title: Intravenous injection of indocyanine green results in an artificial transient desaturation by pulse oximetry.
abstract: OBJECTIVE
  To describe a case series of transient oxygen desaturation measured by pulse oximetry during the intravenous infusion of indocyanine green to enhance transpupillary thermotherapy in treating retinoblastoma after ophthalmic artery chemosurgery.
  
  
  METHODS
  Retrospective descriptive case series.
  
  
  RESULTS
  The intravenous administration of indocyanine green for ophthalmic angiography resulted in a transient drop in oxygen saturation as measured by Nellcor fingertip pulse oximetry in three children with retinoblastoma receiving indocyanine green-guided transpupillary thermotherapy. The magnitude of reduction ranged from 92% to 94% from an initial reading of 99% to 100% in each case, with an average duration of 3 minutes. Concurrent measurement of blood pressure, pulse, and expired CO2 showed no changes during this process.
  
  
  CONCLUSIONS
  Administration of intravenous indocyanine green resulted in a transient desaturation by oximetry during transpupillary thermotherapy for children with retinoblastoma under anesthesia because of the fluorescent dye's absorption of red light in a manner similar to that of deoxygenated hemoglobin, thereby leading to transient instrument misinterpretation and miscalculation of arterial oxygenation.
authors.affiliation: *Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York; †Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; ‡Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York; §Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York; and ¶Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York.
authors.forename: Lilangi S
authors.initials: LS
authors.lastname: Ediriwickrema
authors.forename: Jasmine H
authors.initials: JH
authors.lastname: Francis
authors.forename: Vittoria
authors.initials: V
authors.lastname: Arslan-Carlon
authors.forename: Paul H
authors.initials: PH
authors.lastname: Dalecki
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brodie
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D002675:Child, Preschool; D004396:Coloring Agents / Q000494:pharmacology*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007208:Indocyanine Green / Q000494:pharmacology*; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D012175:Retinoblastoma / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green; D010100:Oxygen