Methaemoglobinaemia in the perioperative period with regional block

Methaemoglobin is a form of haemoglobin with oxidised ferric (+3) iron rather than ferrous (+2) iron, which causes a leftward shift in the oxyhaemoglobin dissociation curve and prevents oxygen delivery. Anaesthesiologists need to be familiar with this differential diagnosis for hypoxia given the use of drugs in the perioperative setting known to induce methaemoglobinaemia, including benzocaine and lidocaine, antibiotics such as dapsone and anaesthetic gases, including nitric oxide. This case report details an interesting case of symptomatic methaemoglobinaemia in the perioperative period in the setting of dapsone use and an erector spinae block performed with ropivacaine.

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Subtle case of dapsone-induced methaemoglobinaemia

BMJ Case Reports ◽

10.1136/bcr-2020-235403 ◽

2020 ◽

Vol 13 (8) ◽

pp. e235403 ◽

Cited By ~ 1

Author(s):

Justin S Lewis ◽

Zachary G Jacobs

Keyword(s):

Differential Diagnosis ◽

Rare Disease ◽

Mental Status ◽

Oxygen Delivery ◽

Medication Reconciliation ◽

Blood Levels ◽

Oxygen Dissociation Curve ◽

Dissociation Curve ◽

Oxygen Dissociation ◽

Lower Blood

Methaemoglobinaemia is a rare disease that is typically caused by a medication or other exogenous agent, with dapsone being the most common. It occurs when the concentration of methaemoglobin rises via ferrous haeme irons becoming oxidised to the ferric state, which shifts the oxygen dissociation curve to the left. The net result of an elevated methaemoglobin concentration is functional anaemia and impaired oxygen delivery to tissues. At lower blood levels, this can cause symptoms such as cyanosis, lethargy, headache and fatigue, whereas at higher levels it can be fatal. Here we discuss a subtle case of dapsone-induced methaemoglobinaemia presenting as subacute mental status changes and apparent hypoxia, thus highlighting the association between methaemoglobinaemia and dapsone. This case demonstrates the importance of thorough medication reconciliation and maintaining a broad differential diagnosis, while also recognising the significance of conflicting data and their implications for the workup.

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Unilateral Intraparotid Swelling: A Case Report of Kimura’s Disease and Review of Differential Diagnosis

Case Reports in Otolaryngology ◽

10.1155/2013/795921 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

N. W. Savage ◽

V. Vucicevic Boras

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Parotid Gland ◽

Correct Diagnosis ◽

Interesting Case ◽

Kimura’S Disease ◽

Fatty Tissue ◽

Parotid Glands ◽

Parotid Swelling

An interesting case of Kimura's disease was described in the 42-year-old patient manifesting itself as a unilateral parotid swelling, albeit the disease usually affects both parotid glands. Furthermore, first pathohistological finding was not suggestive of the disease, revealing only fatty tissue, but on the repeated biopsy together with CT the correct diagnosis was established. It should be emphasized that Kimura's disease has to be taken into account while making differential diagnosis in parotid gland swellings, especially in people of Oriental origin.

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"Tails-up" capnogram: The role in detecting anaesthetic equipment malfunction

Vojnosanitetski pregled ◽

10.2298/vsp150617276m ◽

2017 ◽

Vol 74 (9) ◽

pp. 900-903

Author(s):

Stevan Mihailovic

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Clinical Practice ◽

Perioperative Period ◽

Routine Clinical Practice ◽

Surgical Operation ◽

Monitoring Tool ◽

Anaesthetic Equipment ◽

Course Of Action ◽

Depth Analysis

Introduction. Capnography is an essential part and standard monitoring tool during the perioperative period, which can be invaluable in detecting anaesthetic equipment malfunction. Case report. The atypical, ??tails-up?? capnographic waveform was noticed during routine surgical operation. Comprehensive physico-mathematical and graphical explanation of this complex capnographic pattern has been given, together with in-depth analysis of possible differential diagnosis and clinical significance for routine clinical practice. Conclusion. ?Tails-up?? capnographic trace gives early clue to diagnosing and fixing the problem of cracks in sampling line, before leading to an inadequate course of action. The understanding of the physics and physiology behind capnography is of vital importance for the analysis of capnographic waveforms, for early detection of anaesthetic equipment malfunction and for safe clinical practice.

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