Yanaral, Fatih; Aslan, Ahmet Rüknettin; Çubuk, Alkan; Kökbıyık, Mehmet Taha; Şengör, Feridun
September 2013
Nobel Medicus Journal;Sep-Dec2013, Vol. 9 Issue 3, p142
Academic Journal
Circumcision is reported to be the most common surgical procedure performed on newborns. Local anesthesia infiltration by injection is considered to be the most effective method of analgesia for circumcision. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics. We report the case of a newborn who presented with cyanosis due to methemoglobinemia (methemoglobin. 38.5%) following local anesthesia with prilocaine. Cyanosis resolved after administration of 10% dextrose solution, supplemental oxygen (5 lt/min) via hood and intravenous methylene blue (1 mg/kg). Methemoglobinemia must be considered in the differential diagnosis of the cyanotic patient. Prilocaine should not be used in children younger than 6 months, in pregnant women, or in patients taking other oxidizing drugs and the dose of prilocaine should be adjusted according to weight to prevent methemoglobinemia. Methylene blue with supportive therapy is the first-line treatment.


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