Benzocaine
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Methaemoglobinaemia in an elderly patient following topical administration: case report A 71-year-old man developed methaemoglobulinaemia after receiving topical benzocaine solution prior to undergoing elective eosophageogastroduodenoscopy. The man received three sprays of 20% benzocaine solution topically and, within minutes of completion of the procedure, complained of shortness of breath and chest pain and his oxygen saturation decreased to 76%. He was cyanotic, he had a pulse of 78 beats/min, a BP of 154/57mm Hg and cardiac enzyme estimation revealed mildly elevated cardiac troponin I levels and an ECG revealed ST depression. Co-oximetry revealed a methaemoglobin concentration of 17%, oxyhaemoglobin concentration of 82.2% and a measured oxygen saturation of 99.3%. Treatment with IV methylthioninium chloride [methylene blue] was initiated and repeat arterial blood gas analysis 4 hours later revealed a methaemoglobin concentration of 1.3%, oxyhaemoglobin concentration of 97.6% and measured oxygen saturation of 98.9%. The man’s chest pain improved over the following several hours and his cardiac troponin I level normalised. He was discharged the following day in a stable condition. One month later, a dipyridamole stress test did not reveal any evidence of ischaemia and there was a normal haemodynamic response to dipyridamole on ECG and nuclear imaging, confirming the absence of coronary artery disease. Saha SA, et al. Methemoglobinemia-induced cardio-respiratory failure secondary to topical anesthesia. American Journal of Therapeutics 13: 545-549, No. 6, Nov 801057160 2006 - USA
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Reactions 9 Dec 2006 No. 1131
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