Abstract
Besides several side effects including anaphylaxis, blue dyes are also known to cause false pulse oximeter readings. We aimed to examine the effects of subareolar isosulfan blue injection on pulse oximeter (SpO2) readings. The study group included 27 patients undergoing SLNB using both radiocolloid and isosulfan blue. Another group of 27 patients constituted the control group. Pulse oximeter readings were compared. SpO2 decline ≥4 % was defined as significant. All but one (96.2 %) of the patients in the study group showed SpO2 declines, compared to only one patient in the control group. Median ± Interqartile Range (IR) SpO2 decrease was 3.0 ± 4.0 % in the study and 0.0 ± 1.0 % in the control group (p < 0.001). There were significant (≥4 %) SpO2 decreases in 13 (48.1 %) patients in the study group. Statistically significant differences were noted between the two groups in all recordings between 15 and 180 min (p < 0.001). Initial time for SpO2 fall and the time to the lowest SpO2 recording were 10.0 ± 10.0 and 40.0 ± 30.0 min respectively. Using subareolar injection, the frequency of false readings is comparable with intraparenchymal injections, and is higher than intradermal injections. Time to peak SpO2 fall, and the recovery period, are delayed in the subareolar technique.
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Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39:456–466
Giuliano AE, Haigh PI, Brennan MB, Hansen NM, Kelley MC, Ye W et al (2001) Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 19:1882–1883
Allweis TM, Badriyyah M, Bar Ad V, Cohen T, Freund HR (2003) Current controversies in sentinel lymph node biopsy for breast cancer. Breast 12:163–171
Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T et al (1998) Guidelines for sentinel lymph node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 227:645–653
Linehan DC, Hill AD, Akhurst T, Yeung H, Yeh SD, Tran KN et al (1999) Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients. Ann Surg Oncol 6:450–454
Martin RC II, Edwards MJ, Wong SL, Tuttle TM, Carlson DJ, Brown CM et al (2000) Practical guidelines for optimal gammaprobe detection of sentinel lymph nodes in breast cancer: results of a multiinstitutional study. Surgery 128:139–144
Masannat Y, Shenoy H, Speirs V, Hanby A, Horgan K (2006) Properties and characteristics of the dyes injected to assist axillary sentinel node localization in breast surgery. Eur J Surg Oncol 32(4):381–384
Giuliano AE, Kirgan DM, Guenther JM, Morton DL (1997) Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 225(1):126–127
Sprung J, Tully MJ, Ziser A (2003) Anaphlactic reactions to isosulfan blue dye during sentinel node lymphadenectomy for breast cancer. Anesth Analg 96:1051–1053
Efron P, Knudsen E, Hirshorn S, Copeland EM (2002) Anaphylactic reaction to isosulfan blue used for sentinel node biopsy: case report and literature review. Breast J 8(6):396–399
Sadiq TS, Burns WW III, Taber DJ, Damitz L, Ollila DW (2001) Blue urticaria: a previously unreported adverse event associated with isosulfan blue. Arch Surg 136(12):1433–1435
Hoskin RW, Granger R (2001) Intraoperative decrease in pulse oximeter readings following injection of isosulfan blue. Can J Anaesth 48(1):38–40
Momeni R, Ariyan S (2004) Pulse oximetry declines due to the intradermal isosulfan blue dye: a controlled prospective study. Ann Surg Oncol 11(4):434–437
Kieckbusch H, Coldewey SM, Hollenhorst J, Haeseler G, Hillemanns P, Hertel H (2008) Patent blue sentinel node mapping in cervical cancer patients may lead to decreased pulse oximeter readings and positive methaemoglobin results. Eur J Anaesthesiol 25(5):365–368
El-Tamer M, Komenaka IK, Curry S, Troxel AB, Ditkoff BA, Schnabel FR (2003) Pulse oximeter changes with sentinel lymph node biopsy in breast cancer. Arch Surg 138:1257–1260
Pinero A, Illana J, Garcia-Palenciano C, Cañizarese F, Canteras M, Cañadillas V et al (2004) Effect on oxymetry of dyes used for sentinel lymph node biopsy. Arch Surg 139:1204–1207
Vokach-Brodsky L, Jeffrey SS, Lemmens HJ (2000) Isosulfan blue affects pulse oximetry. Anesthesiology 93(4):1002–1003
Kern KA (2002) Concordance and validation study of sentinel lymph node biopsy for breast cancer using subareolar injection of blue dye and technetium 99 m sulfur colloid. J Am Coll Surg 195(4):467–475
Kargozaran H, Shah M, Li Y, Beckett L, Gandour-Edwards R, Schneider PD, Khatri VP (2007) Concordance of peritumoral technetium 99 m colloid and subareolar blue dye injection in breast cancer sentinel lymph node biopsy. J Surg Res 143(1):126–129
Heinle E, Burdumy T, Recabaren J (2003) Factitious oxygen desaturation after isosulfan blue injection. Am Surg 69(10):899–901
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Zengel, B., Yararbas, U., Bingolballi, O. et al. The Effect of Subareolar Isosulfan Blue Injection on Pulse Oximeter Readings. Indian J Surg 76, 76–80 (2014). https://doi.org/10.1007/s12262-012-0624-3
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DOI: https://doi.org/10.1007/s12262-012-0624-3