Prevalence and Predictors of Prilocaine Induced Abnormal Methemoglobinemia During Cardiac Device Implantation Procedure

Year 2024, Volume: 8 Issue: 3, 203 - 210, 30.12.2024

Görkem Kuş , Göksel Çağırcı , Hanım Kumbul , Ayşe Kevser Tuna , İbrahim Ersoy , Şakir Arslan

https://doi.org/10.30565/medalanya.1512754

Abstract

Aim: The aim was to determine the prevalence and predictors of prilocaine-induced methemoglobinemia during the cardiac implantable electronic device (CIED) implantation procedure.

Methods: One hundred patients who underwent CIED implantation procedures under local anesthesia with prilocaine were included in the study. Patients were divided into two groups according to the percentage of methemoglobin (MetHb) in arterial blood gas analysis. Data regarding patients, laboratory, and procedure-related factors were compared between the two groups.

Results: The mean age of the patients was 70.97 ± 11.54 years, and 42% were female. Based on the criterion of MetHb level above 3%, the prevalence of pathologic methemoglobinemia was 47%. Multivariate logistic regression analyses were performed to identify independent predictors for the development of prilocaine-induced abnormal methemoglobinemia. In multivariate analysis, the presence of low body mass index (BMI) and chronic obstructive pulmonary disease (COPD) (OR: 0.876; 95% CI 0.781-0.981; p=0.022 and OR: 5.170; 95% CI 1.535-17.411; p=0.008) independently predicted the development of abnormal methemoglobinemia.

Conclusion: Abnormal MetHb levels were found in almost half of patients who underwent the CIED implantation procedure after subcutaneous prilocaine injection. Methemoglobinemia may occur even at doses lower than the recommended maximum dose, especially in patients with low BMI and COPD.

Keywords

Methemoglobinemia, Prilocaine, Cardiac device, Anesthesia

Kardiyak Cihaz İmplantasyon Prosedürü Esnasında Prilokain Kaynaklı Anormal Methemoglobineminin Prevelansı ve Prediktörleri

Abstract

Amaç: Kardiyak implante edilebilir elektronik cihaz (CIED) implantasyonu işlemi sırasında prilokainin neden olduğu methemoglobineminin prevalansını ve öngörücülerini belirlemeyi amaçladık.

Yöntem: Prilokain ile lokal anestezi altında CIED implantasyonu yapılan 100 hasta çalışmaya dahil edildi. Hastalar arteriyel kan gazı analizinde methemoglobin (MetHb ) yüzdesine göre iki gruba ayrıldı. Hastalara ilişkin, laboratuvar ve prosedür ilişkili faktörlerle ilgili veriler iki grup arasında karşılaştırıldı.

Bulgular: Hastaların ortalama yaşı 70,97 ± 11,54 yıl olup, %42'si kadındı. MetHb düzeyinin %3'ün üzerinde olması kriterine göre patolojik methemoglobinemi prevalansı %47 idi. Prilokainin neden olduğu anormal methemoglobinemi gelişiminin bağımsız prediktörlerini belirlemek için çok değişkenli lojistik regresyon analizleri yapıldı. Çok değişkenli analizde düşük vücut kitle indeksi (VKİ) ve kronik obstrüktif akciğer hastalığı (KOAH) varlığı (OR: 0,876; 95% GA 0,781-0,981; p=0,022 ve OR: 5,170; 95% GA 1,535-) 17,411; p=0,008) bağımsız olarak anormal methemoglobinemi gelişimini öngördü.

Sonuç: Subkutan prilokain enjeksiyonu sonrası CIED implantasyon işlemi uygulanan hastaların neredeyse yarısında anormal methemoglobin düzeyleri bulundu. Özellikle düşük VKİ ve KOAH'lı hastalarda önerilen maksimum dozun altındaki dozlarda bile methemoglobinemi meydana gelebilir.

Keywords

Methemoglobinemi, Prilokain, Kardiyak cihaz, Anestezi

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