Prilocaine
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Methaemoglobinaemia in an infant: case report A 40-day-old male infant developed methaemoglobinaemia during treatment with prilocaine [Citanest]. The boy underwent circumcision under local anaesthesia via dorsal nerve block with 2% prilocaine 1.5 mg/kg, and developed cyanosis 1.5 hours after the procedure. On admission, he exhibited anxiety, and central and peripheral cyanosis. His WBC count was 11 200/mm3 and his haemoglobin level was 11.9 g/dL. An arterial blood gas analysis showed a pH of 7.28, a PO2 of 85mm Hg and an oxygen saturation of 78%; methaemoglobin levels were 44%. He was diagnosed with methaemoglobinaemia. The boy was administered 100% oxygen with no response, and was then treated with methylthioninium chloride. Within 60 minutes, his cyanosis resolved, methaemoglobin fraction decreased to 4% and oxygen saturation increased to 92%. His cyanosis had completely disappeared after 120 minutes. After 24 hours, his methaemoglobin fraction was 1.5%. Author comment: "As methemoglobinemia is a rare but potentially lethal complication of local anesthetic, physicians should identify patients who are at increased risk of developing methemoglobinemia before administering local anesthetic. Prilocaine should not be used in infants less than 3 months of age because of the risk of methemoglobinemia." Ozdogan H, et al. Methemoglobinemia presenting in a circumcised baby following application of prilocaine: A case report. Journal of Medical Case Reports 4: Feb 2010. Available from: URL: http://dx.doi.org/10.1186/1752-1947-4-4 803013960 Turkey
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Reactions 8 May 2010 No. 1300
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