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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

Journal of Pelvic Medicine & Surgery: January/February 2009 - Volume 15 - Issue 1 - pp 11-15
doi: 10.1097/SPV.0b013e3181986ace
Original Article

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.

The effect of intravenous indigo carmine on blood pressure and heart rate was studied in a series of 71 women undergoing transvaginal high uterosacral ligament fixation. Only 1 patient in our series experienced a critical incident within 1 hour of indigo carmine administration and it is unlikely that this occurred as a direct result of the drug. Therefore, in our experience intravenous indigo carmine appears to be a safe method for assessing ureteric patency during gynecological surgery. However, our results support existing evidence that indigo carmine induces changes in patients’ hemodynamic status by increasing blood pressure and decreasing heart rate. It would be prudent to administer caution during its use in patients with cardiovascular disease, and further investigation of its hemodynamic effects in these patients over shorter time intervals may be of interest.

From the Department of Gynaecology, Weston General Hospital, Weston-super-Mare, United Kingdom.

Reprints: Johnathan Craik, MbChB, BSc, Department of Surgery, Dorset County Hospital, Williams Avenue, Dorchester, DT1 2JY UK. E-mail: johnathancraik@hotmail.com.

© 2009 Lippincott Williams & Wilkins, Inc.