Pediatrics, Albany Medical Center, Albany, New York, USA.
Pediatrics, Albany Medical Center, Albany, New York, USA
BMJ Case Rep. 2022 Feb 28;15(2):e248013. doi: 10.1136/bcr-2021-248013.
Methaemoglobinaemia is a potentially life-threatening condition characterised by hypoxaemia, cyanosis, pallor, fatigue, metabolic acidosis, headache and in severe cases, coma or death. Topical anaesthetics have been reported to cause methaemoglobinaemia. Topical benzocaine was specifically implicated in roughly 66% of anesthetic-induced methaemoglobinaemia cases in a large systematic review in adults. This complication has occurred often in adult patients with pre-existing comorbidities resulting in diminished use in children overall with only few paediatric cases reported worldwide. Additionally, there is growing evidence of a link between sepsis and methaemoglobinaemia due to increased circulating nitrous oxide from infectious pathogen metabolism. In this report, we discuss a case of a 16-year-old young boy, being evaluated for suspected endocarditis, presenting with acute methaemoglobinaemia after use of topical benzocaine spray for transesophageal echocardiogram. This case exemplifies the importance of blood gas with co-oximetry testing in all cases of refractory hypoxemia who have had procedures requiring topical anaesthetics.
高铁血红蛋白血症是一种潜在的危及生命的疾病，其特征是低氧血症、发绀、苍白、疲劳、代谢性酸中毒、头痛，在严重的情况下，还会导致昏迷或死亡。局部麻醉剂已被报道可导致高铁血红蛋白血症。在一项针对成年人的大型系统评价中，局部苯佐卡因被特别认为与大约 66%的麻醉诱导高铁血红蛋白血症病例有关。这种并发症在患有合并症的成年患者中经常发生，导致儿童总体上的使用减少，全球仅报告了少数儿科病例。此外，由于感染病原体代谢产生的循环一氧化二氮增加，败血症与高铁血红蛋白血症之间的联系也越来越多。在本报告中，我们讨论了一例 16 岁的年轻男孩，因疑似心内膜炎接受评估，在接受经食管超声心动图用局部苯佐卡因喷雾后出现急性高铁血红蛋白血症。该病例说明了在所有接受需要局部麻醉的操作后出现难治性低氧血症的患者中，进行血气和 co-oximetry 检测的重要性。
