Document Detail

Risk of topical anesthetic-induced methemoglobinemia: a 10-year retrospective case-control study.
MedLine Citation:
PMID:  23546303     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Methemoglobinemia is a rare but serious disorder, defined as an increase in oxidized hemoglobin resulting in a reduction of oxygen-carrying capacity. Although methemoglobinemia is a known complication of topical anesthetic use, few data exist on the incidence of and risk factors for this potentially life-threatening disorder.
OBJECTIVE: To examine the incidence of and risk factors for procedure-related methemoglobinemia to identify patient populations at high risk for this complication.
DESIGN AND SETTING: Retrospective study in an academic research setting.
PARTICIPANTS: Medical records for all patients diagnosed as having methemoglobinemia during a 10-year period were reviewed.
EXPOSURES: All cases of methemoglobinemia that occurred after the following procedures were included in the analysis: bronchoscopy, nasogastric tube placement, esophagogastroduodenoscopy, transesophageal echocardiography, and endoscopic retrograde cholangiopancreatography.
MAIN OUTCOMES AND MEASURES: Comorbidities, demographics, concurrent laboratory values, and specific topical anesthetic used were recorded for all cases. Each case was compared with matched inpatient and outpatient cases.
RESULTS: In total, 33 cases of methemoglobinemia were identified during the 10-year period among 94,694 total procedures. The mean (SD) methemoglobin concentration was 32.0% (12.4%). The methemoglobinemia prevalence rates were 0.160% for bronchoscopy, 0.005% for esophagogastroduodenoscopy, 0.250% for transesophageal echocardiogram, and 0.030% for endoscopic retrograde cholangiopancreatography. Hospitalization at the time of the procedure was a major risk factor for the development of methemoglobinemia (0.14 cases per 10,000 outpatient procedures vs 13.7 cases per 10,000 inpatient procedures, P < .001).
CONCLUSIONS AND RELEVANCE: The overall prevalence of methemoglobinemia is low at 0.035%; however, an increased risk was seen in hospitalized patients and with benzocaine-based anesthetics. Given the potential severity of methemoglobinemia, the risks and benefits of the use of topical anesthetics should be carefully considered in inpatient populations.
Sejal Chowdhary; Bolanle Bukoye; Arjun M Bhansali; Alexander R Carbo; May Adra; Sheila Barnett; Mark D Aronson; Daniel A Leffler
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-06-07     Completed Date:  2013-07-15     Revised Date:  2014-01-13    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  771-6     Citation Subset:  AIM; IM    
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MeSH Terms
Anesthesia, Local / methods*
Anesthetics, Local / administration & dosage*,  adverse effects*
Antidotes / therapeutic use
Benzocaine / administration & dosage,  adverse effects
Case-Control Studies
Cholangiopancreatography, Endoscopic Retrograde
Echocardiography, Transesophageal
Endoscopy, Digestive System
Inpatients / statistics & numerical data
Intubation, Gastrointestinal
Massachusetts / epidemiology
Medical Records
Methemoglobinemia / chemically induced*,  drug therapy,  epidemiology*
Methylene Blue / therapeutic use
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Reg. No./Substance:
0/Anesthetics, Local; 0/Antidotes; 94-09-7/Benzocaine; T42P99266K/Methylene Blue
Comment In:
JAMA Intern Med. 2013 Nov 25;173(21):2013-4   [PMID:  24276057 ]
JAMA Intern Med. 2013 Nov 25;173(21):2013   [PMID:  24276056 ]
JAMA Intern Med. 2013 May 13;173(9):776   [PMID:  23546394 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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