Which anesthetics can induce methemoglobinemia?
A wide variety of substances (Table 1) are known to induce methemoglobinemia, including amyl nitrite, nitroglycerin, dapsone, phenacetin, phenytoin, primaquine, sulfonamides, and local anesthetics such as lidocaine and benzocaine [7].
Does benzocaine cause methemoglobinemia?
Benzocaine and other local anesthetics can cause methemoglobinemia, a serious condition in which the amount of oxygen carried through the blood is greatly reduced. This condition is life-threatening and can result in death.
What are the most common local anesthetic agents?
Commonly used ester LAs include chloroprocaine, procaine, and tetracaine. The commonly used amide LAs include lidocaine, bupivacaine, ropivacaine, mepivacaine, and outside the United States, levobupivacaine. Articaine is an amide LA used primarily in dentistry.
Can nitroglycerin cause methemoglobinemia?
— Nitrites and nitrates are well-recognized causes of acquired methemoglobinemia. Nitroglycerin has been reported to cause methemoglobinemia in animals. We report on a patient in whom we believe methemoglobinemia developed from an accidental overdose of nitroglycerin.
Does bupivacaine cause methemoglobinemia?
Although the two local anesthetics usually do not cause methemoglobinemia, we suspect that the displacement of lidocaine from protein binding by bupivacaine, in combination with metabolic acidosis and treatment with other oxidants, was the reason for the development of methemoglobinemia.
How much benzocaine can causes methemoglobinemia?
The cause of methemoglobinemia was 20% benzocaine spray used for local anesthesia before intubation. Acutely developing methemoglobinemia is infrequently encountered in clinical practice.
What causes Sulfhemoglobin?
Sulfhemoglobin is formed by irreversible oxidation of hemoglobin by drugs (such as sulfanilamides, phenacetin, nitrites, and phenylhydrazine) or exposure to sulfur chemicals in industrial or environmental settings. It is formed by the addition of a sulfur atom to the pyrrole ring of heme and has a greenish pigment.
