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Updated: Sep 29, 2026

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow
Published on: January 13, 2017
Methemoglobinemia induced by topical benzocaine: a warning for the endoscopist
1Memorial Hospital of Rhode Island, Brown Medical School, Providence, Rhode Island, USA.
Abstract:
Benzocaine is used routinely for topical pharyngeal anesthesia prior to upper endoscopy, to improve patient tolerance. A potentially fatal, although often unrecognized, complication of benzocaine use is methemoglobinemia. Here, we report a case of methemoglobinemia induced by benzocaine given before upper endoscopy. Rapid recognition of this complication and immediate treatment is essential to prevent complications related to significant tissue hypoxia. This case serves as an important reminder to physicians, especially endoscopists, about this serious side effect. Furthermore, we question the need for topical anesthesia for upper endoscopy in sedated patients.
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