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

Abstract

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