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European Journal of Echocardiography 2008 9(2):289-290; doi:10.1016/j.euje.2006.09.003
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

A rare side effect of transesophageal echocardiography: methemoglobinemia from topical benzocaine anesthesia{dagger}

Zehra Jaffery and Karthik Ananthasubramaniam*

Department of Internal Medicine, Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Boulevard, K-14, Detroit, MI 48202, USA

Received 18 July 2006; received in revised form 30 August 2006; accepted after revision 16 September 2006; online publish-ahead-of-print 3 November 2007.

* Corresponding author. Tel.: +1 313 916 5033; fax: +1 313 916 1249. E-mail address: kananth1{at}hfhs.org (K. Ananthasubramaniam)


  Abstract

Background: Benzocaine induced methemoglobinemia is an uncommon, potentially fatal condition.

Case report: A 44-year-old woman with a history of hepatitis C and intravenous drug use was referred for transesophageal echocardiography for bacteremia evaluation. During induction of topical anesthesia with benzocaine spray she became cyanotic. Pulse oximetry revealed marked desaturation (75%) but was discordant from arterial blood O2 saturation (99%). Due to clinical suspicion, methemoglobin level was measured and noted to be 69%. The patient was treated with 2 mg/kg of methylene blue intravenously with resolution of her symptoms.

Conclusion: Physicians using topical anesthesia in endoscopic suites should be aware of this rare, potentially life-threatening treatable condition. High clinical suspicion and availability of methylene blue in endoscopy suites will facilitate prompt diagnosis and treatment.

Keywords: Methemoglobinemia; Topical anesthetics; Methylene blue; Transesophageal echocardiography

{dagger} The authors do not have any financial disclosure or conflict of interest in the preparation of this manuscript.


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