Drug Safety - Case Reports · 2018 · 10 citations · 1 references
MedicineAnesthesiologyPharmacologyAnesthesiaClinical PharmacologyCritical Care PharmacologyAcute Lung InjuryAcute Respiratory Distress SyndromeRespiratory ComplicationsRespiratory EmergenciesRespiratory FailureRespiratory MedicineArterial Blood Gas AssessmentArterial Blood Gas MonitoringArterial Blood Gas SamplingHypoxemia During AnesthesiaIntubation-related HypoxemiaLidocaine TherapyOxygen SaturationTopical Lidocaine
A 55-year-old male was admitted to the hospital with pneumonia. During an intubation procedure, the patient received an application of endobronchial lidocaine (4% gel). Within 2 h of intubation, the patient developed worsening hypoxia, and investigation of arterial blood gasses revealed a pH of 7.21, carbon dioxide partial pressure (PaCO 2 ) of 3.3 kPa, oxygen partial pressure (PaO 2 ) of 55.1 kPa, and measured oxygen saturation of 49%. Co-oximetry of this sample returned a methemoglobin level of 53%. Intravenous methylthioninium chloride (1% solution at 1 mg/kg) was delivered, and subsequent arterial blood gasses, at 30 min and 1 h post administration, showed methemoglobin levels of 12 and 9%, respectively, with return of oxygen saturation to > 90%.
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