Akademik Veri Yönetim Sistemi
International anatolıan congress on multıdıscıplınary scıentıfıc researc, Mardin, Mardin, Türkiye, 12 - 13 Ağustos 2022, ss.8-9
In
order for oxygen molecules to be transported to the tissues by hemoglobin under
normal conditions, the iron molecule in its structure must have +2 (Fe+2)
valence. In methemoglobinemia, due to various oxidative stresses, iron becomes
+3 valent (Fe+3) and methemoglobin, which cannot carry oxygen to the tissues,
emerges.
Methemoglobinemia
can be congenital or acquired. Acquired methemoglobinemia is most commonly seen
after local anesthetic drugs. Under physiological conditions, the methemoglobin
value is less than 2-3% of the total hemoglobin. If it exceeds 15%, agitation,
cyanosis and hypoxia develop and become symptomatic.
Treatment
of methemoglobinemia is removal of the triggering agent and the use of methylene
blue as an antidote. In cases where methylene blue treatment is ineffective or
cannot be used, ascorbic acid, exchange transfusion, and hyperbaric oxygen
therapy can be used as additional options.
Cholecystostomy
was indicated in two patients, aged 47 and 60 years, who were hospitalized in
our clinic for acute calculous cholecystitis. Cholecystostomy was performed in
both patients under local anesthesia with prilocaine. Dyspnea, agitation and
hypotension developed in the clinic approximately 30-60 minutes after the
procedure. On physical examination, oxygen saturation was 85% and
blood pressure was 90/60 despite oxygen support. Breath sounds were normal on
auscultation. As the patients did not improve in their clinics despite oxygen
support and peripheral cyanosis findings persisted, arterial gases were taken
and methemoglobin levels were found to be high between 35-40%. Clinical
improvement was achieved in one of the patients with methylene blue infusion
therapy and oxygen support. In the other patient, ascorbic acid and oxygen
support was provided because methylene blue could not be found. In the blood
gas follow-ups of the patients, the methemoglobin value returned to normal and
clinical improvement was achieved.
As
a result, dyspnea can be detected as a result of inability to perform deep
inspiration due to pain due to both acute cholecystitis clinic and invasive
procedures. However, the lack of clinical improvement and cyanosis in the
distal extremity, especially after the injection of prilocaine, which is a
frequently used local anesthetic for cholecystostomy, should suggest
methemoglobinemia.
Key
words: Cholecystostomy, prilocaine, methemoglobinemia