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Severe methemoglobinemia from topical anesthetic spray: case report, discussion and qualitative systematic review

Published online by Cambridge University Press:  21 May 2015

Riyad B. Abu-Laban ,
Peter J. Zed ,
Roy A. Purssell  and
Kenneth G. Evans
Riyad B. Abu-Laban*
Affiliation:
The Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC
Peter J. Zed
Affiliation:
The Department of CSU Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, BC
Roy A. Purssell
Affiliation:
The Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC
Kenneth G. Evans
Affiliation:
The Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC
*
Department of Emergency Medicine, Vancouver General Hospital, 855 W 12th Ave., Vancouver BC V5Z 1M9; abulaban@interchange.ubc.ca

Abstract

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Few health care professionals realize that topical anesthetic spray can cause methemoglobinemia. We describe a 56-year-old woman who was transferred to our emergency department when severe cyanosis and chest pain developed after administration of topical oropharyngeal benzocaine and lidocaine during outpatient endoscopy. Investigations revealed a methemoglobin level of 51%. Despite rapid diagnosis and treatment with methylene blue, pulmonary edema consistent with adult respiratory distress syndrome developed, endotracheal intubation was required, and the patient suffered a lengthy course in the intensive care unit. This article presents a detailed discussion of the pathophysiology, diagnosis and treatment of methemoglobinemia, as well as a qualitative systematic review of the English literature on methemoglobinemia induced by topical anesthetic. The implications of this condition for emergency physicians are also outlined.

Keywords

methemoglobinemiapulmonary edemaadult respiratory distress syndromebenzocainelidocainetopical administrationanestheticemergency department
Type
Case Report • Observations
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 1 , January 2001 , pp. 51 - 56
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

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