Prevalence of Abnormal Methemoglobinemia and Its Determinants in Patients Receiving Nitroglycerin During Anesthesia (original) (raw)
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Adverse events after prehospital nitroglycerin administration in a nationwide registry analysis
The American Journal of Emergency Medicine, 2021
Objective: Nitroglycerin (NTG) is a vasodilator used in the prehospital setting with chest pain patients. Potential adverse effects include hypotension, bradycardia or tachycardia, and mental status change. However, it is unclear which factors, if any, are associated with patients having an adverse event after receiving NTG. The objective of this study was to determine demographic and clinical factors associated with adverse events after prehospital NTG administration. Methods: The ESO Data Collaborative (Austin, TX), containing records from 1322 EMS agencies, was queried for 911 encounters where NTG was administered to patients ≥18 years old by EMS. Adverse event outcomes were defined as a new systolic blood pressure (SBP) < 90, heart rate (HR) < 50 or > 120, mean arterial pressure (MAP) < 65, or change in mental status following NTG administration. Descriptive statistics and logistic regression models adjusting for age, sex, race, ethnicity, intravenous (IV) access, and initial vital signs were used to assess for adverse event-related factors. Results: Among 80,760 encounters, the mean age was 61 (IQR 50-72), with 52% males, 71% white race, and 7% Hispanic ethnicity. Adverse events occurred in 7% of encounters. Adverse events were found to be less common among Black patients (OR = 0.74, 95%
Risk of Topical Anesthetic–Induced Methemoglobinemia
JAMA Internal Medicine, 2013
Importance: Methemoglobinemia is a rare but serious disorder, defined as an increase in oxidized hemoglobin resulting in a reduction of oxygen-carrying capacity. Although methemoglobinemia is a known complication of topical anesthetic use, few data exist on the incidence of and risk factors for this potentially life-threatening disorder. Objective: To examine the incidence of and risk factors for procedure-related methemoglobinemia to identify patient populations at high risk for this complication. Design and Setting: Retrospective study in an academic research setting. Participants: Medical records for all patients diagnosed as having methemoglobinemia during a 10-year period were reviewed. Exposures: All cases of methemoglobinemia that occurred after the following procedures were included in the analysis: bronchoscopy, nasogastric tube placement, esophagogastroduodenoscopy, transesophageal echocardiography, and endoscopic retrograde cholangiopancreatography. Main Outcomes and Measures: Comorbidities, demographics, concurrent laboratory values, and specific topical anesthetic used were recorded for all cases. Each case was compared with matched inpatient and outpatient cases. Results: In total, 33 cases of methemoglobinemia were identified during the 10-year period among 94 694 total procedures. The mean (SD) methemoglobin concentration was 32.0% (12.4%). The methemoglobinemia prevalence rates were 0.160% for bronchoscopy, 0.005% for esophagogastroduodenoscopy, 0.250% for transesophageal echocardiogram, and 0.030% for endoscopic retrograde cholangiopancreatography. Hospitalization at the time of the procedure was a major risk factor for the development of methemoglobinemia (0.14 cases per 10 000 outpatient procedures vs 13.7 cases per 10 000 inpatient procedures, P Ͻ.001). Conclusions and Relevance: The overall prevalence of methemoglobinemia is low at 0.035%; however, an increased risk was seen in hospitalized patients and with benzocaine-based anesthetics. Given the potential severity of methemoglobinemia, the risks and benefits of the use of topical anesthetics should be carefully considered in inpatient populations.
Effect of intravenous nitroglycerin on cerebral saturation in high-risk cardiac surgery
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2007
Purpose To determine whether or not intravenous nitroglycerin (IV NTG) can prevent a decrease in near-infrared spectros-copy (NIRS) values during cardiopulmonary bypass Methods We conducted a randomized double-blinded study in a tertiary academic center including 30 patients with a Parsonnet score ≥ 15 scheduled for a high-risk cardiac surgery. The patients were randomized to receive either IV NTG (initial dose of 0.05 µg·kg-1 ·min-1, followed by 0.1 µg·kg-1·min-1) or placebo after anesthetic induction until the end of The primary outcome was a decrease of 10% in NIRS values during CPB. Results Despite the absence of between-group difference in the mean cerebral oxygen saturation during there was a significant decrease in NIRS values during CPB in the placebo group, whereas mean NIRS values were maintained in the IV NTG group (-16.7%vs 2.3% in the NTG,P = 0.019). Major hemodynamic variables were similar at corresponding time periods in both groups, while patients in the IV NTG group had higher CK-MB values and experienced greater blood loss during the first 24 hr postoperatively. Conclusion Intravenous nitroglycerin administration before and during CPB may prevent a decrease in NIRS values associated with CPB in high-risk cardiac surgery. Further studies are warranted to determine the efficacy and the risks associated with IV NTG infusion for this indication during CPB in high-risk patients. Objectif Déterminer si la nitroglycérine intraveineuse (NTG IV) peut empêcher ou non une diminution des valeurs de la spectroscopie par infrarouge (NIRS) pendant la circulation extracorporelle (CEC). Méthode Nous avons mené une étude randomisée à double insu dans un centre universitaire tertiaire incluant 30 patients présentant un score de Parsonnet ≥ 15 et devant subir une chirurgie cardiaque à haut risque. Les patients ont été randomisés en deux groupes: NTG IV (dose initiale de 0,05 µg·kg-1 ·min-1, suivie de 0,1 µg·kg-1 ·min-1), ou placebo après l’induction de l’anesthésie et jusqu’à la fin de la CEC. Le résultat primaire a été une diminution de 10% des valeurs de NIRS pendant la CEC. Résultats Malgré l’absence de différence inter-groupe dans la saturation d’oxygène cérébrale moyenne durant la CEC, une diminution significative des valeurs de NIRS pendant la CEC a été observée dans le groupe placebo, alors que les valeurs moyennes de NIRS se sont maintenues dans le groupe NTG IV (-16,7% vs 2,3 % dans le groupe NTG, P = 0,019). Les variables hémodynamiques principales ont été semblables pour des périodes temporelles correspondantes dans les deux groupes, bien que les patients du groupe NTG IV aient présenté des valeurs CK-MB plus élevées et perdu davantage de sang durant les premières 24 h postopératoires. Conclusion L’administration de nitroglycérine intraveineuse avant et pendant la CEC pourrait empêcher une diminution des valeurs de NIRS associées à la CEC dans les chirurgies cardiaques à haut risque. Des études supplémentaires sont nécessaires afin de déterminer l’efficacité et les risques associés à une infusion NTG IV pour cette indication pendant la CEC chez des patients à haut risque.
