Adverse reactions associated with the administration of a tricarbocyanine dye (Cardio-Green) to uremic patients

Iodine allergy: Common misperceptions

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Purpose

The current evidence regarding iodine-containing compounds and iodine allergy cross-reactivity is reviewed.

Summary

Iodine is an essential human nutrient found in the thyroid gland. It is used in the synthesis of the thyroid hormones thyroxine and triiodothyroxine. Patients who report having adverse reactions to iodine-containing substances are often labelled as having an “iodine allergy,” which can result in delays in care or patients being denied essential ICM or other iodine-containing drugs. A literature review was conducted to evaluate the evidence regarding iodine allergy and iodine-containing drugs. Of 435 articles considered potentially appropriate for full review (plus 12 additional articles included on the basis of references from the eligible articles), 113 could not be obtained. After exclusion of 353 articles that did not meet all inclusion criteria, the remaining 81 articles were included in the review. The results of the literature review indicated that iodine has not been shown to be the allergen responsible for allergic reactions to iodinated contrast media, amiodarone, povidone-iodine, and other iodine-containing compounds.

Conclusion

There is a lack of evidence to support cross-reactivity between iodine-containing compounds in so called iodine-allergic individuals.

The safety and feasibility of intraoperative near-infrared fluorescence imaging with indocyanine green in thoracoscopic sympathectomy for primary palmar hyperhidrosis

Background

We investigated the safety and feasibility of intraoperative near‐infrared (NIR) imaging using indocyanine green (ICG) during sympathectomy in the management of primary palmar hyperhidrosis (PPH).

Methods

We performed a retrospective review of 142 patients (ICG group) who underwent endoscopic thoracic sympathectomy (ETS) between February 2018 and April 2019. All patients received a 5 mg/kg infusion of ICG 24 hours preoperatively. The vital signs before and after ICG injection and adverse reactions were recorded. Meanwhile, 498 patients (Non‐ICG group) who underwent ETS by normal thoracoscopy during August 2017 to April 2019 were also reviewed to compare the abnormal white blood cell (WBC) counts, alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), and creatinine (Cr) levels before and after operation between two groups.

Results

For ICG group, the vital signs including body temperature, heart rate and blood pressure before and after ICG injection were stable. There was no significant difference in the abnormal WBC counts, ALT, AST, BUN, and Cr levels before and after operation between two groups. Only one patient had mild adverse reaction (0.7%) after ICG injection. The visibility rate of all sympathetic ganglions was 96.7% (1369/1415). The visibility rate from T1 to T5 was 98.23% (278/283), 98.23% (278/283), 97.17% (275/283), 95.76% (271/283), and 94.35% (267/283), respectively. There was no significant difference in the visibility rate with regard to age, gender, height, weight, body mass index, and PPH grade.

Conclusions

NIR fluorescence imaging with ICG for identifying sympathetic ganglions is relatively safe and feasible.

Key points

• Significant findings of the study.

NIR fluorescence imaging with ICG for identifying sympathetic ganglions is relatively safe and feasible.

• What this study adds.

This technology may take the place of the rib‐oriented method as standard practice for the precise localization of sympathetic ganglions, and may improve the effect of sympathectomies.

Indocyanine green-enhanced fluorescence for assessing parathyroid perfusion during thyroidectomy

Identification of the parathyroid glands during thyroid surgery may prevent their inadvertent surgical removal and thus provide a better postoperative quality of life. Nevertheless, the most common "technique" for intraoperative evaluation of perfusion of parathyroid gland tissues during thyroid surgery is visual inspection of the physical condition of tissues, e.g., their color and bleeding edges. Another technique is measurement of intact parathyroid hormone. Recently, indocyanine green-enhanced fluorescence has been used in various surgical techniques, particularly laparoscopic surgery, to improve visualization and to provide detailed anatomical information. Fluorescent optical guidance helps surgeons to avoid inadvertent tissue injury while enhancing procedural efficiency. This technique has potential use for evaluating perfusion of the parathyroid gland in real-time intraoperative angiography.

Occurrence of severe hypotension after indocyanine green injection during the intraoperative period

Indocyanine green (ICG) is generally considered to be safe for IV administration and has a very low incidence of complications. We report 2 cases of severe hypotension immediately after low dose administration of IV ICG. The first case is a 69-year-old woman who developed severe hypotension after a second 5 mg IV bolus of ICG given shortly after the placement of an aneurysm clip during an otherwise uneventful surgery performed under general anesthesia. The second case is a 56-year-old woman with moyamoya disease who became hypotensive subsequent to a 2.5 mg ICG bolus at the conclusion of an external-carotid to internal-carotid bypass procedure under general anesthesia. Anesthesiologists and surgeons are increasingly likely to encounter or request the intraoperative administration of ICG, and they need to be aware of this potential for an adverse reaction, particularly with the repeated doses. Anesthesia and other intraoperative conditions may mask the typically mild adverse reactions usually associated with ICG.

