Rapid Responses

The primary purpose of Rapid Responses is to provide a venue for readers to comment on and discuss scientific content published in CJA Online.

Please note that Rapid Response comments must be made in one of Canada's official languages, English or French, to solicit response.

General comments or concerns should be sent to the communications{at}cas.ca.

Electronic Letters to:

General Anesthesia: Robert W. Hoskin and Robert Granger Intraoperative decrease in pulse oximeter readings following injection of isosulfan blue Can J Anesth 2001; 48: 38-40 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Isosulfan Blue and intraopeorative pulse oximetry

Robert Paul Gasalberti   (25 September 2005)

Isosulfan Blue and intraopeorative pulse oximetry 25 September 2005
Robert Paul Gasalberti, Anesthesiologist SIUH Send letter to journal: Re: Isosulfan Blue and intraopeorative pulse oximetry mdgas{at}patmedia.net Robert Paul Gasalberti	Our hospital has begun to perfom sentinel node biopsies using Lymphazurin 1%. However, in a number of cases in which I have administered anesthesia, there were no changes in pulse oximetry readings. Recently, however, I was involved in a case of 65 year old woman undergoing bilateral breast sentinel node biopsies. The first breast injection was performed without any change in the pulse oximetry reading. Fifteen minutes after injecting the secound breast, there was a gradual decrease in SpO2 from 99% to a low of 88%. The SpO2 values remained between 88-89% for about 1 hr and then gradually increased, but never above 93% during the course of surgery. As the referenced article suggests, other potential causes of hypoxemia were ruled out in this patient. At the end of the case the patient was tranfered to the PACU and she was subsequently discharged. My concern in the postoperative period was the severe grayish/blue color of the patient's skin following surgery, and the fact it took about 3-4 hrs for Sp02 values to normalize. It is possible that the pronounced decrease in SpO2 and change in skin color may have been due to the volume of Lymphazurin which the surgeon injected. Since it was a bilateral procedure, a total of 6-7 mL was required. Nowhere on the package insert for Lymphazurin is there a warning that pulse oximetry readings may be altered, nor is there a warning of changes in skin color other then the injected area and urine. Perhaps the manufacturer should include these warning in the package insert of this compound.