Kieckbusch H, Coldewey S M, Hollenhorst J, Haeseler G, Hillemanns P, Hertel H
Hannover Medical School, Department of Anesthesiology, Hannover, Germany.
Eur J Anaesthesiol. 2008 May;25(5):365-8. doi: 10.1017/S0265021508003578. Epub 2008 Feb 13.
Patent blue (4-[(4-diethylaminophenyl)-(4-diethylazaniumylidencyclohexa-2,5-dienyliden) methyl]-6-hydroxy-3-sulfo-benzolsulfonate, sodium salt) is a contrast dye used for the intraoperative detection of the primary lymphatic nodes draining the area of tumour infiltration. The dye is known to interact with pulse oximeter readings. However, the degree of alteration seems to be moderate and predictable when patent blue is injected into the perimammilar region during breast surgery.
Here we report severe interference with the anaesthetic monitoring when patent blue was injected into the cervix prior to laparoscopy-assisted radical vaginal hysterectomy for cervical cancer.
Injection of patent blue into the cervix induced a rapid (within 14 +/- 9 min after the injection) and severe (from 98% to 89 +/- 2%) decrease in pulse oximeter readings, accompanied by positive methaemoglobin values of 7.3 +/- 2.5% (arterial co-oximetry, Bayer Rapidlab 865 blood gas analyser; Bayer, Fernwald, Germany). Control of these values by a different device (Radiometer ABL co-oximeter blood gas analyser; Radiometer, Willich, Germany) yielded negative methaemoglobin results (<1.7%, mean 0.9 +/- 0.6%). The arterial PO2 was normal in all patients throughout the procedure.
Injection of patent blue into the cervix uteri interferes dramatically with pulse oximeter readings. This situation is further complicated by device-dependent arterial co-oximetry methaemoglobin results. For the time being it is recommendable to monitor adequate oxygenation of the patient in the presence of patent blue by regular control of the arterial PO2. Clearly, the unresolved issue of reliable methaemoglobin determination in the presence of patent blue remains a matter of clinical concern for anaesthetists.
专利蓝（4-[(4-二乙氨基苯基)-(4-二乙铵基环亚己-2,5-二烯基亚甲基)]-6-羟基-3-磺基苯磺酸钠盐）是一种用于术中检测肿瘤浸润区域引流的主要淋巴结的造影剂。已知该染料会与脉搏血氧饱和度仪读数相互作用。然而，在乳腺手术中将专利蓝注入乳头周围区域时，其改变程度似乎适中且可预测。
在此我们报告，在腹腔镜辅助下宫颈癌根治性阴道子宫切除术前将专利蓝注入宫颈时，对麻醉监测产生了严重干扰。
将专利蓝注入宫颈后，脉搏血氧饱和度仪读数迅速（注射后14±9分钟内）且显著下降（从98%降至89±2%），同时高铁血红蛋白值为7.3±2.5%（动脉血气联合分析，拜耳Rapidlab 865血气分析仪；拜耳，德国费恩瓦尔德）。使用不同设备（雷度ABL血气联合分析仪；雷度，德国维利希）检测这些值时，高铁血红蛋白结果为阴性（<1.7%，平均0.9±0.6%）。在整个手术过程中，所有患者的动脉血氧分压均正常。
将专利蓝注入子宫颈会显著干扰脉搏血氧饱和度仪读数。由于设备依赖的动脉血气联合分析高铁血红蛋白结果，这种情况进一步复杂化。目前，建议在使用专利蓝的情况下，通过定期监测动脉血氧分压来监测患者的充分氧合。显然，在存在专利蓝的情况下可靠测定高铁血红蛋白这一未解决的问题仍是麻醉医生临床关注的问题。
