Anesthetic management of a patient with congenital methemoglobinemia.
Methemoglobinemia occasionally causes cyanosis particularly in congenital methemoglobinemia. Avoidance of exposure to oxidizing agents is important for patients with congenital methemoglobinemia because of their deficient enzymatic pathways and decreased oxygen-carrying capacity. Here, we present a patient with preoperatively undiagnosed congenital methemoglobinemia who underwent uterine myomectomy under general anesthesia. The patient was a 35-year-old woman who displayed a low pulse oximetry reading of 91% prior to induction of anesthesia. Methemoglobinemia was first suspected intraoperatively because of a mismatch of SpO2 of finger pulse oximetry and SaO2 of arterial blood, and was later confirmed by multiple-wavelength CO-oximetry. The pathophysiology, etiology, clinical manifestations, anesthetic considerations, and treatment options of methemoglobinemia are discussed.
Lin
Chiao-Yi
CY
Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Yang
Jenn-Ming
JM
Chen
Chiun-Ting
CT
Hsu
Yung-Wei
YW
Huang
Chun-Jen
CJ
Chen
Chien-Chuan
CC
Tsai
Hsin-Jung
HJ
D000328:Adult; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D008708:Methemoglobinemia / Q000151:congenital* / Q000628:therapy; D008751:Methylene Blue / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood
D010100:Oxygen; D008751:Methylene Blue