Methylene Blue

Case: 65 yo male with septic endocarditis and septic emboli with + valve vegetations.  Severe MR, mod AI, mod TR, no PFO, EF 60-70%. Mild pericardial effusion. Large bilateral pleural effusions.

 

Vasoplegic syndrome—the role of methylene blue. European Journal of Cardio-Thoracic Surgery, Volume 28, Issue 5, 1 November 2005, Pages 705–710.

OpenAnesthesia: Methylene Blue

Dose:
2 mg/kg bolus –> 0.5 mg/kg/hr x 12 hours
Worked wonderfully for vasoplegia unresponsive to levophed or vasopressin.

Intraoperative cystoscopy and ureteral visualization

Over the years, I’ve been asked to inject various dyes to help light up the urine for visualization of the ureters.  Now, we’ve moved to fluorescein because it “lights up” quicker than other previous dyes.  Why are we always switching?  Drug shortages.

Dosing: 0.25 – 1.0 ml of 10% preparation of sodium fluorescein

Dose: 5 ml. bolus of 10% fluorescein intravenously.