Bender P, Neuhaus H
Medizinische Klinik, EVK Düsseldorf, Germany.
Dtsch Med Wochenschr. 2011 Apr;136(15):762-4. doi: 10.1055/s-0031-1275803. Epub 2011 Apr 5.
A 19 year-old female patient suffered from severe hypoxemia after an ambulant surgery for splayfeet. Local anesthesia had been performed with prilocain and bupivacain. Methemoglobinemia was suspected and treated with ascorbine acid and methylene blue. The patient was then admitted to hospital.
The patient was well orientated and awake. She complained of a mild headache and general illness. There was marked central cyanosis. A blood sample was dark-red to brownish. The periphere oxygen saturation was 85%. A cardiac ultrasound and a chest X ray were without pathological findings.
DIAGNOSIS, TREATMENT AND COURSE: Initial arterial blood gas analysis showed a concentration of methemoglobin of 24%. On intensive care clinical and laboratory findings quickly resolved and methemoglobin concentration normalized after one day. The patient had no symptoms anymore and was discharged the next day.
In treatment-resistent hypoxemia after local anesthesia toxic methemoglobinaemia should be suspected. Therapy of choice is immediate administration of methylene blue.
一名19岁女性患者在门诊进行扁平足手术后出现严重低氧血症。手术采用丙胺卡因和布比卡因进行局部麻醉。怀疑出现高铁血红蛋白血症，给予抗坏血酸和亚甲蓝治疗。随后患者入院。
患者定向力良好且清醒。她主诉轻度头痛和全身不适。有明显的中央性发绀。采集的血样呈暗红色至褐色。外周血氧饱和度为85%。心脏超声和胸部X线检查未发现病理改变。
诊断、治疗及病程：初始动脉血气分析显示高铁血红蛋白浓度为24%。在重症监护病房，临床和实验室检查结果迅速好转，高铁血红蛋白浓度在一天后恢复正常。患者不再有症状，于次日出院。
在局部麻醉后出现难治性低氧血症时，应怀疑中毒性高铁血红蛋白血症。首选治疗方法是立即给予亚甲蓝。
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