| Metahemoglobinemia relacionada con los anestésicos locales: sumario de 242 episodios |
Methemoglobinemia related to local anesthetics: a summary of 242 episodes.
Guay J.
Department of Anesthesia, Maisonneuve-Rosemont Hospital, 5415 L'Assomption Boulevard, Montreal, Quebec, Canada H1T 2M4.joanne.guay@umontreal.ca
Anesth Analg. 2009 Mar;108(3):837-45.
Abstract
BACKGROUND: The purpose of this article is to summarize all episodes of local anesthetic-related methemoglobinemia found in the medical literature.
METHODS: I performed a search of the American National Library of Medicine's PubMed with the following key words: "local anesthetic" and "methemoglobinemia." RESULTS: Two-hundred-forty-two episodes (40.1% published in year 2000 or after) were found. Chocolate-colored blood suggests methemoglobinemia but other colors may be found. A discrepancy between the pulse oximeter saturation (< or = 90%) and the arterial oxygen partial pressure (> or = 70 mm Hg) was present in 91.8% of the episodes. The difference between oxygen saturation measured by pulse oximetry and co-oximetry varied from -6.2% to 44.7%. Plain prilocaine may induce clinically symptomatic methemoglobinemia in children older than 6 mo at doses exceeding 2.5 mg/kg. In adults, the dose of prilocaine should be kept lower than 5.0 mg/kg, which is reduced to 3.2 mg/kg in the presence of renal insufficiency and to 1.3 mg/kg if other oxidizing drugs are used concurrently. A single spray of benzocaine may induce methemoglobinemia. Clinical symptoms may be observed at relatively low methemoglobin values, including coma at 32.2 and 29.1% in children and adults, respectively. Rebound methemoglobinemia (benzocaine on mucous membranes) with methemoglobin values as high as 59.9% may occur up to 18 h after methylene blue administration. Complications of methemoglobinemia include hypoxic encephalopathy, myocardial infarction, and death.CONCLUSION: Benzocaine should no longer be used. Prilocaine should not be used in children younger than 6-mo-old, in pregnant women, or in patients taking other oxidizing drugs. The dose should be limited to 2.5 mg/kghttp://www.anesthesia-analgesia.org/content/108/3/837.full.pdf+html |
| Metahemoglobinemia en un bebé circuncidado después de la aplicación de prilocaína: informe de un caso. |
Methemoglobinemia presenting in a circumcised baby following application of prilocaine: a case report.
Ozdogan H, Osma S, Aydin GB, Dinc A, Ozgun G.
Department of Anesthesiology and Reanimation, Diskapi Yildirim Beyazit Training and Research Hospital, Ulus Diskapi, Ankara, Turkey.drgozdeaydin@yahoo.com.
J Med Case Reports. 2010 Feb 10;4(1):49.
Abstract
INTRODUCTION: Local anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics. CASE PRESENTATION: We report the case of a 40-day-old Turkish boy who presented with cyanosis after receiving local anesthesia with prilocaine. His methemoglobin level revealed severe methemoglobinemia (methemoglobin = 44%). His cyanosis resolved after intravenous administration of methylene blue. CONCLUSION: Although the association between prilocaine use and methemoglobinemia has generally restricted the use of prilocaine in babies, it is still widely used in ambulatory procedures, especially during circumcision in the neonatal period. Prilocaine should not be used in babies who are less than 3 months old because of the risk of methemoglobinemia; other local anesthetics may be used for this age group. Furthermore, general anesthesia by mask ventilation may be favored for babies less than 3 months of age instead of local anesthetics
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| Reconocimiento, fisiología y tratamiento de la metahemoglobina inducida por medicamentos: informe de un caso |
The recognition, physiology, and treatment of medication-induced methemoglobinemia: a case report.
Turner MD, Karlis V, Glickman RS.
Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, New York 10010-4086, USA. mdt4@nyu.edu
Anesth Prog. 2007 Fall;54(3):115-7.
Abstract
Dapsone is a leprostatic agent commonly prescribed for the management of leprosy, malaria, and the immunosuppression-induced infections of Pneumocystis carinii and Toxoplasma gondii. In susceptible patients, methemoglobinemia, a potentially life-threatening event, can occur. We report a case of dapsone-induced methemoglobinemia which was observed during general anesthesia for the management of a fractured mandible. The pathophysiology, diagnosis, and management of dapsone-induced methemoglobinemia will be discussed. |
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