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Anaesthetists are well trained to detect subtle skin signs of life-threatening situations such as cyanosis in hypoxia. However, cyanosis resulting from drug-induced, asymptomatic methaemoglobinaemia is rare and is likely to go undetected preoperatively. Patients presenting with asymptomatic methaemoglobinaemia may, therefore, offer a dramatic challenge to the unprepared anaesthetist. We report a case of methaemoglobinaemia secondary to dapsone ingestion that was diagnosed intraoperatively.

Methylene blue is used to check tubal patency during laparoscopy. A case of methemoglobinemia which was induced by methylene blue is presented. Methemoglobinemia is usually treated with methylene blue; however, in patients with glucose-6-phosphate dehydrogenase deficiency, methylene blue can induce methemoglobinemia.

Flutamide, an anti-androgen used in prostate cancer therapy, is also a derivative of aniline. Mild, usually asymptomatic, methaemoglobinaemia has been reported. We report a patient receiving flutamide therapy who developed cyanosis, dyspnoea and anaemia, initially attributed to marked methaemoglobinaemia by the CO-Oximeter method. An unsuccessful trial of methylene blue therapy led to the finding of marked sulphaemoglobinaemia. Sulphaemoglobinaemia has not previously been reported with flutamide use. Recognition of this association is important, given the refractoriness of sulphaemoglobinaemia to methylene blue therapy.

Two cases are described and discussed in which penicillin powder applied to the theca at the end of laminectomy caused delayed convulsions.

A case is reported in which a major generalised convulsive seizure followed the administration of Althesin. The patient had no clinically demonstrable predisposition to epilepsy. The fits were rapidly controlled by the intravenous injection of thiopentone.