Benzocaine-induced methemoglobinemia

In our unit we use cytocaine spray to block a patient's gag reflex during transesophageal echo. Rarely, the medication can cause methemoglobinemia. We had this happen on our unit yesterday and the problem was properly diagnosed but there was quite a bit of discussion about the dose of methylene blue to give and the preferred IV administration technique. The patient recovered but we are considering what standards we should institute so the dosing does not cause treatment delays if this should ever happen again.
Does your place of practice have a standard of care for this rare occurence?
Quote from NYLadyIn our unit we use cytocaine spray to block a patient's gag reflex during transesophageal echo. Rarely, the medication can cause methemoglobinemia. We had this happen on our unit yesterday and the problem was properly diagnosed but there was quite a bit of discussion about the dose of methylene blue to give and the preferred IV administration technique. The patient recovered but we are considering what standards we should institute so the dosing does not cause treatment delays if this should ever happen again.Does your place of practice have a standard of care for this rare occurence?

we do continuous monitoring during procedures to prevent [font=helveticaneueltstd-lt][color=#231f20][font=helveticaneueltstd-lt][color=#231f20][font=helveticaneueltstd-lt][color=#231f20]methb levels from reaching a point of requiring treatment since methylene blue is controversial in itself for dosing and rebound.

Quote from greygullwe do continuous monitoring during procedures to prevent [font=helveticaneueltstd-lt][color=#231f20][font=helveticaneueltstd-lt][color=#231f20][font=helveticaneueltstd-lt][color=#231f20]methb levels from reaching a point of requiring treatment since methylene blue is controversial in itself for dosing and rebound.

Quote from core0The PI says .1-.2 mg/kg which is the pretty standard dose. We use doses up to 2 mg per Kg in refractory hypotension so anything in that range should be OK.

We occasionally use benzocaine for sore throats. Many of the nurses think it's okay for the patient to keep at bedside, however, my facility's policy prevents this due to this. They had to start sending the bottles up with labels saying they're not to be kept at bedside. I've seen methemoglobinemia once, but it was from an anesthesia agent (not sure what) not benzocaine. She was treated successfully with methylene blue. I'm sorry, I don't have much to contribute.

Quote from NYLadyCould you please tell me more about what you mean regarding the controversy surrounding treatment?

Thank you all!