Acute Methemoglobinemia Secondary to Topical Benzocaine Spray

CASE REPORT An 82-year-old white woman with a history of hypertension, paroxysmal atrial tachycardia, and hypothyroidism underwent laparoscopic left adrenalectomy for possible adrenal carcinoma. On the third postoperative day, the patient’s course was complicated by a paralytic ileus. A nasogastric tube was placed, preceded by a 3-second dose of Hurricane spray (20% benzocaine, approximately 600to 885-mg total dose) to the oropharynx. Within several minutes, the patient developed lethargy and confusion. She then became dyspneic and syncopal, and developed a cyanotic appearance. She did not respond to 100% O2 by nonrebreather mask despite an arterial blood gas (ABG) with a PaO2 of 310 mm Hg and an C L IN IC A L V IG N E T T E Acute Methemoglobinemia Secondary to Topical Benzocaine Spray