Risk of acquired methemoglobinemia with different topical anesthetics during endoscopic procedures.
BACKGROUND
Methemoglobinemia is a recognized complication of the use of topical anesthetic sprays. The true scope of the problem or the risk with different topical anesthetic sprays and endoscopic procedures is unknown.


METHODS
We retrospectively identified all cases of methemoglobinemia that occurred in a university affiliated community hospital from 2001 to 2007.


RESULTS
Eleven cases of methemoglobinemia were identified over the 6-year period. Nine (82%) occurred with use of benzocaine spray during transesophageal echocardiography (TEE). Patients who developed methemoglobinemia secondary to the topical anesthetic spray compared to other causes were more likely to be older, have lower mean hemoglobin levels (10.5 ± 0.5 g/dL vs 11.3 ± 0.0 g/dL), and a higher mean methemoglobin concentration at diagnosis (40.8% ± 5.2% vs 24% ± 10%). However, only age reached statistical significance (P = 0.004).


CONCLUSIONS
In a university-affiliated community hospital, topical anesthetic sprays account for most of the burden of methemoglobinemia. Benzocaine use in the context of TEE caused more methemoglobinemia compared to lidocaine and other endoscopic procedures. This observation supports previous data and findings deserve further study.
Division of General Internal Medicine, Department of Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA.
Srikanth
S
Vallurupalli
Shalini
S
Manchanda