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Perioperative Management of the Glucose-6-Phosphate Dehydrogenase Deficient Patient: A Review of Literature
Cpt Ali R. ElyassiDDS and
Maj Henry H. RowshanDDS
Article Category: Research Article
Volume/Issue: Volume 56: Issue 3
Online Publication Date: Jan 01, 2009
DOI: 10.2344/0003-3006-56.3.86
Page Range: 86 – 91

Lindsey Krstic, B.A.) The World Health Organization has classified the different G6PD variants according to the magnitude of the enzyme deficiency and the severity of hemolysis ( Table 1 ). 3 – 5 Class I variants have severe enzyme deficiency (less than 10% of normal) and have chronic hemolytic anemia. Class II variants also have severe enzyme deficiency, but there is usually only intermittent hemolysis. Class III variants have moderate enzyme deficiency (10 to 60% of normal) with intermittent hemolysis, usually associated with infection or

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Figure 1; The hexose monophosphate shunt.
Cpt Ali R. Elyassi and
Maj Henry H. Rowshan
Figure 1
Figure 1

The hexose monophosphate shunt.

Figure 2; Peripheral smear from a patient with Heinz body hemolytic anemia. Heinz body preparation reveals the denatured hemoglobin precipitates. (© 2007 Rector and Visitors of the University of Virginia Charles E. Hess, M.D., and Lindsey Krstic, B.A.)
Cpt Ali R. Elyassi and
Maj Henry H. Rowshan
Figure 2
Figure 2

Peripheral smear from a patient with Heinz body hemolytic anemia. Heinz body preparation reveals the denatured hemoglobin precipitates. (© 2007 Rector and Visitors of the University of Virginia Charles E. Hess, M.D., and Lindsey Krstic, B.A.)

Figure 3; High-power view of a normal peripheral blood smear. The red cells are of relatively uniform size and shape. A lymphocyte can also be seen. The diameter of the normal red cell should approximate that of the nucleus of the small lymphocyte. (© 2007 Rector and Visitors of the University of Virginia Charles E. Hess, M.D., and Lindsey Krstic, B.A.)
Cpt Ali R. Elyassi and
Maj Henry H. Rowshan
Figure 3
Figure 3

High-power view of a normal peripheral blood smear. The red cells are of relatively uniform size and shape. A lymphocyte can also be seen. The diameter of the normal red cell should approximate that of the nucleus of the small lymphocyte. (© 2007 Rector and Visitors of the University of Virginia Charles E. Hess, M.D., and Lindsey Krstic, B.A.)

General Anesthesia in a Glucose-6-Phosphate Dehydrogenase Deficiency Child: A Case Report
Takahiro GoiDDS,
Yoshiki ShionoyaDDS, PhD,
Katsuhisa SunadaDDS, PhD, and
Kiminari NakamuraDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 66: Issue 2
Online Publication Date: Jan 01, 2019
DOI: 10.2344/anpr-66-01-05
Page Range: 94 – 96

caries treatment under general anesthesia. Preoperative blood tests revealed normal indirect bilirubin, potassium, and lactic acid dehydrogenase values. In addition, his hemoglobin count was normal, 11.9 g/dL. We observed no physical signs indicating hemolysis, including jaundice. Electrocardiogram and chest X-ray were unremarkable. We did not administer any medication prior to anesthesia. Intraoperative monitoring included oxygen saturation, electrocardiogram, noninvasive blood pressure, capnography, and body temperature. Anesthesia was gradually

Benzocaine-induced Methemoglobinemia
Frederick HegedusDDS and
Kathleen HerbDMD, MD
Article Category: Case Report
Volume/Issue: Volume 52: Issue 4
Online Publication Date: Jan 01, 2005
DOI: 10.2344/0003-3006(2005)52[136:BM]2.0.CO;2
Page Range: 136 – 139

prilocaine. Oral Surg 1974 . 37 : 866 . 9 Sinisterra , S. , E. Miravet , I. Alfonso , A. Soliz , and O. Papazian . Methemoglobinemia in an infant receiving nitric oxide after use of eutectic mixture of local anesthetic. J Pediatr 2002 . 141 : 285 – 286 . 10 Allegaert , K. , M. Miserez , T. Lerut , G. Naulaers , C. Vanhole , and H. Devlieger . Methemoglobinemia and hemolysis after enteral administration of

The Recognition, Physiology, and Treatment of Medication-Induced Methemoglobinemia: A Case Report
Michael D. TurnerDDS, MD,
Vasiliki KarlisDMD, MD, and
Robert S. GlickmanDMD
Article Category: Research Article
Volume/Issue: Volume 54: Issue 3
Online Publication Date: Jan 01, 2007
DOI: 10.2344/0003-3006(2007)54[115:TRPATO]2.0.CO;2
Page Range: 115 – 117

accepting an electron from NADPH in the presence of NADPH-methemoglobin reductase. Leukomethylene blue then donates this electron to methemoglobin resulting in its conversion back to hemoglobin. 7 The therapeutic dose of methylene blue is 1 to 2 mg/kg administered intravenously. An additional dose may be repeated if there is an insufficient response after 1 hour. Reported side effects are nausea, diarrhea, oral dysesthesia, dyspnea, and excessive perspiration. In patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, a delay in hemolysis can occur

Anesthetic Management of the Pregnant Patient: Part 1
Jaimin ShinDMD MES
Article Category: Research Article
Volume/Issue: Volume 68: Issue 1
Online Publication Date: Apr 07, 2021
DOI: 10.2344/anpr-68-01-15
Page Range: 52 – 62

, are unable to process fatty acids. The mother, possessing a heterozygous deficiency for this enzyme, accumulates metabolites leading to enhanced lipid peroxidation while simultaneously decreasing antioxidant capacity. 30 , 43 A parturient experiencing AFLP requires expeditious delivery and intensive care support. AFLP has significant overlap with a rare but deadly condition known as HELLP syndrome (hemolysis, elevated liver enzyme, low platelet count), accompanied by severe preeclampsia. 44 Hypertension is a common underlying theme to all these diagnoses. Complex

Hepatitis: Sedation and Anesthesia Implications
Gina ChenDDS,
Ryan CheungDDS, and
James W. TomDDS, MS
Article Category: Research Article
Volume/Issue: Volume 64: Issue 2
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-64-02-13
Page Range: 106 – 118

free bilirubin so that it can be secreted in bile and ultimately excreted in the feces. Increases in unconjugated bilirubin, or increases in total bilirubin in the setting of normal levels of conjugated bilirubin, can be indicative of prehepatic conditions such as overproduction of bilirubin (hemolysis, anemia) or impaired uptake of bilirubin (decreased hepatic flow, Gilbert syndrome). Abnormal levels of conjugated bilirubin, however, are more indicative of hepatocellular dysfunction or posthepactic biliary obstruction. 21 , 22 Alkaline phosphatase (ALP) is