Mathew S, Linhartova L, Raghuraman G
Department of Anaesthetics, Birmingham Heartlands Hospital, UK.
Anaesthesia. 2006 Jun;61(6):580-3. doi: 10.1111/j.1365-2044.2006.04619.x.
A 65-year-old man underwent parathyroidectomy for hyperparathyroidism secondary to renal failure. Intra-operatively he received methylene blue infusion (7.5 mg.kg(-1), a total of 650 mg in 500 ml 0.9% sodium chloride) for visualisation of parathyroid glands. At the end of surgery, following extubation he developed agitation, intense shivering and hyperpyrexia, and his level of consciousness decreased to a Glasgow Coma score of 7. The differential diagnoses included methylene blue toxicity or malignant hyperpyrexia. His lungs were ventilated, and intravenous dantrolene was administered to control hyperpyrexia. Haemodialysis was started to remove the methylene blue dye. We review the literature on the pharmacological actions of methylene blue, and discuss the differential diagnosis and management of this patient.
一名65岁男性因肾衰竭继发甲状旁腺功能亢进接受了甲状旁腺切除术。术中他接受了亚甲蓝输注（7.5mg·kg⁻¹，在500ml 0.9%氯化钠中总共650mg）以帮助甲状旁腺可视化。手术结束时，拔管后他出现躁动、剧烈寒战和高热，意识水平降至格拉斯哥昏迷评分7分。鉴别诊断包括亚甲蓝中毒或恶性高热。对其进行了肺部通气，并静脉注射丹曲林以控制高热。开始进行血液透析以清除亚甲蓝染料。我们回顾了关于亚甲蓝药理作用的文献，并讨论了该患者的鉴别诊断和管理。
