基準投与量以下の塩酸プロピトカインの浸潤麻酔により発症したメトヘモグロビン血症の1例

DOI
  • 市田 賀子
    昭和大学歯学部全身管理歯科学講座歯科麻酔科学部門
  • 渥美 広子
    昭和大学歯学部全身管理歯科学講座歯科麻酔科学部門
  • 高見 智香恵
    昭和大学歯学部全身管理歯科学講座歯科麻酔科学部門
  • 田中 崇之
    昭和大学歯学部全身管理歯科学講座歯科麻酔科学部門
  • 西村 晶子
    昭和大学歯学部全身管理歯科学講座歯科麻酔科学部門
  • 増田 陸雄
    昭和大学歯学部全身管理歯科学講座歯科麻酔科学部門

書誌事項

タイトル別名
  • A Case Report of Propitocaine-induced Methemoglobinemia at Low Dose

抄録

<p>  Methemoglobinemia is reportedly caused by propitocaine administration. According to the clinical statement from the Japanese Dental Society of Anesthesiology, the maximum dose of propitocaine is 400-600 mg (6-8 mg/kg). We experienced a case of propitocaine-induced methemoglobinemia at a dose of 4.3 mg/kg in a 28-year-old woman with a height of 152.8 cm and weight of 50.8 kg. Surgery for placement of a dental implant was scheduled under intravenous sedation. The patient had a diagnosis of schizophrenia and took aripiprazole regularly. We planned to inject 3% propitocaine and 0.03 IU/mL felypressin as local anesthetic because aripiprazole is contraindicated for combined administration of adrenaline. Intravenous sedation was maintained with midazolam and propofol. The patient’s initial SpO2 was 96% under air, but rose to 94% after administration of 7.2 mL propitocaine. Administration of oxygen resulted in recovery of SpO2 to 100%, and her final SpO2 was 96% under air after the need for sedation. However, SpO2 rose to 91% after 20 min in the recovery room. We started to monitor the hemoglobin concentration ; SpMet® using a pulse CO oximeter (Rainbow®, MASIMO Inc.), which was 4.6%. We diagnosed the patient with methemoglobinemia and continued to measure the hemoglobin concentration and this measurement decreased to 2.5% 4h and 25 min after propitocaine injection. We decided to discharge the patient from the hospital because the hemoglobin concentration was lower than normal value ; <3% and the patient strongly wished to be discharged. The patient was ultimately discharged from the hospital without any symptoms of methemoglobinemia.</p>

収録刊行物

詳細情報 詳細情報について

  • CRID
    1390581301851417344
  • DOI
    10.24569/jjdsa.52.2_118
  • ISSN
    24334480
  • 本文言語コード
    ja
  • データソース種別
    • JaLC
  • 抄録ライセンスフラグ
    使用不可

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