Risk of Topical Anesthetic–Induced Methemoglobinemia A 10-Year Retrospective Case-Control Study Topical Anesthetic–Induced Methemoglobinemia

Chowdhary S, Bukoye B, Bhansali AM, et al. — Mon, 13 May 2013 00:00:00 GMT

Importance

Methemoglobinemia is a rare but serious disorder, defined as an increase in oxidized hemoglobin resulting in a reduction of oxygen-carrying capacity. Although methemoglobinemia is a known complication of topical anesthetic use, few data exist on the incidence of and risk factors for this potentially life-threatening disorder.

Objective

To examine the incidence of and risk factors for procedure-related methemoglobinemia to identify patient populations at high risk for this complication.

Design and Setting

Retrospective study in an academic research setting.

Participants

Medical records for all patients diagnosed as having methemoglobinemia during a 10-year period were reviewed.

Exposures

All cases of methemoglobinemia that occurred after the following procedures were included in the analysis: bronchoscopy, nasogastric tube placement, esophagogastroduodenoscopy, transesophageal echocardiography, and endoscopic retrograde cholangiopancreatography.

Main Outcomes and Measures

Comorbidities, demographics, concurrent laboratory values, and specific topical anesthetic used were recorded for all cases. Each case was compared with matched inpatient and outpatient cases.

Results

In total, 33 cases of methemoglobinemia were identified during the 10-year period among 94 694 total procedures. The mean (SD) methemoglobin concentration was 32.0% (12.4%). The methemoglobinemia prevalence rates were 0.160% for bronchoscopy, 0.005% for esophagogastroduodenoscopy, 0.250% for transesophageal echocardiogram, and 0.030% for endoscopic retrograde cholangiopancreatography. Hospitalization at the time of the procedure was a major risk factor for the development of methemoglobinemia (0.14 cases per 10 000 outpatient procedures vs 13.7 cases per 10 000 inpatient procedures, P < .001).

Conclusions and Relevance

The overall prevalence of methemoglobinemia is low at 0.035%; however, an increased risk was seen in hospitalized patients and with benzocaine-based anesthetics. Given the potential severity of methemoglobinemia, the risks and benefits of the use of topical anesthetics should be carefully considered in inpatient populations.

Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients With Cancer Creative Arts Therapies in Cancer Patients

Puetz TW, Morley CA, Herring MP. — Mon, 13 May 2013 00:00:00 GMT

Importance

Creative arts therapies (CATs) can reduce anxiety, depression, pain, and fatigue and increase quality of life (QOL) in patients with cancer. However, no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients has been conducted.

Objectives

To estimate the effect of CAT on psychological symptoms and QOL in cancer patients during treatment and follow-up and to determine whether the effect varied according to patient, intervention, and design characteristics.

Evidence Review

We searched ERIC, Google Scholar, MEDLINE, PsycInfo, PubMed, and Web of Science from database inception to January 2012. Studies included RCTs in which cancer patients were randomized to a CAT or control condition and anxiety, depression, pain, fatigue and/or QOL were measured pre- and post-intervention. Twenty-seven studies involving 1576 patients were included. We extracted data on effect sizes, moderators, and study quality. Hedges d effect sizes were computed, and random-effects models were used to estimate sampling error and population variance.

Findings

During treatment, CAT significantly reduced anxiety (Δ = 0.28 [95% CI, 0.11-0.44]), depression (Δ = 0.23 [0.05-0.40]), and pain (Δ = 0.54 [0.33-0.75]) and increased QOL (Δ = 0.50 [0.25-0.74]). Pain was significantly reduced during follow-up (Δ = 0.59 [95% CI, 0.42-0.77]). Anxiety reductions were strongest for studies in which (1) a non-CAT therapist administered the intervention compared with studies that used a creative arts therapist and (2) a waiting-list or usual-care comparison was used. Pain reductions were largest during inpatient treatment and for homogeneous cancer groups in outpatient settings; significantly smaller reductions occurred in heterogeneous groups in outpatient settings.

Conclusions and Relevance

Exposure to CAT can improve anxiety, depression, and pain symptoms and QOL among cancer patients, but this effect is reduced during follow-up.

JAMA Internal Medicine: Radiography Topic Collection

Risk of Topical Anesthetic–Induced Methemoglobinemia A 10-Year Retrospective Case-Control Study Topical Anesthetic–Induced Methemoglobinemia

Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients With Cancer Creative Arts Therapies in Cancer Patients