Wilburn-Goo D, Lloyd L M
Ike's Pharmacy, Memphis, Tenn., USA.
J Am Dent Assoc. 1999 Jun;130(6):826-31. doi: 10.14219/jada.archive.1999.0306.
The authors conducted literature review to create a heightened awareness of the potential for developing toxic methemoglobinemia from local anesthetics. Methemoglobin normally is present in the blood at levels less than 1 percent. Levels may become toxic as hemoglobin is oxidized to methemoglobin after local anesthetics such as benzocaine and prilocaine are administered.
The authors searched the medical and pharmaceutical industry literature. They found and reviewed case studies of incidences of methemoglobinemia that resulted from local anesthetic overdoses.
Cases of local anesthetic-induced methemoglobinemia in dental practice are under-recognized and rare. Reported cases of prilocaine-induced methemoglobinemia have resulted in recent changes in some prilocaine literature. These changes include maximum recommended doses for patients of various weights.
Dentists should identify patients who are at increased risk of developing methemoglobinemia before administering local anesthetics. They also should follow new recommended dosing guidelines for prilocaine and be aware of symptoms of this adverse reaction.
作者进行文献综述，以提高对局部麻醉药引发中毒性高铁血红蛋白血症可能性的认识。正常情况下，血液中高铁血红蛋白的含量低于1%。在使用苯佐卡因和丙胺卡因等局部麻醉药后，血红蛋白被氧化为高铁血红蛋白，其水平可能会变得有毒。
作者检索了医学和制药行业文献。他们发现并回顾了因局部麻醉药过量导致高铁血红蛋白血症发生率的病例研究。
牙科实践中由局部麻醉药引起的高铁血红蛋白血症病例未得到充分认识且较为罕见。丙胺卡因引起的高铁血红蛋白血症的报告病例导致了一些丙胺卡因文献的近期变化。这些变化包括针对不同体重患者的最大推荐剂量。
牙医在使用局部麻醉药前应识别出发生高铁血红蛋白血症风险增加的患者。他们还应遵循丙胺卡因的新推荐给药指南，并了解这种不良反应的症状。
