Methemoglobinemia after local anesthetic (prilocaine) application: a case report

Introduction: Circumcision is a surgical procedure performed by many societies for religious, medical and cultural purposes. One of the agents used during this procedure is prilocaine, a commonly used local anesthetic. In the literature, cases of methemoglobinemia which can be developed with the application of prilocaine in normal dose have been reported. Oxidation of hemoglobin with various oxidative stresses is called methemoglobinemia when the divalent iron in its content is converted into its trivalent form. This reaction leads to hypoxaemia in the tissue and a clinical picture of cyanosis occurs at varying degrees.Case Report: Two-and-a-half-month-old patient was referred to my hospital by a physician because of the complaint of bruising after local anesthesia with prilocaine and the measured oxygen saturation was 79%. Physical examination revealed cyanosis in the peroral region, hands and feet. It was decided that methylene blue should be administered considering the fact that the patient was given prilocaine as a local anesthetic, due to the inability to find an underlying respiratory and cardiac cause, and because of the high value of methemoglobin in blood gas. Methylene blue 2 mg/kg was given orally. About an hour later, cyanosis disappeared. The control methhemoglobin level was found to be 2.7%. Conclusion: Methemoglobinemia should be considered in the differential diagnosis of cyanosis after local anesthetic application and local anesthetics with less side effects should be preferred in early infancy. In this case report, it was aimed to discuss the differential diagnosis and treatment methods of methemoglobinemia after local anesthesia with prilocaine

Do gastrointestinal and respiratory signs and symptoms correlate with the severity of gastroesophageal reflux?

Abstract Background Gastroesophageal reflux (GER) is a disorder that is common by seen in childhood and may lead to severe complications. In this study, we ascertained the incidence of GER among the children who had typical and atypical complaints of GER and whether there was a difference between two groups comparing the findings of 24-hour pH-meter. Methods 39 out of 70 patients with typical and atypical GER symptoms were diagnosed as GER by 24-hour pH-meter monitoring. The patients were divided into three groups, those having gastrointestinal complaints, those having respiratory complaints and those having both gastrointestinal and respiratory symptoms. Results Evaluated the GER prevalence in these groups, it was found to be 60% in the gastrointestinal group, 48.6% in the respiratory group and 75% in the mixed group. When pH-meter measurements of GER positive patients were compared within the clinical groups, the fraction of time that pH was lower than 4 was found to be significantly higher in the mixed group (p = 0.004). Conclusions The coexistence of gastrointestinal and respiratory symptoms in the patients with GER may be related to the severe reflux.</p

Sedoanalgesia in pediatric daily surgery

Kaya, Ertugrul/0000-0003-0081-682XWOS: 000323568000013PubMed: 23936597Purpose: The present report was focused on clinical advantages of sedoanalgesia in the pediatric outpatient surgical cases. Method: Sedoanalgesia has been used to sedate patients for a variety of pediatric procedures in our department between 2007 and 2010. This is a retrospective review of 2720 pediatric patients given ketamine for sedation with midazolam premedication. Ketamine was given intravenously (1-2 mg/kg) together with atropine (0.02 mg/kg) and midazolam (0.1 mg/kg) + a local infiltration anesthetic 2 mg/kg 0.5% bupivacaine hydrochloride. Result: Median age of the patients included in the study was 5.76 +/- 2.12 (0-16 years). The main indications for ketamine include circumcision (69%), inguinal pathologies (inguinal hernia (17%), orchidopexy (2.68%), hydrocele (3.38%), hypospadias (1.94%), urethral fistula repair (0.33%), urethral dilatation (0.25%), and other conditions. All of our patients were discharged home well. In this regard, we have the largest group of patients ever given ketamine. Conclusion: Sedoanalgesia might be used as a quite effective method for daily surgical procedures in children

Do gastrointestinal and respiratory signs and symptoms correlate with the severity of gastroesophageal reflux?

PubMed ID: 22436080Background: Gastroesophageal reflux (GER) is a disorder that is common by seen in childhood and may lead to severe complications. In this study, we ascertained the incidence of GER among the children who had typical and atypical complaints of GER and whether there was a difference between two groups comparing the findings of 24-hour pH-meter.Methods: 39 out of 70 patients with typical and atypical GER symptoms were diagnosed as GER by 24-hour pH-meter monitoring. The patients were divided into three groups, those having gastrointestinal complaints, those having respiratory complaints and those having both gastrointestinal and respiratory symptoms.Results: Evaluated the GER prevalence in these groups, it was found to be 60% in the gastrointestinal group, 48.6% in the respiratory group and 75% in the mixed group. When pH-meter measurements of GER positive patients were compared within the clinical groups, the fraction of time that pH was lower than 4 was found to be significantly higher in the mixed group (p = 0.004).Conclusions: The coexistence of gastrointestinal and respiratory symptoms in the patients with GER may be related to the severe reflux. © 2012 Uzun et al; licensee BioMed Central Ltd