Indocyanine green - Evidence of neurotoxicity in spinal root axons
Indocyanine green - Evidence of neurotoxicity in spinal root axons
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DOI：
10.1097/00000542-200302000-00034
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发表时间：
2003-02-01
期刊：
影响因子：
8.8
通讯作者：
Jaffe, RA
中科院分区：
文献类型：
--
作者：
Dietz, FB;Jaffe, RA
背景：硬膜外麻醉期间不慎血管内注射局部麻醉剂是一种罕见但潜在的严重并发症。肾上腺素是最常用的标记物，不能提供足够的敏感性来排除所有患者群体中的血管内注射。吲哚青绿(ICG)已被提出作为一种替代标记。已经证明，ICG可以通过一种简单的经皮分光光度技术来检测血管内注射。尽管静脉注射ICG的安全性已经得到了很好的证明，但考虑到在用于验证硬膜外导管放置的测试注射过程中意外鞘内注射的可能性，它的神经毒性潜力需要仔细研究。在这项研究中，作者通过测量对冲动产生和传导的影响，研究了临床相关浓度的ICG(28.6-286um)对大鼠单个有髓和无髓背根轴突的神经生理学影响。结果：与静脉注射时明显的毒性相反，ICG应用于完整的背根，在硬膜外试验剂量下可能遇到的浓度，产生了长时间的传导阻滞(26个轴突中的21个)或自发的爆裂活动(26个轴突中的7个)。结论：鉴于这种明显的神经毒性，当鞘内或神经根注射时，不应使用ICG。
Background: The inadvertent intravascular injection of a local anesthetic during epidural anesthesia is an uncommon but potentially serious complication. Epinephrine, the most commonly used marker, does not provide sufficient sensitivity to exclude intravascular injection in all patient populations. The dye indocyanine green (ICG) has been proposed as an alternative marker. it has been demonstrated that ICG could be used to detect intravascular injections with a simple transcutaneous spectrophotometric technique. Although the safety of intravenous ICG is well documented, its neurotoxic potential requires careful study given the probability of inadvertent intrathecal injection during test injections used to verify epidural catheter placement.Methods. In this study, the authors investigated the neurophysiologic effects of clinically relevant concentrations of ICG (range, 28.6-286 muM) on single myelinated and unmyelinated dorsal root axons in rats by measuring effects on impulse generation and conduction.Results: In contrast to the apparent absence of toxicity when injected intravenously, ICG applied to intact dorsal roots at concentrations likely to be encountered with an epidural test dose produced long-lasting conduction block (21 of 26 axons) or spontaneous bursting activity (7 of 26 axons) in myelinated and unmyelinated dorsal root axons.Conclusion: Given this apparent neurotoxicity, ICG should not be used when intrathecal or nerve root injection is possible.