Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Anesthetic experience: congenital methemoglobinemia due to hemoglobin M

  • Ri, Hyunsu (Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital) ;
  • Park, Youngje (Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital) ;
  • Jeon, Younghoon (Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital)
  • Received : 2021.07.15
  • Accepted : 2021.09.01
  • Published : 2021.10.01
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Abstract

Methemoglobinemia is rare. It is classified into two types: congenital methemoglobinemia and acquired methemoglobinemia. Methemoglobin is incapable of binding oxygen, leading to complications such as cyanosis, dyspnea, headache, and heart failure. In the present case, a 35-year-old man with congenital methemoglobinemia underwent general anesthesia for thyroidectomy. The patient was diagnosed with hemoglobin M at 7 years of age. Ventilation was performed with FiO2 1.0. Arterial blood gas analysis showed that the pH was 7.4, PaO2 439 mmHg, PaCO2 40.5 mmHg, oxyhemoglobin level of 83.2%, and methemoglobin level of 15.5%. The patient had a stable course, although cyanosis was observed during surgery.

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References

  1. Curry S. Methemoglobinemia. Ann Emerg Med 1982; 11: 214-21. https://doi.org/10.1016/S0196-0644(82)80502-7
  2. Trapp L, Will J. Acquired methemoglobinemia revisited. Dent Clin North Am 2010; 54: 665-75. https://doi.org/10.1016/j.cden.2010.06.007
  3. Hegesh E, Hegesh J, Kaftory A. Congenital methemoglobinemia with a deficiency of cytochrome b5. N Engl J Med 1986; 314: 757-61. https://doi.org/10.1056/NEJM198603203141206
  4. Cortazzo JA, Lichtman AD. Methemoglobinemia: a review and recommendations for management. J Cardiothorac Vasc Anesth 2014; 28: 1043-7. https://doi.org/10.1053/j.jvca.2013.02.005
  5. Moore TJ, Walsh CS, Cohen MR. Reported adverse event cases of methemoglobinemia associated with benzocaine products. Arch Intern Med 2004; 164: 1192-6. https://doi.org/10.1001/archinte.164.11.1192
  6. Maurtua MA, Emmerling L, Ebrahim Z. Anesthetic management of a patient with congenital methemoglobinemia. J Clin Anesth 2004; 16: 455-7. https://doi.org/10.1016/j.jclinane.2003.10.005
  7. Brown C, Bowling M. Methemoglobinemia in bronchoscopy: a case series and a review of the literature. J Bronchology Interv Pulmonol 2013; 20: 241-6. https://doi.org/10.1097/LBR.0b013e3182a125de
  8. Alexander CM, Teller LE, Gross JB. Principles of pulse oximetry: theoretical and practical considerations. Anesth Analg 1989; 68: 368-76.
  9. Lin CY, Yang JM, Chen CT, Hsu YW, Huang CJ, Chen CC, et al. Anesthetic management of a patient with congenital methemoglobinemia. Acta Anaesthesiol Taiwan 2009; 47: 143-6. https://doi.org/10.1016/S1875-4597(09)60042-4
  10. Shirasawa T, Izumizaki M, Suzuki Y, Ishihara A, Shimizu T, Tamaki M, et al. Oxygen affinity of hemoglobin regulates O2 consumption, metabolism, and physical activity. J Biol Chem 2003; 278: 5035-43. https://doi.org/10.1074/jbc.M211110200
  11. Schiemsky T, Penders J, Kieffer D. Failing blood gas measurement due to methemoglobin forming hemoglobin variants: a case report and review of the literature. Acta Clin Belg 2016; 71: 167-70. https://doi.org/10.1080/17843286.2016.1148299
  12. Cefalu JN, Joshi TV, Spalitta MJ, Kadi CJ, Diaz JH, Eskander JP, et al. Methemoglobinemia in the operating room and intensive care unit: early recognition, pathosphysiology, and management. Adv Ther 2020; 37: 1714-23. https://doi.org/10.1007/s12325-020-01282-5
  13. Melarkode K, Prinzhausen H. Hemoglobin M variant and congenital methemoglobinemia: methylene blue will not be effective in the presence of hemoglobin M. Can J Anaesth 2008; 55: 129-30. https://doi.org/10.1007/BF03016328
  14. do Nascimento TS, Pereira RO, de Mello HL, Costa J. Methemoglobinemia: from diagnosis to treatment. Rev Bras Anestesiol 2008; 58: 651-64. https://doi.org/10.1590/S0034-70942008000600011
  15. Shibuya M, Hojo T, Hase Y, Kimura Y, Fujisawa T. Methemoglobinemia caused by a low dose of prilocaine during general anesthesia. J Dent Anesth Pain Med 2021; 21: 357-61. https://doi.org/10.17245/jdapm.2021.21.4.357