Methemoglobinemia in an infant receiving nitric oxide after the use of eutectic mixture of local anesthetic

Sinisterra, Scarlett; Miravet, Elena; Alfonso, Israel; Soliz, Amed; Papazian, Óscar

doi:10.1067/mpd.2002.125732

Cited by 31 publications

(12 citation statements)

References 9 publications

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“…94 There is a risk of methemoglobinemia after use of topical lidocaine-prilocaine cream in certain situations. 95,96 The risks can be minimized if used no more than once daily, on intact skin only, and not with other drugs known to cause methemoglobinemia. 97,98 Prolonged Mechanical Ventilation Many preterm neonates receiving intensive care undergo prolonged mechanical ventilation, and its use defines a population of patients experiencing numerous minor painful procedures as described previously.…”

Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

418

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

418

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“…14 This postulation is supported by numerous incidents where life-threatening methemoglobinemia has occurred post-NO therapy. [15][16][17] This NO-induced methemoglobinemia phenomenon could be also explained in that the NO production requires the conversion of NADPH to NADP+, in which the former is required by the NADPH-dependent methemoglobin reductase for the conversion of methemoglobin to hemoglobin. 18 Hence, extensive production of NO could reduce the levels of NADPH low enough to impair the proper activity of methemoglobin reductase.…”

Section: Salicylate Toxicity and Methemoglobinemiamentioning

confidence: 99%

Carboxyhemoglobinemia and Methemoglobinemia in an Atypical Case of Salicylate Toxicity: A Potentially Hidden Association

Aintablian¹,

Kabbara²

2017

Exploratory Research and Hypothesis in Medicine

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We report an atypical case of salicylate toxicity in a child without a reported exposure to aspirin, who presented with coexisting methemoglobinemia and carboxyhemoglobinemia, and provide mechanistic theories as to the potential pathway by which salicylates can lead to such dyshemoglobinemias. The patient, a 17-month old male, presented to the hospital 10 h after six episodes of vomiting, tachypnea and hyperpnea. Laboratory values showed a mixed respiratory alkalosis and metabolic acidosis; however, the parent's denial of aspirin exposure, coupled with laboratory results indicating carboxyhemoglobinemia, methemoglobinemia and neutrophilic leukocytosis, disguised a toxic salicylate level of 51.1 mg/dL. We searched the PubMed database for sources of salicylate exposure using the terms: "salicylate exposure", "salicylate toxicity", "sources", and an association of salicylates with carboxyhemoglobinemia methemoglobinemia using those three terms. Furthermore, Google Scholar and PubMed were used to search for biochemical literature explaining the association of salicylates with red blood cell oxidation, methemoglobin and carbon monoxide formation. We discovered that the mechanism by which high dose salicylates lead to carboxyhemoglobinemia and methemoglobinemia had not been previously described. We propose that salicylates in high doses can induce a methemoglobinemia through increased vascular release of nitric oxide through induction of IL-1β and carboxyhemoglobinemia via lipid peroxidation, leading to the release of carbon monoxide.

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“…3 La méthémoglobinémie peut être causée par la crème EMLA et a été rapportée avec l'usage concurrent d'autres agents oxydants comme le protoxyde d'azote. [9][10][11] Les anesthésiques locaux comme la benzocaïne, la tétracaïne et les mélanges butoformes ou une vaporisation de benzocaïne à 20 % peuvent causer de la méthémoglobinémie associée à des niveaux maximaux de méthémoglobine jusqu'à 43,8 %. 3,12,13 La solution croisée d'hémoglobine-diaspirine est un produit d'hémoglobine humaine purifiée qui résulte d'une augmentation de méthémoglobine de 0,84 ± 0,77 %, au départ, à 4,08 ± 1,36 %.…”

unclassified

“…3 Methemoglobinemia can be caused by EMLA cream and has been reported with concurrent use of other oxidizing agents such as nitrous oxide. [9][10][11] Topical anesthetics such as benzocaine, tetracaine, and butamben mixes or 20% benzocaine spray can cause methemoglobinemia associated with peak methemoglobin levels of up to 43.8%. 3,12,13 Diaspirin cross-linked hemoglobin solution is a purified human hemoglobin product which results in an increase of methemoglobin from 0.84 ± 0.77% at baseline to 4.08 ± 1.36%.…”

mentioning

confidence: 99%

Perioperative methemoglobinemia

Johnson

2005

Can J Anesth/J Can Anesth

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Methemoglobinemia in an infant receiving nitric oxide after the use of eutectic mixture of local anesthetic

Cited by 31 publications

References 9 publications

Prevention and Management of Pain in the Neonate: An Update

Prevention and Management of Pain in the Neonate: An Update

Carboxyhemoglobinemia and Methemoglobinemia in an Atypical Case of Salicylate Toxicity: A Potentially Hidden Association

Perioperative methemoglobinemia

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