Volume 11, Issue 1 (3-2022)                   WJPS 2022, 11(1): 111-116 | Back to browse issues page

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Brandt S, Kimberger O, Weber B, Klose A, Stockmann S, Schmeller W, et al . Methaemoglobinemia after Liposuction under Tumescent Local Anaesthesia – Diagnostic Value of Pulse Oximetry. WJPS 2022; 11 (1) :111-116
URL: http://wjps.ir/article-1-866-en.html
Department of Anaesthesiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany , sebastian.brandt@uksh.de
Abstract:   (1772 Views)
Tumescent local anaesthesia with prilocain can lead to clinically significant methemoglobin levels. New generation multiple wavelength pulse oximeters (e. g. Masimo Radical 7®) can measure methemoglobin levels.
In this prospective observational study we compared the venous methemoglobin levels and the corresponding pulse oximetric values of the Radical 7® in patients undergoing tumescent local anaesthesia for liposuction procedures. The measurements were performed in Hanseklinik, Luebeck, Germany between 2008 and 2011.
In 133 patients, we measured a maximum methemoglobin level of 18 per cent. In a Bland-Altman analysis we found a mean bias of +2.2 % (-4.1 to 8.4 limits of agreement) for pulse oximetric values compared to hemoximetry.
Pulse oximetric measurement of methemoglobin is an early-warning tool for the detection of clinically significant methaemoglobinemia in patients with tumescent local anaesthesia.
Full-Text [PDF 332 kb]   (930 Downloads)    
Type of Study: Original Article | Subject: Special
Received: 2021/11/24 | Accepted: 2021/10/26 | Published: 2022/03/4

1. Scott D, Owen J, Richmond J. Methaemoglobinaemia due to prilocaine. Lancet 1964; 2: 728-729. 2. Wright R, Lewander W, Woolf A. Methemoglobinemia: Etiology, pharmacology, and clinical management. Ann Emerg Med 1999; 34: 646-656. 3. Guay J. Methemoglobinemia related to local anesthetics: A summary of 242 episodes. Anesth Analg 2009; 108: 837-845. 4. Barker S, Tremper K, Hyatt J. Effects of methemoglobinemia on pulse oximetry and mixed venous oximetry. Anaesthesiology 1989; 70: 112-117. 5. Reynolds K, Palayiwa E, Moyle J, Sykes M, Hahn C. The effect of dyshemoglobins on pulse oximetry: Part I, theoretical approach and part ii, experimental results using an in vitro test system. J Clin Monitor 1993; 9: 81-90. 6. Yang J, Lin N, Lv R, Sun J, Zhao F, Zhang J, Xu J. Methemoglobinemia misdiagnosed as ruptured ectopic pregnancy. Acta Anaesthesiologica Scandinavica 2005; 49: 586-588. 7. Feiner J, Bickler P, Mannheimer P. Accuracy of methemoglobin detection by pulse co-oximetry during hypoxia. Anesth Analg 2010; 111: 143-148. 8. Soeding P, Deppe M, Gehring H. Pulse-oximetric measurement of prilocaine-induced methemoglobinemia in regional anesthesia. Anesth Analg 2010; 111: 1065-1068. 9. Schmeller W, Meier-Vollrath I. Zum aktuellen Stand der Liposuktion. Der Deutsche Dermatologe 2002; 9: 590-594. 10. Bland J, Altman D. Stat Methods Med Res 1999; 8: 135-160. 11. Bland J, Altman D. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat 2007; 17: 571-582. 12. R. The R Project for statistical calculations. In: http://www.r-project.org (4th Dec 2020). 13. Clarke W, Cox D, Gonder-Frederick LA, Carter W, Pohl S. Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care 1987; 10: 622-628. 14. Morey T, Gravenstein N, Rice M. Assessing point-of-care hemoglobin measurement: Be careful we don't bias with bias. Anesth Analg 2011; 113: 1289-1291. 15. Morey T, Gravenstein N, Rice M. Let's think clinically instead of mathematically about device accuracy. Anesth Analg 2011; 113: 89-91. 16. Codina EG. Clark Error Grid Analysis. In: http://www.mathworks.com/matlabcentral/fileexchange/20545-clarke-error-grid-analysis (27 July 2020). 17. Jaffe E. Enzymopenic hereditary methemoglobinemia: A clinical/biochemical classification. Blood Cells, Molecules and Diseases 1986; 12: 81-90. 18. Mang W, Materak J, Kuntz S, Sawatzki K, Arnold W. Liposuction in tumescent local anaesthesia: Maximum recommended doses for prilocaine. Zeitschrift für Hautkrankheiten 1999; 74: 157-161. 19. Ash-Bernal R, Wise R, Wright S. Acquired methemoglobinemia: A retrospective series of 138 cases at 2 teaching hospitals. Medicine (Baltimore) 2004; 83: 265-273. 20. Feiner J, Bickler P. Improved accuracy of methemoglobin detection by pulse co-oximetry during hypoxia. Anesth Analg 2010; 111: 1160-1167. 21. Deppe M. Pulsoximetrisches Monitoring von Methämoglobin bei Regionalanästhesien mit Prilocain. Doctoral Thesis, University of Luebeck, Faculty of Medicine 2009; 1-80.

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