Original ArticlesBenzocaine-induced methemoglobinemia: Experience from a high-volume transesophageal echocardiography laboratory*,**
Section snippets
Study population
Patients who underwent TEE between January 1999 and August 2001 were identified from the Cleveland Clinic Foundation echocardiographic database. Patients undergoing intraoperative TEE were excluded, as preprocedural oropharyngeal topical anesthetics are not used in this setting. Methylene blue administration and increased methemoglobin levels were identified by cross-referencing the above patients with our institutional pharmacy and laboratory databases, respectively. Data regarding topical
Patient characteristics
During the 32-month study period, a total of 4336 TEE examinations were performed. Of these, 5 patients were identified who met criteria for benzocaine-induced methemoglobinemia, resulting in an estimated incidence of 0.115% (95% confidence interval 0.037-0.269). In other words, the incidence of clinically significant methemoglobinemia ranged from approximately 1 in 370 to 1 in 2700. All 5 patients were hospital inpatients; there were no cases that occurred in the outpatient setting. The mean
Discussion
Benzocaine-induced methemoglobinemia is an uncommon occurrence in clinical practice, yet knowledge of this life-threatening condition is vital. Since its first description in the literature in 1950,4 at least 60 cases have been reported. This investigation reports on another 5 cases of clinically significant benzocaine-induced methemoglobinemia in patients undergoing TEE. We estimated the incidence of this complication to be approximately 0.115%. Our study constitutes the only systematic
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Causes of acquired methemoglobinemia – A retrospective study at a large academic hospital
2024, Toxicology ReportsNursing Staff Administered Topical Lidocaine Anesthesia in Transesophageal Echocardiography: Impact on Quality, Delivery of Care, and the Rates of Methemoglobinemia
2021, Journal of the American Society of EchocardiographyGuidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the american society of echocardiography and the society of cardiovascular anesthesiologists
2013, Journal of the American Society of EchocardiographyCitation Excerpt :The physician-patient interaction and efficacy of verbal sedation should not be underestimated. The risk for methemoglobinemia with excess use of benzocaine is rare (0.07%–0.12%) and possibly related to a number of clinical factors, including age, dose of medication, enzyme deficiencies, malnutrition, mucosal erosion, hospitalization, sepsis, and anemia.43,44 Signs and symptoms of methemoglobinemia (methemoglobin level > 1.5%) include dyspnea, nausea, tachycardia, cyanosis, and a drop in oxygen saturation by pulse oximetry.
Preparation of the Patient for Awake Intubation
2013, Benumof and Hagberg's Airway ManagementPreparation of the Patient for Awake Intubation
2012, Benumof and Hagberg's Airway Management: Third Edition
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Reprint requests: Ellen Mayer Sabik, MD, Section of Cardiovascular Imaging, Desk F15, 9500 Euclid Ave, Cleveland, OH 44195 E-mail: [email protected]).
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