METHEMOGLOBINEMIA FROM TOPICALLY APPLIED ANESTHETIC SPRAY

Topically applied anesthetic spray is commonly used as part of premedi cation for general anesthesia and for endoscopic procedures; it is rar ely associated with side effects. In this report, we describe two case s of toxic methemoglobinemia that resulted from topically applied anes thetic spray used before endoscopy. In both cases, standard doses were used; however, methemoglobin levels of 45 % and 38 % developed within P hour of the procedure. Both patients had normal levels of erythrocy te methemoglobin reductase, an indication that this rare but potential ly fatal side effect can occur in persons who have no predisposing fac tors. Because toxic methemoglobinemia is easily treated, our report em phasizes the need to recognize this problem when topically applied ane sthetic sprays are used.