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Canadian Journal of Anesthesia 52:258-261 (2005)
© Canadian Anesthesiologists' Society, 2005
General Anesthesia

Prophylactic methylene blue in a patient with congenital methemoglobinemia

[L’administration prophylactique de bleu de méthylène chez un patient atteint de méthémoglobinémie congénitale]

Anis S. Baraka, MD FRCA, Chakib M. Ayoub, MD, Vanda Yazbeck-Karam, MD, Roland N. Kaddoum, MD, Frederic J. Gerges, MD, Ussama M. Hadi, MD and Carla M. Dagher, MD

From the Department of Anesthesiology and Otorhinolaryngology, American University of Beirut-Medical Center, Beirut, Lebanon.

Address correspondence to: Dr. Anis S. Baraka, Professor & chairman, Department of Anesthesiology, American University of Beirut, P.O. Box: 11-0236, Beirut 1107-2020, Lebanon. Phone: 961-1-350000, ext: 6380; Fax: 961-1-744464; E-mail: abaraka{at}aub.edu.lb

Purpose: To report the beneficial effect of prophylactic methylene blue administration before induction of anesthesia in a patient with congenital methemoglobinemia.

Clinical features: A 26-yr-old male patient known to have congenital methemoglobinemia was scheduled for turbinectomy under general anesthesia. The patient was clinically cyanotic with a pulse oximetry of 91%. Arterial blood gas analysis showed a partial pressure of oxygen (PaO2) of 81.3 mmHg associated with a fractional oxyhemoglobin of 80.7%, and a methemoglobin fraction of 0.159. Preoperative iv administration of 1 mg·kg–1 of methylene blue resulted, within five minutes, in a decrease of methemoglobin fraction down to 0.05 associated with an increase of the fractional oxyhemoglobin saturation up to 94.7%. After two hours, the methemoglobin fraction decreased to 0.01 and the fractional oxyhemoglobin concentration increased to 97.7%. Induction of anesthesia as well as intraoperative and postoperative course were uneventful without any episode of hypoxemia. Postoperatively, the methemoglobin fractions remained low for 24 hr, to be followed by a gradual increase up to 0.02 on the second day to reach 0.094 on the fifth day.

Conclusion: The prophylactic preoperative methylene blue administration in a patient with congenital methemoglobinemia significantly decreased the methemoglobin level and increased the fractional oxygen saturation with a consequent increase of the safety margin against perioperative hypoxemia.




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Home page
 Canadian J. AnesthesiaHome page
A. S. Baraka, C. M. Ayoub, V. Yazbeck-Karam, R. N. Kaddoum, F. J. Gerges, U. M. Hadi, and C. M. Dagher
REPLY
Can J Anesth, October 1, 2005; 52(8): 885 - 885.
[Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
D. Sharma, M. P. Pandia, and P. K. Bithal
Methylene blue in congenital methemoglobinemia: prophylactic or on demand?
Can J Anesth, October 1, 2005; 52(8): 884 - 885.
[Full Text] [PDF]


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