Indocyanine Green Administration May Cause an Exaggerated Peripheral Oxygen Desaturation in the Presence of Liver Disease—An Underemphasized Observation

Microscope-integrated indocyanine green video angiography (ICG-VA) is used to assess the completeness of clipping and cerebral vascular fl ow during aneurysm surgery. 1 It is a more practical and less time-consuming alternative to intraoperative digital subtraction angiography (DSA). ICG has been reported to cause a decrease in peripheral oxygen saturation (SpO 2 ). 2 – 4 We report a 48-year-old male who presented with complaints of holocranial throbbing headache for 1 month without any history of seizures or focal neurological de fi cit. The patient was a known alcoholic for the past 20 years. Liver function test showed hyperbilirubinemia and elevat-ed serum transaminases. Noncontrast computed tomogra-phy brain revealed subarachnoid hemorrhage. The patient was found to have two aneurysms in the anterior cerebral circulation, one in the anterior communicating artery and one in the right M1 middle cerebral artery, on a DSA scan. He was scheduled for a craniotomy and clipping of both aneurysms. ICG (Aurogreen, Aurolab, Madurai, Tamil Nadu, India) at a dose of 0.25mg/kg