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Volume 348:85-86 January 2, 2003 Number 1
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Methemoglobinemia and Topical Pharyngeal Anesthesia

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To the Editor: Methemoglobinemia results from oxidation of ferrous iron (Fe2+) to ferric iron (Fe3+), which renders the hemoglobin molecule unavailable for oxygen transport, resulting in potentially life-threatening hypoxemia. This disorder may be triggered by topical anesthetics1 used in endoscopic procedures. However, reports on the safety of transesophageal echocardiography in more than 25,000 patients2,3 and upper endoscopy in more than 500,000 patients4,5 do not list methemoglobinemia as a potential complication. We recently observed two cases of methemoglobinemia during transesophageal echocardiography within a three-month period. These cases underscore the importance of familiarity with the expected findings on physical examination, . . . [Full Text of this Article]


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