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A Case of Methemoglobinemia Thought to Have Been Caused by the Combined Use of Propitocaine and Nitroglycerin During General Anesthesia
Takayuki HojoDDS, PhD,
Yukifumi KimuraDDS, PhD,
Daisuke OhiwaDDS, and
Toshiaki FujisawaDDS, PhD
Article Category: Brief Report
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
DOI: 10.2344/anpr-67-03-06
Page Range: 170 – 171

Acquired methemoglobinemia can occur following exposure to oxidizing agents including high doses of certain local anesthetics. 1 Many studies have investigated the dose at which each causative drug causes methemoglobinemia. However, few studies have reported methemoglobinemia being caused by the combined use of causative drugs or agents. 2 This is a report of a methemoglobinemia case presumably caused by the combined use of prilocaine (propitocaine in Japan) and nitroglycerin (NTG) during general anesthesia. CASE REPORT

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Figure 3.; Hypertension algorithm. Episodes of hypertension rarely require treatment. Asymptomatic episodes will generally correct after addressing possible causes. If pressure remains elevated, referral to the primary care physician should be considered. When accompanied by symptoms, emergency medical service transport should be arranged and nitroglycerin or labetalol may be considered.
Daniel E Becker and
Daniel A Haas
Figure 3.
Figure 3.

Hypertension algorithm. Episodes of hypertension rarely require treatment. Asymptomatic episodes will generally correct after addressing possible causes. If pressure remains elevated, referral to the primary care physician should be considered. When accompanied by symptoms, emergency medical service transport should be arranged and nitroglycerin or labetalol may be considered.

Figure 5.; Chest pain algorithm. It may be difficult to determine whether sudden onset of chest pain is an episode of stable angina or acute coronary syndrome. If the episode was provoked in a patient with a known history of ischemic heart disease and spontaneously subsides or responds to his or her usual dose of nitroglycerin, treatment may be continued and emergency medical support transport is not necessary.
Daniel E Becker and
Daniel A Haas
Figure 5.
Figure 5.

Chest pain algorithm. It may be difficult to determine whether sudden onset of chest pain is an episode of stable angina or acute coronary syndrome. If the episode was provoked in a patient with a known history of ischemic heart disease and spontaneously subsides or responds to his or her usual dose of nitroglycerin, treatment may be continued and emergency medical support transport is not necessary.

Figure. ; Vial of 1% methylene blue.
Takayuki Hojo,
Yukifumi Kimura,
Daisuke Ohiwa, and
Toshiaki Fujisawa
Figure. 
Figure. 

Vial of 1% methylene blue.

Severe Bleeding During Orthognathic Surgery for a Noonan Syndrome Patient
Haruka SasakiDDS and
Kentaro MizutaDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 69: Issue 4
Online Publication Date: Dec 19, 2022
DOI: 10.2344/anpr-69-02-02
Page Range: 22 – 25

of 1% lidocaine with 1:200,000 epinephrine (lidocaine 110 mg, epinephrine 55 μg) for local anesthesia prior to the Le Fort I osteotomy, hemostasis was difficult to achieve from the start of the surgery even though her blood pressure was not elevated (109–93/53–44 mm Hg). Therefore, mild hypotensive anesthesia was started to reduce blood loss using a nitroglycerin infusion 0.5–0.8 μg/kg/min for a targeted mean arterial blood pressure of 65 mm Hg. At the end of the Le Fort I osteotomy, blood loss reached 825 mL and hematological examination revealed anemia

Recognition and Management of Complications During Moderate and Deep Sedation. Part 2: Cardiovascular Considerations
Daniel E BeckerDDS and
Daniel A HaasDDS, PhD, FRCD(C)
Article Category: Research Article
Volume/Issue: Volume 58: Issue 3
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.3.126
Page Range: 126 – 138

collateral perfusion pressure. Any reduction in blood pressure could prove catastrophic. In this scenario, only extremely high systolic blood pressure (≥220 mm Hg) or diastolic blood pressure (≥120 mm Hg) should even be considered for treatment. 15 A variety of drugs and drug classes are suggested for management of hypertensive emergencies. However, nitroglycerin and labetalol are consistently mentioned and are adequate for office preparedness. Nitroglycerin is a vasodilator that acts predominantly on the venous system, decreasing venous return to the atria and

Anaphylactoid-like Reaction to Midazolam During Oral and Maxillofacial Surgery
Terumi AyuseDDS,
Shinji KurataDDS, PhD, and
Takao AyuseDDS, PhD
Article Category: Other
Volume/Issue: Volume 62: Issue 2
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.1.64
Page Range: 64 – 65

-prednisolone 1000 mg were injected intravenously. Because of sustained hypotension and ischemic ST depression in lead II, dopamine and nitroglycerine were continuously infused for 30 minutes. After the patient stabilized, we decided to postpone surgery until she was fully recovered from shock and for further examination of a possible allergic drug reaction. Even though several allergy tests, including skin tests, were completed, we did not obtain clear evidence for an allergic drug reaction. There was a widespread flush on the body and neck and edema

Management of Complications During Moderate and Deep Sedation: Respiratory and Cardiovascular Considerations
Daniel E. BeckerDDS and
Daniel A. HaasDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 54: Issue 2
Online Publication Date: Jan 01, 2007
DOI: 10.2344/0003-3006(2007)54[59:MOCDMA]2.0.CO;2
Page Range: 59 – 69

height of the column of mercury in the sphygmomanometer confers no demonstrable benefit on the patient and risks doing harm.” Symptomatic hypertensive crisis is a medical emergency and requires emergency medical services (EMS) transport to the nearest emergency department. While awaiting transport, it is appropriate to consider drug therapy, provided there are no signs of stroke, eg, aphasia, paresthesia, or paralysis. When stroke is suspected blood pressure should not be lowered. Nitroglycerin administered as a 0.4 mg sublingual tablet

Emergency Drug Kits: Pharmacological and Technical Considerations
Daniel E. BeckerDDS
Article Category: Other
Volume/Issue: Volume 61: Issue 4
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.4.171
Page Range: 171 – 179

inhalers, and minimize the need for a coordinated effort on the part of the patient. If a patient becomes hysterical, or for other reasons cannot be administered an inhalant, epinephrine can be injected IM as described above for allergic reactions. 6 If the primary assessment reveals both bronchospasm and laryngeal edema, the event is anaphylactoid, not asthmatic, and epinephrine is the drug of choice. DRUGS FOR CHEST PAIN (ANGINA) Nitroglycerin is indicated if a patient experiences an acute onset of chest pain. Episodes of chest pain can be

Deliberate Hypotensive Anesthesia With the Rapidly Acting, Vascular-Selective, L-Type Calcium Channel Antagonist—Clevidipine: A Case Report
Kevin CroftDDS and
Stephen ProbstMD
Article Category: Other
Volume/Issue: Volume 61: Issue 1
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.1.18
Page Range: 18 – 20

prolonged duration of action, a slow onset of peak effect, and an unpredictable dose requirement. The use of beta blockers can be further complicated by bradycardia, cardiac conduction delays, left ventricular dysfunction, and bronchospasm. Deliberate hypotensive effects of sodium nitroprusside or nitroglycerin result from the dilation of capacitance vessels, and are often used for inducing deliberate hypotension, but can carry potential complications such as increased intracranial pressure. Remifentanil has also been used, but it tends to have a ceiling effect and