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Methemoglobinemia after Intravenous Lidocaine for Rapid Sequence Intubation

快速插管流程中靜脈注射lidocaine導致嚴重變性紅血球血症

摘要


Lidocaine常用於快速插管時降低氣管的阻力與顱內壓上升。此藥常見的副作用包括心律不整、焦慮不安和氣管收縮。雖然文獻上指出靜脈注射lidocaine造成的變性血紅素血症並不嚴重,但仍有可能出現嚴重的變性血紅素血症。但此38歲女性卻因快速插管時,靜脈注射lidocaine之後出現急性的變性血紅素血症。所幸使用methylene blue總劑量3mg/kg治療後,病人的甲基血紅素降至正常值且發紺的情況就緩解了。臨床上若出現脈搏血氧飽和度分析與動脈血氣體分析的氧飽和度有明顯的差別時,需高度懷疑變性血紅素血症的鑑別診斷並且及早治療。

並列摘要


Lidocaine is widely used during rapid sequence intubation to decrease the airway resistance and intracranial pressure that occur in general anesthesia. Common side effects of lidocaine include arrhythmia, agitation and bronchospasm. Although lidocaine induced methemoglobinemia tends to be clinically insignificant, it does carry the risk of life threatening hypoxemic respiratory failure. Herein we report a 38-year-old woman who developed acute methemoglobinemia after intravenous lidocaine administration during rapid sequence intubation. Her methemoglobin level reduced and cyanosis resolved after intravenous methylene blue infusion (a total of 3 mg/kg). A discrepancy in pulse oximetry and the blood gas analysis result is the hallmark of this treatable, but life-threatening clinical condition and should be recognized for a timely treatment.

並列關鍵字

Lidocaine Methemoglobinemia Methylene blue

被引用紀錄


施屏、楊振昌(2021)。變性血紅素血症臨床醫學月刊87(1),31-37。https://doi.org/10.6666/ClinMed.202101_87(1).0005

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