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Acute hemodynamic effects of indigo carmine in the presence of compromised cardiac function
1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Indigo carmine administration can cause acute afterload increase and left ventricular failure in patients with severe cardiac dysfunction. Caution is advised when using this dye in such surgical patients.
Area of Science:
- Cardiovascular Physiology
- Surgical Pharmacology
Background:
- A 68-year-old patient with severe cardiac dysfunction and renal artery stenosis underwent aortorenal bypass.
- Hemodynamic stability was maintained until indigo carmine administration.
Observation:
- Intravenous administration of 5 ml indigo carmine induced acute hemodynamic changes.
- The patient experienced a significant increase in afterload.
Findings:
- Acute left ventricular failure was observed.
- Cardiac output decreased, and pulmonary artery pressure increased.
- Indigo carmine demonstrated a hypertensive side effect.
Implications:
- Indigo carmine should be used cautiously in patients with compromised cardiac function.
- Further research is needed to elucidate the mechanism of its hypertensive effects.
Abstract:
This report describes the acute hemodynamic effects of indigo carmine in a surgical patient with compromised cardiac function. A 68-year-old woman with stable but severe cardiac dysfunction and renal artery stenosis was scheduled for an elective aortorenal bypass procedure. No hemodynamic instability occurred during the operation until the patient was administered intravenous (IV) indigo carmine 5 ml. At that time, the patient experienced an acute increase in afterload, which resulted in acute left ventricular failure documented by a decrease in cardiac output (CO) and an increase in pulmonary artery pressure (PAP). Until further studies defining the mechanism for its hypertensive side effect are performed, indigo carmine should be used with caution in patients with severe cardiac dysfunction.