchi T. Use of perioperative ureteral stent in abdominal aortic aneurysm with retroperitoneal fibrosis - a report of two cases. BJU Int. 2013;190(2):574–9. 1991;98:1139–42. Kuno K, Menzin A, Kauder HH, Sison C, Gal D. Prophylactic ureteral catheterization in gynecologic surgery. Surg Gynecol Obstet. Although MB was administered to these two patients, it had no beneficial effect because it was administered after the development of multiorgan failure. 105(3):335-40. Bothwell WM, Cathcart KS, Bombardt PA. An on-line, column-switching high-performance liquid chromatographic procedure for the removal of probenecid from human plasma, serum, or urine in the quantitative determination of cefmetazole or cefoxitin. 2007;178(5):2197–202. Chung D, Briggs J, Turney BW, Tapping CR. Mol Imaging. The early use of MB, in these patients may potentially reverse the vasodilatory state in these patients and reduce the dose and duration of vasoconstrictors in these patients. Colorectal Dis. Argenziano et al. Your list will be saved and can be edited at any time. 2004;83:293–8. 454617-overview Urol Clin North Am. 49(2):95-8. If you log out, you will be required to enter your username and password the next time you visit. ACE inhibitors decrease angiotensin II levels and increase the plasma levels of the vasodilator bradykinin. [Medline]. Urologists use intravenous dyes in diagnosing genitourinary fistulas and in investigating ureteral patency. If you log out, you will be required to enter your username and password the next time you visit. The incidence of VS associated with the pre-operative use of these three agents has been as high as 55.6, 44.4, and 47.2%, respectively [6], in one study. Siddighi S, Carr KR. VS can occur during CPB and a few authors have reported the use of MB intra-operatively to treat profound vasodilatation. In vascular smooth-muscle cells cyclic guanosine monophosphate causes vasodilation [29] and in myocytes may decrease contractility [27]. Procedures, encoded search term (methylene blue (Provayblue)) and methylene blue (Provayblue), New FDA Watch List Has Insulin Pens, Muscle Relaxants, and More, 11 Oncologic Emergencies You Need to Know, Don't Use N95 Masks for More Than 2 Days, Research Suggests, ACEP Withdraws Keynote Invitation to Deepak Chopra, Lower Back Pain: NSAID + Muscle Relaxant No Better Than NSAID + Placebo, Aortic Dissection: Still the Great Masquerader, Alcohol Abuse and Unusual Abdominal Pain in a 49-Year-Old. Twenty minutes after intravenous injection, no dye was seen cystoscopically, and 5 mg of furosemide and a fluid bolus were given. The prophylactic infusion of MB in these patients was associated with a higher SVR during surgery (compared to placebo) and a lower requirement for norepinephrine, inotropic support, fluid and blood transfusions.