Methemoglobinemia Secondary to Benzocaine Topical Anesthetic.

An 80-year-old white woman with a history of hypertension presented to the Emergency Department with bright red bleeding from the rectum. She was treated with 5 mg of midazolam and benzocaine topical anesthetic spray prior to undergoing colonoscopy and esophageal gastroduodenoscopy. Thirty minutes after endoscopy, the patient became cyanotic and dyspneic; she was suffering from methemoglobinemia, a rare complication secondary to the use of benzocaine topical anesthetic spray. After i.v. administration of methylene blue, 120 mg (2 mg/kg) in 100 cc of normal saline solution, the cyanosis and dyspnea resolved

Asymptomatic carotid endarterectomy. Patient and surgeon selection.

BACKGROUND AND PURPOSE: The applicability of prospective carotid endarterectomy protocols to the general population has been questioned. Outcomes for asymptomatic patients undergoing carotid endarterectomy were compared with the results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) patients treated concurrently at our institution. METHODS: Asymptomatic patients undergoing carotid endarterectomies (n = 277) from 1987 to 1993 (ACAS enrollment period) were reviewed. Primary end points were mortality, myocardial infarction, and stroke. Five subgroups were studied: (1) ACAS surgical patients; (2) ACAS-eligible patients not enrolled and ACAS surgeons; (3) ACAS-eligible patients not enrolled and non-ACAS surgeons; (4) ACAS-ineligible patients and ACAS surgeons; and (5) ACAS-ineligible patients and non-ACAS surgeons. RESULTS: ACAS-eligible patients were younger (P = .014), had more severe carotid stenosis (P = .001), and had lower incidences of pulmonary (P = .015) and renal (P = .008) diseases compared with ineligible patients. Patient selection (ACAS eligibility) significantly improved outcomes for mortality (P = .014) and myocardial infarction (P = .006). Length of stay favored ACAS-eligible patients (P = .004). ACAS surgeons operated on more severely stenotic carotid lesions (P = .005) and on patients with a lower incidence of coronary artery disease (P = .007). There was no difference in outcomes between ACAS and non-ACAS surgeons. CONCLUSIONS: Patient selection was a significant factor in determining outcome. With strict adherence to ACAS enrollment guidelines, the conclusions of ACAS appear applicable to patients seen at our institution with asymptomatic carotid stenosis