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Journal of Pelvic Medicine & Surgery:
doi: 10.1097/SPV.0b013e3181986ace
Original Article

The Safety of Intravenous Indigo Carmine to Assess Ureteric Patency During Transvaginal Uterosacral Suspension of the Vaginal Vault

Craik, Johnathan Donaldson MbChB, BSc; Khan, Delilah MbChB, BSc; Afifi, Reda FRCOG, MSc

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Abstract

Objective: There is approximately a 0.6% to 10.9% risk of intraoperative ureteric injury with transvaginal uterosacral suspension of the vaginal vault. Indigo carmine (indigotridisulfonate sodium) is a blue dye used primarily in urological and gynecological surgery in combination with cystoscopy to assess ureteric patency. Manufacturers warn that mild pressor effects may be encountered in some patients and serious adverse reactions to the drug have been reported. This study evaluates the hemodynamic responses to indigo carmine during gynecological surgery.

Methods: The effect of indigo carmine on blood pressure and heart rate was reviewed retrospectively in a series of 71 patients who underwent transvaginal high uterosacral ligament fixation between January 2007 and April 2008 at Weston General Hospital, United Kingdom.

Results: Indigo carmine was shown to induce a statistically significant increase in both systolic and diastolic blood pressure with a maximum response observed at 5 minutes. In addition, a statistically significant fall in heart rate was seen with a maximum difference at 10 minutes. One critical incident was encountered in our patient group within 1 hour after the administration of indigo carmine. This is unlikely to have occurred as a direct result of indigo carmine administration.

Conclusions: In our experience, intravenous indigo carmine is a safe method for assessing ureteric patency during gynecological surgery. However, our results support existing evidence that indigo carmine induces an increase in blood pressure, together with a fall in heart rate, and as a result caution should be taken during its use in patients with cardiovascular disease.

© 2009 Lippincott Williams & Wilkins, Inc.

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