Methylene Blue and Indocyanine Green Artfactually Lower Pulse Oximetry Readings of Oxygen Saturation. Studies in Dogs

Abstract

The effects of fluorescein, methylene blue, and indocyanine green on hemodynamic variables and on pulse oximetry and co-oximetry measurements of arterial hemoglobin oxygen saturation (SaO₂) and oxyhemoglobin percentage (% HbO₂) were evaluated in 16 anesthetized dogs in vitro by cooximetry (% HbO₂) and in vivo by pulse oximetry (SaO₂). The light absorbance (optical density) in plasma (range 500 to 800 nm) was measured by a spectrophotometer. Fluorescein did not affect oximetry measurements, plasma light absorbance in the range measured, or hemodynamic variables. Methylene blue caused dose-dependent decreases in measurements made with both forms of oximetry for up to 30 minutes, the decrease being greater and longer lasting with pulse oximetry (P < 0.05). Hemodynamic measurements in 5 dogs showed that methylene blue (1 to 5 mg/kg) increased arterial pressure transiently, after which cardiac output, stroke index, and left ventricular stroke work index decreased and left ventricular end-diastolic pressure and systemic and pulmonary vascular resistances increased (P < 0.05 with 5 mg/kg). Methemoglobin concentration measured by co-oximetry increased significantly (to 19.9 ± 1.4%, P < 0.05) 1 minute after 5 mg/kg of methylene blue was injected. Methylene blue had a dose- and time-dependent effect on plasma light absorbance, and this effect peaked in the 660- to 670-nm range. The data do not distinguish the relative contributions of physiology (hemodynamic change), chemistry (methemoglobin production), and physics (optical properties) to the decrease in pulse oximetry and co-oximetry measurements that follows injection of methylene blue. Indocyanine green affected neither hemodynamic variables nor co-oximetry readings but decreased pulse oximetry readings for up to 10 minutes dose dependently. With doses of 0.1 to 3.0 mg/kg of indocyanine green plasma light absorbance peaked at 805 nm but increased dose dependently for up to 30 minutes at 660 nm. Methylene blue and indocyanine green (and, by implication, other dyes with plasma light absorbance peaks in the 600- to 1,000-nm range) artifactually alter oximetric detection of arterial hemoglobin oxygen saturation and oxyhemoglobin percentage.