Neuhaeuser Christoph, Weigand Nikola, Schaaf Heidrum, Mann Valesco, Christophis Petros, Howaldt Hans Peter, Heckmann Matthias
Department of General Pediatrics and Neonatology, University Hospital Giessen and Marburg GmbH, Giessen, Germany.
Paediatr Anaesth. 2008 Feb;18(2):125-31. doi: 10.1111/j.1460-9592.2007.02358.x.
Infiltrative anesthesia of the scalp with lidocaine was used in an attempt to reduce blood loss and anesthetic requirements during pediatric craniofacial surgery. Lidocaine, however, has the potential to cause methemoglobinemia. In this retrospective cohort-study we analyzed the incidence and effects of postoperative methemoglobinemia following subcutaneous lidocaine administration.
During 1999-2006, 50 infants (age: 3-31 months) undergoing elective craniofacial surgery were analyzed. All infants received general anesthesia and routine monitoring, including invasive arterial blood pressure measurement. Prior to incision, the scalp was infiltrated with 6-15 ml lidocaine 1% (with epinephrine 1 : 200.000). Blood loss and blood transfusions were recorded. Methemoglobin (Met-Hb) levels were determined postoperatively using co-oximetry.
Twenty percent of the operated infants showed elevated Met-Hb levels (median of maximal levels: 6%; range: 2.2-18%) at admission on the PICU. In 80% of these methemoglobinemia resolved spontaneously within 12 h, only two children received methylene blue because of visible cyanosis. The intra- and postoperative course was otherwise uneventful in all the children despite significant total blood loss (median of blood loss as percentage from total estimated blood volume: 43%; range: 11-110%). Lidocaine was the only substance identified to have the potential to cause methemoglobinemia. However, the average administered dose of lidocaine was not significantly different between patients with or without methemoglobinemia (13 +/- 3.1 vs 12 +/- 3.5 mg.kg(-1); P = 0.37).
Even though we did not measure lidocaine plasma levels, lidocaine was the most likely cause of postoperative methemoglobinemia. Despite a high incidence, methemoglobinemia occurred sporadically and was without dangerous consequences.
在小儿颅面外科手术中，使用利多卡因对头皮进行浸润麻醉，试图减少术中失血和麻醉剂用量。然而，利多卡因有导致高铁血红蛋白血症的潜在风险。在这项回顾性队列研究中，我们分析了皮下注射利多卡因后术后高铁血红蛋白血症的发生率及影响。
对1999年至2006年期间接受择期颅面外科手术的50例婴儿（年龄3至31个月）进行分析。所有婴儿均接受全身麻醉和常规监测，包括有创动脉血压测量。在切口前，用6至15毫升1%利多卡因（含1:200000肾上腺素）对头皮进行浸润。记录失血量和输血情况。术后使用血气分析仪测定高铁血红蛋白（Met-Hb）水平。
20%的手术患儿在入住儿科重症监护病房（PICU）时高铁血红蛋白水平升高（最高水平中位数：6%；范围：2.2%至18%）。其中80%的高铁血红蛋白血症在12小时内自行消退，只有两名患儿因出现明显发绀而接受了亚甲蓝治疗。尽管总失血量较大（失血量中位数占估计总血容量的百分比：43%；范围：11%至110%），但所有患儿的术中和术后过程均顺利。利多卡因是唯一被确定有导致高铁血红蛋白血症潜在风险的物质。然而，发生高铁血红蛋白血症和未发生高铁血红蛋白血症的患者之间利多卡因的平均给药剂量无显著差异（13±3.1 vs 12±3.5 mg·kg⁻¹；P = 0.37）。
尽管我们未测量利多卡因血浆水平，但利多卡因最有可能是术后高铁血红蛋白血症的原因。尽管发生率较高，但高铁血红蛋白血症呈散发性发生，且无危险后果。
