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Wiener Medizinische Wochenschrift

, Volume 169, Issue 1–2, pp 41–43 | Cite as

Acute edema induced by toluidine blue extravasation—first report

  • Uwe WollinaEmail author
  • André Koch
  • Birgit Heinig
case report
  • 31 Downloads

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.

Keywords

Tumescent anesthesia Toluidine blue Acute painful edema Lipedema Liposuction 

Akutes Ödem durch Toluidinblau-Extravasat – erster Fallbericht

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.

Schlüsselwörter

Tumeszenzanästhesie Toluidinblau Akutes schmerzhaftes Ödem Lipödem Liposuktion 

Notes

Compliance with ethical guidelines

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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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Dermatology and AllergologyStädtisches Klinikum Dresden, Academic Teaching HospitalDresdenGermany
  2. 2.Center of Physical and Rehabilitative MedicineStädtisches Klinikum Dresden, Academic Teaching HospitalDresdenGermany

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