title: Parathyroid surgery and methylene blue: a review with guidelines for safe intraoperative use.
abstract: 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.
authors: 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
authors: Geoffrey
authors: G
authors: Pollack
authors: Aron
authors: A
authors: Pollack
authors: Joel
authors: J
authors: Delfiner
authors: John
authors: J
authors: Fernandez
mesh_terms: 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
chemical_list: D015283:Citalopram; D004791:Enzyme Inhibitors; D008751:Methylene Blue; D017367:Selective Serotonin Reuptake Inhibitors