Dental anesthesia management of methemoglobinemia-susceptible patients: a case report and review of literature

Abstract

A healthy but slightly pale 24-year-old female patient with a history of "turning blue" following dental procedures performed under local anesthesia claimed allergies to sulfa drugs, aspirin, Benadryl, and "all caines." The patient also acknowledged mild cyanosis after extreme exertion, Native American ancestry, and a 1996 diagnosis of methemoglobinemia following administration of a sulfa drug. Previous medical and dental records were reviewed. Restoration of several teeth and extraction of 2 third-molar teeth were completed under general anesthesia. Anesthesia was induced with propofol, nasotracheal intubation was accomplished with succinylcholine, and anesthesia was maintained with desflurane in oxygen supplemented by meperidine without local anesthesia. Vital signs, including pulse oximetry, remained stable, and the patient was dismissed after a 2-hour recovery/observation period. The patient experienced no postoperative complications. This case report provides a review of literature and clinical guidelines for management of methemoglobinemia-susceptible patients.