Potentiation of the hemodynamic effects of acutely administered nitroglycerin by methionine
Circulation, 1988
It is believed that nitroglycerin causes vasodilatation by interacting with sulfhydryl groups present in vascular smooth muscle. This study was performed to assess whether methionine, an amino acid capable of increasing sulfhydryl availability, would potentiate the hemodynamic effects of nitroglycerin. Nitroglycerin was initially infused in incremental doses from 1 to 50 micrograms/min in all patients to determine the dose required to reduce mean arterial pressure by 10% and pulmonary capillary wedge pressure by 30%. After a washout period, 10 patients received 5 g methionine i.v. and five patients received an equal volume of 5% dextrose in water (control). Nitroglycerin dose titration was then repeated. Methionine alone induced no hemodynamic effects, but after methionine infusion, there was a significant reduction in the nitroglycerin infusion rate required to reach each hemodynamic endpoint (p less than 0.01). In the control group, there was no significant change in responsivenes...
Bulletin of emergency and trauma, 2013
To investigate the decrease in hemoglobin concentration and hematocrit during elective surgery. This was a prospective study being performed in Nemazee Hospital of Shiraz University of Medical Sciences. We included a total of 50 American Society of Anesthesiology (ASA) I and II patients undergoing elective minor surgeries. Perioperative fluid administration was performed for all the patients and hemoglobin and hematocrit levels were measured three times: Once before the operation, once one hour after start of operation and once in the recovery room. Values were compared using paired sample t-test. The mean age of the patients and controls was 39.66 ± 8.27 years. Hemoglobin level decreases significantly after one hour (p<0.001) and after the end of operation (p<0.001). In the same way hematocrit level was decreased significantly after one hour (p<0.001) and after the end of operation (p<0.001). In this patient population undergoing elective minor operations, there was sig...
IP Innovation Publication Pvt. Ltd, 2017
Aim: Is to find the effectiveness of dexmedetomidine versus nitroglycerin to provide hemodynamic stability during dental surgeries Methods: Forty ASA I and II patients undergoing dental surgeries were randomly allocated into two groups of 20 each: Nitroglycerine (Group NTG) and Dexmedetomidine (Group DEX). Group NTG received infusion of nitroglycerine at a rate of 1-10 μg/kg/min & group DEX received infusion of dexmedetomidine at a rate of 0.2-0.7 μg/kg/hr after a bolus dose of 1 μg/kg. Results: There was better control of hemodynamic variables during intraoperative period in dexmedetomidine group in comparison to nitroglycerine group. There was significant difference in mean changes of heart rate and blood pressure from baseline value at all points of study between both the groups except just before the intubation when both the groups were comparable. Conclusion: Dexmedetomidine was superior to nitroglycerin for maintenance of hemodynamic variables during dental surgeries.
Methemoglobinemia incidence after the application of lidocaine for small surgical procedures
Agri : Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology, 2017
Methemoglobinemia (MetHb) is a rare condition that may have mortal consequences. Literature shows cases of methemoglobinemia due to the use of lidocaine and other local anesthetics. This is a cross-sectional study to determine the incidence of methemoglobinemia after the application of lidocaine. In this study, 88 patients admitted to the emergency department of a university hospital between May 2014 and May 2015 and needed lidocaine application for small surgical procedures were included. When compared before and after the administration of lidocaine <2 mg/kg and >2 mg/kg, there was not a significant difference in the level of methemoglobin, hemoglobin, or in the hematocrit (p=0.604, p=0.502, and p=0.367, respectively). Mean age of the patients was 33.85 (±17.58) years, and 83% of the patients were male. Methemoglobin levels were not significantly different before and after the procedures (p>0.05). The results of our study were consistent with the literature; lidocaine ass...
Benzocaine-Induced Methemoglobinemia During an Outpatient Procedure
Pharmacotherapy, 2000
Outpatient transesophageal echocardiography was performed in a 69-year-old man with a history of aortic valve repair. During the procedure the patient became markedly cyanotic and hypotensive. Oxygen saturation measured by pulse oximetry decreased from 97% to the mid-80s. The man's condition continued to deteriorate. On transfer to a critical care unit, blood analysis by co-oximetry showed methemoglobin saturation of 67.8%. The patient's condition improved significantly after intravenous administration of methylene blue 1 mg/kg. With increasing numbers of outpatient procedures performed under topical anesthesia, measures should be in place to deal with a potential life-threatening adverse event such as methemoglobinemia. (Pharmacotherapy 2000;20(6):735-738)