Methemoglobinemia after local anesthesia with prilocaine: a case report

Erkuran, Mansur Kürşad; Duran, Arif; Kurt, Bekir Barış; Ocak, Tarık

doi:10.1016/j.ajem.2014.09.021

Cited by 7 publications

(5 citation statements)

References 7 publications

(4 reference statements)

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“…However, the blood color was chocolate brown, as in previous reports; and this color is one of the important symptoms for diagnosis of MetHbemia . Methylene blue is the first choice for treating MetHbemia, but medication is not necessarily required and oxygen therapy alone can promote oxygen transport by residual hemoglobin in a case with no symptoms and MetHb <20% . In our case, neither methylene blue nor ascorbic acid was administered because of the absence of symptoms.…”

Section: Discussionsupporting

confidence: 63%

“…A decrease of SpO2 was found 15 min after local anesthesia and SpO2 remained at 85–87% for 45 min while MetHb was 10–11% in our case. We concluded that MetHb developed 15 min after prilocaine infiltration from the anesthetic record and previous reports, in which MetHbemia has been found to occur within 20 min after exposure to prilocaine . However, it was difficult to show that MetHb was responsible for the SpO2 decrease because the patient was also sedated at that time.…”

Section: Discussionmentioning

confidence: 71%

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Methemoglobinemia should be suspected when oxygen saturation apparently decreases after prilocaine infiltration during intravenous sedation

Wakita

Fukayama

2018

Clinical Case Reports

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 71%

Methemoglobinemia should be suspected when oxygen saturation apparently decreases after prilocaine infiltration during intravenous sedation

Wakita

Fukayama

2018

Clinical Case Reports

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“…The oximeter showed quite low reading (<80%) in contrast to the 85% saturation expected, as highlighted in the literature. [ 8 9 10 ] Excessive reliance on cyanosis therefore is not advocated.…”

Section: Discussionmentioning

confidence: 99%

Clofazimine-induced methemoglobinemia: A rare incidence

Ahmed

Preetham

Mahajyoti

2018

J Family Med Prim Care

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Clofazimine is commonly used for the treatment of leprosy and chronic use of it can lead to methemoglobinemia, which is a rare but major concern. Iron of hemoglobin remains in the form of ferric (Fe3+) in methemoglobinemia as compared with ferrous form (Fe2+) in normal situation. This transformation prevents oxygen carriage and results in higher level of MetHb in blood which could be dangerous to life. In normal patients the level of MetHb is <1%. We report a case where acute ingestion of many tablets of clofazimine resulted in methemoglobinemia. Cyanosis was not apparent in this case leading to delayed diagnosis, and despite >30% MetHb levels, the clinical presentation was not very suggestive. Because of the nonavailability of intravenous methylene blue and parenteral ascorbic acid, tablet ascorbic acid was used for the management. Gradual decrease of MetHb levels was observed, with amelioration of symptoms and improvement in patient's condition. Review of the literature failed to reveal publication of acute methemoglobinemia with such presentation in the past. Awareness about possibility of methemoglobinemia and its possible contributors will help primary care physician and emergency physician suspect this condition early in patients presenting with history of unknown drug overdose and work in proper direction.

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“…Dapsone, sulfonamides, benzocaine, primaquine, and some local anesthetics have been reported as causes of acquired MetHb. (9,10). In clinical practice, it occurs mostly as a result of the use of local anesthetics (6).…”

Section: Introductionmentioning

confidence: 99%

Derin Beyin Stimulatörü Uygulanan Hastalarda Skalp Bloğu ve İnfiltrasyon Anestezisinde Methemoglobinemi Riski

Onay¹,

Harbelioğlu²,

Vural³

et al. 2020

Osmangazi̇ Journal of Medicine

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The application of local anesthetics in areas with a high blood supply, such as scalp block, is more susceptible to systemic effects of local anesthetics such as methemoglobinemia because of the high absorption rate and the risk of intravascular injection. In this study, we aimed to evaluate the risk of methemoglobinemia by reviewing methemoglobin values after scalp block in patients with a deep brain stimulation (DBS) due to neurological diseases, especially Parkinson's.The study included 41 patients aged >18 years who were admitted between January 2017 and December 2018 for DBS and underwent regional anesthesia (n = 41). Patients were administered scalp block (n = 10) and infiltration anesthesia (n = 31). Using data from the patients' medical records, we statistically analyzed the patients' age, American Society of Anesthesiologists (ASA) status, gender, DBS indication, scalp block/infiltration anesthesia, highest methemoglobin level in arterial blood gas, pH, pO2, SpO2, and clinical symptoms.The indications for DBS were Parkinson's disease in 29 patients hyperreactivity, dystonia and tremor in the remaining patients. Furthermore, 33 patients were classified as ASA class II. The methemoglobinemia level was >2% in two patients who underwent scalp block and six patients who underwent infiltration anesthesia. However, there was no statistically significant difference in methemoglobin levels between scalp and infiltration anesthesia.In areas with high blood flow, such as the scalp, caution should be exercised in administering local anesthesia because of the patient's risk of developing methemoglobinemia, although there are no clinical findings on this topic.

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Methemoglobinemia after local anesthesia with prilocaine: a case report

Cited by 7 publications

References 7 publications

Methemoglobinemia should be suspected when oxygen saturation apparently decreases after prilocaine infiltration during intravenous sedation

Methemoglobinemia should be suspected when oxygen saturation apparently decreases after prilocaine infiltration during intravenous sedation

Clofazimine-induced methemoglobinemia: A rare incidence

Derin Beyin Stimulatörü Uygulanan Hastalarda Skalp Bloğu ve İnfiltrasyon Anestezisinde Methemoglobinemi Riski

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