Safety of methylene blue dye for lymphatic mapping in patients taking selective serotonin reuptake inhibitors

American Journal of Surgery
Miraj G Shah-KhanAmy C Degnim

Abstract

Methylene blue dye has an important role in lymphatic mapping for sentinel lymph node surgery. A recent safety announcement from the US Food and Drug Administration warned physicians about possible serious central nervous system reactions in patients on serotonergic medications who received intravenous methylene blue for the identification of parathyroid glands. This report summarizes evidence from the Food and Drug Administration's announcement and methylene blue pharmacokinetics. The authors conclude that the use of methylene blue dye at low doses for lymphatic mapping likely carries very little risk for serotonin neurotoxicity, although breast surgeons should be aware of this potential complication in the event of mental status or neuromuscular changes in patients after lymphatic mapping.

References

Oct 27, 2004·Anesthesia and Analgesia·Kevin K BachRed S Howard
Oct 31, 2006·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Swapna S KarthaMichael B Flynn
Feb 28, 2007·Journal of the American College of Surgeons·Gary Sweet, Steven B Standiford
Mar 28, 2008·American Journal of Surgery·Shaheen ZakariaAmy C Degnim

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Citations

Apr 5, 2016·Brain Circulation·Zhao Jiang, Timothy Q Duong
Dec 10, 2013·Biochemical Pharmacology·F Gonzalez-LimaJulio C Rojas
Dec 22, 2017·Plastic and Reconstructive Surgery. Global Open·Andrew McGregorDeepak Narayan
Sep 11, 2013·Journal of the Korean Surgical Society·Kuk-Jin KimCheong Soo Park
Jul 17, 2015·Plastic and Reconstructive Surgery·Isabel Teo, Christopher Tam Song
Sep 3, 2017·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·T J CudaA R L Stevenson

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