title: Safe intrathecal fluorescein use for identification of cerebrospinal fluid leaks: Case-report and perioperative algorithm description.
abstract: Intrathecal injection of fluorescein is a method for repairing cerebrospinal fluid fistulas. The most frequent surgical procedure is endonasal endoscopy and the purpose of injecting this dye is to locate the fistula. The anaesthesiologists usually perform the puncture, therefore it is necessary to review this method and to specify some anaesthetic considerations such as correct dosing, safe management protocols and medical-legal aspects. In this case-report we describe the pre, intra and postoperative protocol of action implemented in our department that basically consists of: obtaining a specific consent, prior neurological/ophthalmologic assessment to rule out hypertension and brain damage, use of corticosteroids and previous antihistamines, choosing the correct dose and concentration of intrathecal sodium fluorescein (maximum 1ml at a concentration of 5% diluted in 9ml of cerebrospinal fluid) and close intra and postoperative monitoring.
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Morales Meseguer, Murcia, España. Electronic address: marodrigueznavarro@yahoo.es.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Rodríguez-Navarro
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Morales Meseguer, Murcia, España.
authors.forename: C
authors.initials: C
authors.lastname: Díaz-Alejo
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Morales Meseguer, Murcia, España.
authors.forename: M L
authors.initials: ML
authors.lastname: Padilla-Del Rey
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Morales Meseguer, Murcia, España.
authors.forename: A B
authors.initials: AB
authors.lastname: Alcaraz
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Morales Meseguer, Murcia, España.
authors.forename: P
authors.initials: P
authors.lastname: González-Pérez
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Morales Meseguer, Murcia, España.
authors.forename: M
authors.initials: M
authors.lastname: Benítez
mesh_terms: D000368:Aged; D000465:Algorithms; D001099:Arachnoid / Q000000981:diagnostic imaging / Q000293:injuries; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D002985:Clinical Protocols; D006259:Craniocerebral Trauma / Q000150:complications; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000293:injuries; D004724:Endoscopy; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D005456:Fluorescent Dyes / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007278:Injections, Spinal; D011183:Postoperative Complications / Q000139:chemically induced; D012997:Solvents / Q000009:adverse effects
chemical_list: D005456:Fluorescent Dyes; D012997:Solvents; D019793:Fluorescein
keywords: Cerebrospinal fluid; Cirugía endoscópica por orificios naturales; Fistula; Fluoresceína de sodio; Fístula; Líquido cefalorraquídeo; Natural orifice endoscopic surgery; Sodium fluorescein