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[A man with black blood].

M P de Boer1, S Nicia, Q Kolff

  • 1VUmc, Amsterdam.

Nederlands Tijdschrift Voor Geneeskunde
|March 30, 2017
PubMed
Summary

A patient developed life-threatening methaemoglobinemia after local anaesthetics during an epidural. Prompt treatment with methylene blue led to a complete recovery, highlighting this critical complication.

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Area of Science:

  • Anesthesiology
  • Toxicology
  • Emergency Medicine

Background:

  • Epidural anesthesia is a common procedure for pain management.
  • Local anesthetics can rarely cause serious adverse events.
  • High-energy trauma necessitates urgent medical intervention.

Observation:

  • A 71-year-old male patient experienced sudden deterioration hours after epidural anesthesia.
  • The patient presented with black blood and a critically elevated methaemoglobin level of 69%.

Findings:

  • The patient's condition was diagnosed as severe methaemoglobinemia, likely induced by local anesthetics used in the epidural.
  • Administration of methylene blue resulted in a complete clinical and biochemical recovery.

Implications:

  • This case underscores the importance of recognizing and rapidly treating methaemoglobinemia following epidural anesthesia.
  • Awareness of this rare but severe complication is crucial for anesthesiologists and emergency physicians.
  • Prompt intervention with methylene blue is a life-saving treatment for anesthetic-induced methaemoglobinemia.

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