Acquired Methemoglobinemia Revisited

Trapp, Larry D.; Will, John J.

doi:10.1016/j.cden.2010.06.007

Cited by 38 publications

(52 citation statements)

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“…5,8 However, there is no direct evidence supporting the claims that lidocaine definitively induces the formation of methemoglobin. 4 In fact, the extent of the formation of methemoglobin has not been reported for either local anesthetic.…”

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confidence: 99%

“…3 An important risk with some injectable local anesthetics is the formation of methemoglobin. 4,5 There are currently 5 injectable local anesthetics prepared for and marketed to the dental profession: articaine, bupivacaine, lidocaine, mepivacaine, and prilocaine. 2,3,6,7 Lidocaine is the prototypical amide local anesthetic agent and remains the most commonly used dental local anesthetic in the US with a 60% US market share.…”

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confidence: 99%

“…The iron in the ferrous state in the heme groups allows hemoglobin to optimally transport oxygen and carbon dioxide in a physiologic manner. 4 Methemoglobin is a form of hemoglobin in which 1 or more of the ferrous ions found in the 4 heme groups have been oxidized to become ferric ions (Fe 3þ ). The presence of the ferric ion(s) alters the molecular shape and function of the newly formed methemoglobin.…”

mentioning

confidence: 99%

“…Consequently, less oxygen is transported and released to peripheral tissues, which can result in tissue hypoxia. 4,[8][9][10] Furthermore, with less oxygen being released in the periphery, the affinity for carbon dioxide is reduced. As a result, less carbon dioxide is removed from the tissues and peripheral acidosis may ensue.…”

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confidence: 99%

“…As a result, less carbon dioxide is removed from the tissues and peripheral acidosis may ensue. 4 Human physiologic blood levels of methemoglobin normally range between 0% and 2% as a result of the oxidation of hemoglobin by the prototypical oxidant oxygen. The human body has several protective physiologic mechanisms that reduce methemoglobin to hemoglobin.…”

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confidence: 99%

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Methemoglobin Levels in Generally Anesthetized Pediatric Dental Patients Receiving Prilocaine Versus Lidocaine

Gutenberg

Chen

Trapp

2013

Anesthesia Progress

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The purpose of this study was to measure and compare peak methemoglobin levels and times to peak methemoglobin levels following the use of prilocaine and lidocaine in precooperative children undergoing comprehensive dental rehabilitation under general anesthesia. Ninety children, 3–6 years of age, undergoing dental rehabilitation under general anesthesia were enrolled and randomly assigned into 3 equal groups: group 1, 4% prilocaine plain, 5 mg/kg; group 2, 2% lidocaine with 1 : 100,000 epinephrine, 2.5 mg/kg; and group 3, no local anesthetic. Subjects in groups 1 and 2 were administered local anesthetic prior to restorative dental treatment. Methemoglobin levels (SpMET) were measured and recorded throughout the procedure using a Masimo Radical-7 Pulse Co-Oximeter (Masimo Corporation, Irvine, Calif, RDS-1 with SET software with methemoglobin interface). Data were analyzed using chi-square, one-way analysis of variance (ANOVA), and Pearson correlation (significance of P < .05). Group 1 had a significantly higher mean peak SpMET level at 3.55% than groups 2 and 3 at 1.63 and 1.60%, respectively. The mean time to peak SpMET was significantly shorter for group 3 at 29.50 minutes than that of group 1 at 62.73 and group 2 at 57.50 minutes. Prilocaine, at 5 mg/kg in pediatric dental patients, resulted in significantly higher peak SpMET levels than lidocaine and no local anesthetic. In comparison to no local anesthetic, the administration of prilocaine and lidocaine caused peak SpMET levels to occur significantly later in the procedure.

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confidence: 99%