Parathyroid surgery and methylene blue: A review with guidelines for safe intraoperative use

Authors

  • Geoffrey Pollack MD,

    Corresponding author
    1. Department of Otolaryngology and Head and Neck Surgery, St. Luke's–Roosevelt Hospital Center and the Department of Otolaryngology, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A.
    • 211 Central Park West, Suite 1F, New York, NY 10024
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  • Aron Pollack MS,

    1. The State University of New York at Stony Brook, Stony Brook, St. Luke's–Roosevelt Hospital Center, New York, New York, U.S.A.
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  • Joel Delfiner MD,

    1. Department of Neurology, St. Luke's–Roosevelt Hospital Center, New York, New York, U.S.A.
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  • John Fernandez MD

    1. Department of Surgery, St. Luke's–Roosevelt Hospital Center, New York, New York, U.S.A.
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  • The authors have no conflicts of interest to disclose. The work was funded by the authors.

Abstract

Methylene blue has been used to help facilitate parathyroid surgery for over 30 years. Its use has been widely considered both safe and cost effective. Twenty-six cases of a toxic metabolic encephalopathy, however, have been reported with its use. As a result, some surgeons have stopped using this technique altogether. It is now known that methylene blue is a monoamine oxidase inhibitor. When combined with drugs that increase central serotonin neurotransmission, serotonin toxicity results. This is the cause of the encephalopathy described in the literature. A case report, review of the literature, and guidelines as to its proper use are presented so as to allow for safe parathyroid surgery. Laryngoscope, 2009

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