Parathyroid surgery and methylene blue: a review with guidelines for safe intraoperative use.
Methylene blue has been used to help facilitate parathyroid surgery for over 30 years. Its use has been widely considered both safe and cost effective. Twenty-six cases of a toxic metabolic encephalopathy, however, have been reported with its use. As a result, some surgeons have stopped using this technique altogether. It is now known that methylene blue is a monoamine oxidase inhibitor. When combined with drugs that increase central serotonin neurotransmission, serotonin toxicity results. This is the cause of the encephalopathy described in the literature. A case report, review of the literature, and guidelines as to its proper use are presented so as to allow for safe parathyroid surgery.
Pollack
Geoffrey
G
Department of Otolaryngology and Head and Neck Surgery, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, U.S.A. gjp2@columbia.edu
Pollack
Aron
A
Delfiner
Joel
J
Fernandez
John
J
D000236:Adenoma / Q000601:surgery; D001927:Brain Diseases / Q000139:chemically induced*; D015283:Citalopram / Q000494:pharmacology; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008751:Methylene Blue / Q000494:pharmacology*; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000601:surgery; D016105:Parathyroidectomy; D017410:Practice Guidelines as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology
D015283:Citalopram; D004791:Enzyme Inhibitors; D008751:Methylene Blue; D017367:Selective Serotonin Reuptake Inhibitors