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Acute edema induced by toluidine blue extravasation—first report

Akutes Ödem durch Toluidinblau-Extravasat – erster Fallbericht

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Summary

Methemoglobinemia is characterized by an increased level of methemoglobin (MetHb) in the peripheral blood. MetHb levels increase after tumescent anesthesia and need to be monitored. If a patient becomes symptomatic and/or the MetHb levels increase >10%, intravenous injection of an antidote is recommended. Toluidine blue is twice as effective as methylene blue in this respect.

A 27-year-old woman with advanced lipedema underwent her third liposuction under tumescent anesthesia. After surgery, her MetHb levels increased and needed injection of toluidine blue. She developed an acute and painful edema after extravasation of some toluidine blue due to a bursting vein. This is the first report in the recent medical literature. Clinical presentation, course, and treatment are described.

Zusammenfassung

Die Methämoglobinämie ist durch einen erhöhten Spiegel des Methämoglobins (Met-Hb) im peripheren Blut gekennzeichnet. Met-Hb-Spiegel steigen nach einer Tumeszenzanästhesie an und sollten kontrolliert werden. Sobald der Patient symptomatisch wird oder der Met-Hb-Spiegel >10 % beträgt, wird die intravenöse Injektion eines Antidots empfohlen. Dabei ist Toluidinblau doppelt so effektiv wie Methylenblau.

Eine 27-jährige Frau mit fortgeschrittenem Lipödem hatte ihre dritte Liposuktion in Tumeszenzanästhesie erhalten. Postoperativ stieg der Met-Hb-Spiegel, was die Gabe von Toluidinblau erforderlich machte. Die Patientin entwickelte ein akutes und schmerzhaftes Ödem nach Extravasation einer geringen Menge von Toluidinblau infolge einer geplatzten Vene. Erstmals wird hier über einen solchen Fall in der neueren medizinischen Literatur berichtet. Klinisches Bild, Verlauf und Behandlung werden dargestellt.

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Authors and Affiliations

  1. Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Friedrichstraße 41, 01367, Dresden, Germany

    Uwe Wollina &  André Koch

  2. Center of Physical and Rehabilitative Medicine, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany

    Birgit Heinig

Authors
  1. Uwe Wollina
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  2. André Koch
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  3. Birgit Heinig
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Correspondence to Uwe Wollina.

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Conflict of interest

U. Wollina, A. Koch, and B. Heinig declare that they have no competing interests.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Wollina, U., Koch, A. & Heinig, B. Acute edema induced by toluidine blue extravasation—first report. Wien Med Wochenschr 169, 41–43 (2019). https://doi.org/10.1007/s10354-018-0666-7

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  • DOI: https://doi.org/10.1007/s10354-018-0666-7

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