Upper Extremity Discoloration Caused by Subcutaneous Indigo Carmine Injection

Indigo carmine (indigotin disulfonate sodium) is usually used as a marker dye to locate the ureteral orifice, severed ureters, or fistulas. Although it is considered pharmacologically inert, it can cause significant problems, some of which are very important for anesthesiologists. The most commonly encountered cardiovascular effect of intravenous indigo carmine administration is transient alpha -receptor stimulation, which causes increases in peripheral vascular resistance, diastolic and systolic blood pressure, and central venous pressure, with compensatory decreases in cardiac output, stroke volume, and heart rate. We report an unusual complication that resulted from accidental subcutaneous injection of indigo carmine into a patient's forearm during general anesthesia: transient blue discoloration of the entire infiltrated area. This rare complication and the duration of tissue discoloration have never been described.