Blood flow index using near-infrared spectroscopy and indocyanine green as a minimally invasive tool to assess respiratory muscle blood flow in humans

Near-infrared spectroscopy (NIRS) in combination with indocyanine green (ICG) dye has recently been used to measure respiratory muscle blood flow (RMBF) in humans. This method is based on the Fick principle and is determined by measuring ICG in the respiratory muscles using transcutaneous NIRS in relation to the [ICG] in arterial blood as measured using photodensitometry. This method is invasive since it requires arterial cannulation, repeated blood withdrawals, and reinfusions. A less invasive alternative is to calculate a relative measure of blood flow known as the blood flow index (BFI), which is based solely on the NIRS ICG curve, thus negating the need for arterial cannulation. Accordingly, the purpose of this study was to determine whether BFI can be used to measure RMBF at rest and during voluntary isocapnic hyperpnea at 25, 40, 55, and 70% of maximal voluntary ventilation in seven healthy humans. BFI was calculated as the change in maximal [ICG] divided by the rise time of the NIRS-derived ICG curve. Intercostal and sternocleidomastoid muscle BFI were correlated with simultaneously measured work of breathing and electromyography (EMG) data from the same muscles. BFI showed strong relationships with the work of breathing and EMG for both respiratory muscles. The coefficients of determination ( R2) comparing BFI vs. the work of breathing for the intercostal and sternocleidomastoid muscles were 0.887 ( P < 0.001) and 0.863 ( P < 0.001), respectively, whereas the R2 for BFI vs. EMG for the intercostal and sternocleidomastoid muscles were 0.879 ( P < 0.001) and 0.930 ( P < 0.001), respectively. These data suggest that the BFI closely reflects RMBF in conscious humans across a wide range of ventilations and provides a less invasive and less technically demanding alternative to measuring RMBF.

Near-Infrared Fluorescence Imaging in Humans with Indocyanine Green: A Review and Update

Near-infrared (NIR) fluorescence imaging clinical studies have been reported in the literature with six different devices that employ various doses of indocyanine green (ICG) as a non-specific contrast agent. To date, clinical applications range from (i) angiography, intraoperative assessment of vessel patency, and tumor/metastasis delineation following intravenous administration of ICG, and (ii) imaging lymphatic architecture and function following subcutaneous and intradermal ICG administration. In the latter case, NIR fluorescence imaging may enable new discoveries associated with lymphatic function due to (i) a unique niche that is not met by any other conventional imaging technology and (ii) its exquisite sensitivity enabling high spatial and temporal resolution. Herein, we (i) review the basics of clinical NIR fluorescence imaging, (ii) survey the literature on clinical application of investigational devices using ICG fluorescent contrast, (iii) provide an update of non-invasive dynamic lymphatic imaging conducted with our FDPM device, and finally, (iv) comment on the future NIR fluorescence imaging for non-invasive and intraoperative use given recent demonstrations showing capabilities for imaging following microdose administration of contrast agent.

Alteration of laser-tissue interaction with the 805 nm diode laser using indocyanine green in the canine prostate

BACKGROUND AND OBJECTIVE

Research interests in laser prostatectomy continue to evaluate a variety of wavelengths and treatment parameters in an effort to optimize treatment. Recently, a semiconductor diode laser with a wavelength of 805 nm has become available for clinical use; however, free-beam noncontact applications were limited by the low power output (25 W). In this study in the canine prostate, the possible potentiating effects of intravenously administered indocyanine green (ICG) were evaluated with the 805 nm diode laser.

STUDY DESIGN/MATERIALS AND METHODS

A total of 16 fixed position, free-beam lasings were performed at 25 W for 60 sec in four dogs with eight lasings before and eight lasings after ICG administration. Endoscopic observations and measurements of lesion volumes were used to evaluate the laser-tissue interactions.

RESULTS

Prior to ICG administration, we observed that side fire irradiation produced primarily small coagulative lesions. Following ICG administration, however, immediate and more noticeable tissue vaporization occurred, although total lesion size was not increased. Pathologic review demonstrated less coagulation and hyperemia, but a larger vaporized cavity in the ICG treated tissue.

CONCLUSION

These findings suggest intravenous ICG alters laser-tissue interaction with the 805 nm diode laser in the canine prostate. The use of the 805 nm diode laser with enhancing chromophores deserves further investigation.

Adverse reactions to indocyanine green: a case report and a review of the literature

Indocyanine green is a dye used primarily in cardiac output determinations, and in ophthalmic angiography. It has a low incidence of side effects; however, they occur and have included death. We report a case of anaphylactoid reaction to indocyanine green and review the literature on these reactions.

The sensitivity of contrast echocardiography in detecting intracardiac shunts

While contrast echocardiography has been shown to delineate intracardiac shunts, no information is available concerning the sensitivity of the method. This study establishes the relative sensitivity of the technique in detecting and localizing shunts by comparing the contrast echocardiograms with the simultaneously recorded cardiogreen dye curves in 26 children during cardiac catheterization. The echocardiograms substantiated isolated intracardiac shunting as small as 5%. There were no false-positive or false-negative echocardiograms in patients with or without shunt defects. This report demonstrates the contrast echocardiographic technique to be extremely sensitive in detecting intracardiac communications. It reviews the diagnostic patterns necessary for diagnosis and proposes the technique as a sensitive, safe, and accurate alternate method of study in the cardiac catheterization laboratory.