Cetacaine-induced complication during transesophageal echocardiography placement.

摘要

Cetacaine (Cetylite Industries, Pennsauken, NJ) is often used for topical anesthesia by cardiologists to facilitate transesoph-ageal echocardiography (TEE) probe insertion in awake patients. We are reporting a case of cetacaine-related complication, namely methemoglobinemia,1 which resulted in severe hypoxemia. Many nonanesthesiologists are not familiar with this potential complication and use this drug indiscriminately to anesthetize the pharynx for TEE placement2 and endoscopies.An 86-year-old woman, American Society of Anesthesiologists IV, with a history of aortic valve replacement, was admitted to the intensive care unit after pelvic exenteration for ovarian cancer. Postoperatively, she developed sepsis believed to be caused by seeding of her valvular prosthesis. To exclude endocarditis, a TEE was scheduled to be performed by the cardiologist. At the beginning of the procedure, fentanyl, 200 jag, was administered by the cardiology nurse followed by multiple applications of cetacaine spray.