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題名 | Methemoglobinemia Induced by Exposure to Topical Benzocaine for an Awake Nasal Intubation--A Case Report=清醒經鼻插管使用Benzocaine引發變性血紅素血症--病例報告 |
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作者 | 林士凱; 吳基烈; 李永隆; 曹紹倫; | 書刊名 | 麻醉學雜誌 |
卷期 | 45:2 2007.06[民96.06] |
頁次 | 頁111-116 |
分類號 | 416.5 |
關鍵詞 | 變性血紅素血症; Benzocaine; Lidocaine; Methemoglobinemia; |
語文 | 英文(English) |
中文摘要 | 我們報告一個29歲48公斤女性患者其接受咬合異常的矯正手術,因清醒經鼻插管使用局部麻醉劑(Benzocaine)而引起變性血紅素血症之併發症。病人約3週前因車禍造成下頜骨骨折而接受手術治療;其插管前經氣管給4毫升的2% lidocaine與、5% lidocaine局部噴劑,以內視鏡引導下清醒經鼻完成插管,並順利完成手術。病人無對藥物或食物過敏之病史,術後血液檢查除血小板偏低外,並無任何異常。此次因咬合異常再次手術,因其嘴巴張開小於一公分,故採取清醒盲目經鼻插管。插管前經氣管給予4毫升的4% lidocaine及20% benzocaine局部噴劑於口腔與鼻孔。在順利插完管後約10分鐘後,病人出現嘴唇與四肢末端發疳的情形,此時SpO2降至約65%。但動脈血氧分析卻發現其PaO2為406mmHg,SaO2為100%,因此高度懷疑為局部麻醉藥所引發之變性血紅素血症。此時以CO-oximetry檢驗變性血紅素濃度,高達25.9%。在一小時後,其持續升高至39.6%。於是經靜脈給予甲基藍50毫克。期間病人之血行動力學並無顯著變化。在八小時後,其MetHb濃度降至0.3%。局部麻醉藥所致之變性血紅素血症是一個不常見但可能致命的併發症。診斷有賴於臨床線索及高度的警覺心。對於嚴重的病例,靜脈給與甲基藍是其治療的選擇藥物。 |
英文摘要 | Topical benzocaine and lidocaine are widely used in general anesthesia to minimize the stimulation by awake intubation and in very rare occasion they may induce methemoglobinemia. Although this complication is uncommon, it may be potentially lethal. Here we report a 29-year-old female who was scheduled to receive correction of malocclusion and developed acute methemoglobinemia soon after induction of general anesthesia. Three weeks ago, she had received open reduction for fracture of mandible with intermaxillary fixation under general anesthesia, for which awake fiberoptic intubation was smoothly performed after premedication with 2% topical lidocaine and intravenous fentanyl. This time, trachomucosal block with 4 mL of 4%topical lidocaine and spray of 20% topical benzocaine over the oral cavity and nostrils were carried out before intubation. Awake blind intubation was performed because she could not open her mouth for more than 1 cm. A 6.5 mm-sized nasal endotracheal tube was smoothly placed in first attempt. About 10 min later, an unexplained cyanosis occurred and SpO2 fell to about 70%. Based on a high oxygen tension by arterial blood gas analysis (PaO2) with a contradictory fall of oxygen saturation by pulse oximetry (SpO2), acute methemoglobinemia was highly suspected. The diagnosis was confirmed by multiple-wavelength CO-oximetry. The methemoglobinemia was resolved gradually after methylene blue was given. In conclusion, we must always take the possibility of methemoglobinemia into consideration for differential diagnosis in case of unexplained cyanosis, particularly when patients have prior exposure to methemoglobininducing agents. |
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