• Chiao-Yi Lin, Jenn-Ming Yang, Chiun-Ting Chen, Yung-Wei Hsu, Chun-Jen Huang, Chien-Chuan Chen, and Hsin-Jung Tsai.
• Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
• Acta Anaesthesiol Taiwan. 2009 Sep 1; 47 (3): 143-6.

AbstractMethemoglobinemia occasionally causes cyanosis particularly in congenital methemoglobinemia. Avoidance of exposure to oxidizing agents is important for patients with congenital methemoglobinemia because of their deficient enzymatic pathways and decreased oxygen-carrying capacity. Here, we present a patient with preoperatively undiagnosed congenital methemoglobinemia who underwent uterine myomectomy under general anesthesia. The patient was a 35-year-old woman who displayed a low pulse oximetry reading of 91% prior to induction of anesthesia. Methemoglobinemia was first suspected intraoperatively because of a mismatch of SpO2 of finger pulse oximetry and SaO2 of arterial blood, and was later confirmed by multiple-wavelength CO-oximetry. The pathophysiology, etiology, clinical manifestations, anesthetic considerations, and treatment options of methemoglobinemia are discussed.

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