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Background: Indigotindisulfonate (Indigo Carmine, American Regent, Shirely, NY) is a blue dye that is commonly used for localizing ureteral orifices during surgery. In general, it is safe and biologically inactive, with the package insert citing only rare idiosyncratic reactions and mild pressor effects in some patients. We report a case of a severe life-threatening anaphylactoid reaction due to indigotindisulfonate following intravenous administration.

Case Report: We describe a case of a 42-year-old female admitted for a total abdominal hysterectomy. Upon arrival to the operating room, her heart rate (HR) was 80/min, blood pressure (BP) was 135/75 mm Hg, and a SpO2 of 98%. During surgery, the patient received 5 mL of slow IV bolus of 0.8 percent Indigotindisulfonate sodium injectable solution, at which time her blood pressure was 110/60 mm Hg and heart rate was 75/min. Fifteen minutes later the patient became hypotensive and bradycardic (BP = 70/50 mm Hg; HR = 37/min). The team performed advanced cardiac life support for 16 minutes, administering epinephrine 1 mg IV BOLUS x 4 doses and sodium bicarbonate 50 mEqIV BOLUS x 3 doses.

Conclusion: Although this is a rare adverse event, it is prudent to consider the possibility of these reactions when a bolus of Indigotindisulfonate is administered intravenously.

Publisher's Statement

Originally published in the Journal of Anaesthesia & Critical Care Case Reports, 2(1), 8-11. Licensed under CC BY-NC 3.0. This material can be found here.



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