Methemoglobinemia after transesophageal echocardiography: a life-threatening complication.
Methemoglobinemia is an uncommon cause of tissue hypoxemia that can be life-threatening if not promptly identified and treated. It can occur after exposure to an oxidizing agent from contaminated well water or from nitroglycerin, sodium nitroprusside, or certain local anesthetics. During oropharyngeal use of topical anesthetics for transesophageal echocardiography, systemic drug uptake is unpredictable and unexplained complications can ensue. Treatment of acquired methemoglobinemia may require methylene blue, as oxygen is not usually sufficient. Avoidance of the oxidizing agent, probably benzocaine in the cases presented, is prudent.
Jacka
Michael J
MJ
Department of Anesthesiology, University of Alberta, Canada. mjacka@ualberta.ca
Kruger
Marelise
M
Glick
Naomi
N
D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects*; D001566:Benzocaine / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D008875:Middle Aged; D016877:Oxidants / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000628:therapy
D000779:Anesthetics, Local; D016877:Oxidants; D008012:Lidocaine; D008751:Methylene Blue; D001566:Benzocaine