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Robert M. Bojar
Hassan Rastegar
Douglas D. Payne
Joseph J. Stetz
Richard J. Cleveland
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Ann Thorac Surg 1987;43:332-334
© 1987 The Society of Thoracic Surgeons

Articles

Methemoglobinemia from Intravenous Nitroglycerin: A Word of Caution

Robert M. Bojar, M.D.*, Hassan Rastegar, M.D., Douglas D. Payne, M.D., Steven H. Harkness, M.D., Michael R. England, M.D., Joseph J. Stetz, M.D., Bruce Weiner, M.S., Richard J. Cleveland, M.D.

From the Departments of Cardiothoracic Surgery and Anesthesia, New England Medical Center and the Tufts University School of Medicine, Boston, MA

Accepted for publication March 18, 1986.

* Address reprint requests to Dr. Bojar, New England Medical Center, Box 266, 171 Harrison Ave, Boston, MA 02111

The dose of intravenously administered nitroglycerin (IV NTG) used to control ischemic chest pain usually is limited by hypotension from decreased preload. Herein we describe 2 patients who tolerated IV NTG without hemodynamic compromise but in whom severe impairment of blood oxygen content developed from methemoglobinemia noted during coronary bypass surgery. Methemoglobinemia must be suspected if chocolate-brown blood is encountered despite a normal arterial oxygen tension and calculated oxygen saturation. Before a methemoglobin level is available, the extent of hypoxemia can be determined by an oximetric oxygen saturation and therapy begun with intravenous administration of methylene blue. These case reports focus attention on the potential deleterious effects of undetected hypoxemia from methemoglobinemia in patients being stabilized with high-dose IV NTG for urgent cardiac surgery.




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