Allergy-like reactions to methylene blue following laparoscopic chromopertubation: A systematic review of the literature

Prevalence of Serotonergic Drug Use in Patients Exposed to Perioperative Methylene Blue: A Cross-Sectional Study

BACKGROUND

Methylene blue is a widely used medication in various medical procedures, particularly in cardiovascular operations where it serves as a diagnostic dye and a treatment for conditions like methemoglobinemia and vasoplegic syndrome. While its clinical applications are well-documented, methylene blue's pharmacological properties as a monoamine oxidase (MAO) inhibitor present a potential risk of serotonin syndrome when administered to patients taking serotonergic medications. This study examines the prevalence of serotonergic medications, including lithium, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs), in patients who were administered methylene blue.

METHODS

This cross-sectional study used de-identified electronic health records (EHRs) from the TriNetX database, which pools data from 97 healthcare organizations. The analysis focused on isolating patients who were administered methylene blue perioperatively and calculating the prevalence of concomitant serotonergic drug use by drug class.

RESULTS

The large database analysis revealed that among the 249,131 patients who received perioperative methylene blue, 25,282 (10.14%) were concomitantly given serotonergic drugs. By drug class, SSRIs had the highest concomitant use with 15,705 cases and a prevalence of 63.04/1000 cases. Next were SNRIs, with 6,341 cases and a prevalence of 25.45/1000 cases; TCAs, with 2,979 cases and a prevalence of 11.96/1000 cases; lithium, with 292 cases and a prevalence of 1.17/1000 cases; and MAO inhibitors, which had the lowest concomitant use at 65 cases and a prevalence of 0.26/1000 cases.

CONCLUSION

The prevalence of serotonergic agent use in patients administered methylene blue is relatively high exceeding 10%, with the highest prevalence observed in those on SSRIs, followed by SNRIs and TCAs. This underscores the importance of a thorough preoperative evaluation by an anesthesiologist to minimize the risk of intraoperative complications such as serotonin syndrome.

Intraoperative dyes, fluorescence and enhanced imaging in benign gynaecologic surgery

PURPOSE OF REVIEW

We review the literature regarding the use of dyes and fluorescence-guided visualization techniques in gynaecological surgery. We also discuss advances in imaging that may enhance surgery by incorporating real-time visual feedback through augmented reality and preoperative planning with patient-specific, three-dimensional printed surgical fields.

RECENT FINDINGS

Methylene blue is one of the most commonly used dyes, while indocyanine green is the most used agent in fluorescence-guided surgery. Augmented reality and three-dimensional printing are also being increasingly used in gynaecology.

SUMMARY

Dyes and fluorescence-based surgeries are commonly utilized to improve anatomic identification, preservation of healthy tissue and excision of disease. In addition, we explore how augmented reality and three-dimensional printing are used in gynaecology.

THE ROUTINE USE OF THE METHYLENE BLUE TEST IN SLEEVE GASTRECTOMY: WHY NOT?

Background:

Although considered a safe procedure, sleeve gastrectomy (SG) has a non-negligible risk of major postoperative complications related to it, with special attention to gastric leaks.

Aim:

Evaluate the clinical value of the methylene blue test (MBT) in predicting the occurrence of post-SG leaks.

Methods:

Retrospective study that included 1136 patients who underwent SG with intraoperative MBT between 2012 and 2016. Sensitivity, specificity, positive predictive value (PPV) and negative predicted value (NPV) were calculated to determine the clinical correlation between the MBT and the occurrence of postoperative leaks. Staple line oversewing was performed in all patients who presented positive MBT.

Results:

Laparoscopic SG was performed in 97.0% of cases; open in 2.3%, and robotic in 0.7%. MBT was positive in 19 cases (1.67%). One positive MBT occurred during an open SG and the other 18 at laparoscopy. Moreover, there were nine cases (0.8%) of postoperative leaks, among which, only two presented positive MBT. MBT diagnostic value was evaluated through the calculation of sensitivity (22.0%), specificity (98.0%), PPV (11.0%) and NPV (99.0%). There were no cases of allergic reaction or any other side effect with the use of the methylene blue solution.

Conclusion:

MBT showed high specificity and negative predictive value, thus presenting an important value to rule out the occurrence of postoperative leaks.

Tubal Flushing Treatment for Unexplained Infertility

Tubal patency testing was initially introduced as a diagnostic test. However, it has been observed that some tubal patency tests also have a therapeutic effect. This therapeutic effect can be influenced by the contrast medium used during tubal flushing. In this review, we discuss current evidence associated with different methods for tubal flushing and their potential impact on reproductive outcomes in women with unexplained infertility. Furthermore, we discuss their diagnostic accuracy, safety, and cost-effectiveness.

Could methylene blue be used to manage burning mouth syndrome? A pilot case series

Objective: Burning mouth syndrome is a disabling condition of complex pathophysiology characterized by spontaneous pain felt in the oral mucosa in the absence of evident mucosal lesions which lacks efficient treatments to this day. The purpose of this study was to demonstrate the efficacy of methylene blue in the management of burning mouth syndrome. Methods: The study was conducted at the dental clinic of the Anta Diop University and Newtown dental clinic of Dakar, Senegal. A solution of methylene blue as a mouth-rinse (0.5%) was applied for 5 minutes in five patients satisfying the ICHD-3 diagnostic criteria for burning mouth syndrome. This procedure was repeated every 6 hours 3 times per 24h, during 7 days. Using numeric rating scale, pain severity was assessed as the mean pain felt during the last day of application. Results: After 7 days, the pain was significantly reduced by two-thirds and almost absent at 3 and 6 months follow-up. No secondary effects of the use of methylene blue were observed. Putative mechanisms of action and potential implications for treatment are discussed. Conclusion: Methylene blue is an old compound but a novel topical therapy that could prove beneficial in the management of burning mouth syndrome.