Abstract
Prilokain, pek çok alanda kullanılan lokal anestetik bir ajandır, ancak hayatı tehdit edebilen bir yan etki olan methemoglobinemiye neden olabilmektedir. Methemoglobinin O2 taşıma kapasitesi düşüktür ve doku düzeyinde hipoksiye neden olabilir. Sünnet operasyonundan iki saat sonra ağız bölgesinde, ellerinde ve ayak parmaklarında morarma yakınması ile acil servise başvuran 54 günlük bebeğin fizik muayenesinde mevcut durumu açıklayacak patoloji saptanmadı. Oksijen tedavisine yanıtsız olan hasta yoğun bakım ünitesine alındı. Sünnet işlemi öncesi 2 mg/kg prilokain yapıldığı öğrenilen, oksijen tedavisine rağmen satürasyon değerleri düşük seyreden ve kan gazı incelemesinde methemoglobin düzeyi %24,7 saptanan hastaya methemoglobinemi tanısı konuldu. Hastaya 300 mg/kg/doz askorbik asit başlandı ve 24 saatlik izlem sonrası şifa ile taburcu edildi. Cerrahi girişim sonrasında siyanoz gelişen ve SaO2 ile pO2 değerleri arasında uyumsuzluk saptanan hastalarda methemoglobinemi düşünülmeli ve gelişebilecek problemler açısından tam donanımlı çocuk yoğun bakım ünitelerinde izlenmelidirler.
References
- 1. Honig GR. Hemoglobin disorder. In: Behrman RE, Kleigman RM, Jenson HB (eds). Nelson Textbook of Pediatrics. Philadelpiha: Saunders, 2000:1478-88.
- 2. Svecová D, Böhmer D. Congenital and acquired methemoglobinemia and its therapy. Cas Lek Cesk 1998;137:168-70.
- 3. Benini D, Vivo L, Fanos V. [Acquired methemoglobinemia: a case report]. Pediatr Med Chir 1998;20:411-3.
- 4. Sivasli E, Gursoy T, Yurdakok M. Which local anesthesia should be used in neonatal circumcision in newborns? Saudi Med J 2005;26:690-1.
- 5. LiaoYP,HungDZ,YangDY.Hemolyticanemiaaftermethylene blue therapy for aniline-induced methemoglobinemia. Vet Hum Toxicol 2002;44:19-21.
- 6. Kara A, Yiğit S, Aygün C, Oran O. Toxic methemoglobinemia after injection of prilocaine in a newborn. A case report. Turk J Pediatr 1998;40:589-92.
- 7. Bristol I, Brown J, Slomovitz BM, Shannon VR, Eifel PJ. Methemoglobinemia induced by topical vaginal sulfanilamide cream in a patient with cervical cancer: a case report. Gynecol Oncol 2005;97:953-6.
- 8. Armstrong C, Burak KW, Beck PL. Benzocaine-induced methemoglobinemia: a condition of which all endoscopists should be aware. Can J Gastroenterol 2004;18:625-9.
- 9. Bayard M, Farrow J, Tudiver F. Acute methemoglobinemia after endoscopy. J Am Board Fam Pract 2004;17:227-9.
- 10. Kumar AR, Dunn N, Naqvi M. Methemoglobinemia associated with a prilocaine-lidocaine cream. Clin Pediatr 1997;36:239-40.
- 11. Gülgün M, Kul M, Sarıcı S. Prilocaine-induced methemoglobinemia: report of two cases and review of literature. Erciyes Medical Journal 2007;29:322-5.
- 12. Aydoğan M, Toprak DG, Türker G ve ark. Prilokaine bağlı toksik methemaglobinemide intravenöz askorbik asit kullanımı: İki vaka takdimi. Çocuk Sağlığı ve Hastalıkları Dergisi 2005;48:65-8.
- 13. Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesth Analg 2009;108:837-45.
- 14. Sinisterra S, Miravet E, Alfonso I, Soliz A, Papazian O. Methemoglobinemia in an infant receiving nitric oxide after the use of eutectic mixture of local anesthetic. J Pediatr 2002;141:285-6.
- 15. Hahn IH, Hoffman RS, Nelson LS. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004;26:85-8.
- 16. Gunter JB. Benefit and risks of local anesthetics in infants and children. Paediatr Drugs 2002;4:649-72.
Abstract
Prilocaine is a local anesthetic agent and is widely used in most of ambulatory procedures, but it can cause methemoglobinemia which is a life-threatening condition. Methemoglobinemia may cause hypoxia of tissue because methemoglobin has less oxygen carrying capability than hemoglobin. A 54-dayold boy who developed cyanosis around his mouth, on his hands and toes two hours after the circumcision operation was admitted to the emergency department. No abnormality was established on his physical examination except for cyanosis. Cyanosis did not improve with oxygen administration and the patient was admitted to intensive care unit. His history revealed that prilocaine hydrochloride 2 mg/ kg was administered subcutaneously as local anesthesia prior to circumcision operation. Diagnosis of methemoglobinemia was established in the patient in whom saturation levels were low in spite of the oxygen therapy and in whom methemoglobinemia level was 24.7%. His cyanosis completely disappeared after administration of intravenous ascorbic acid 300 mg/kg/dose and he was discharged after a 24-hour follow-up period with recovery. Methemoglobinemia should be considered in cases with cyanosis and inconsistency between oxygen saturation and partial arterial oxygen pressure. These cases should be monitored in pediatric intensive care units for lethal complications.
References
- 1. Honig GR. Hemoglobin disorder. In: Behrman RE, Kleigman RM, Jenson HB (eds). Nelson Textbook of Pediatrics. Philadelpiha: Saunders, 2000:1478-88.
- 2. Svecová D, Böhmer D. Congenital and acquired methemoglobinemia and its therapy. Cas Lek Cesk 1998;137:168-70.
- 3. Benini D, Vivo L, Fanos V. [Acquired methemoglobinemia: a case report]. Pediatr Med Chir 1998;20:411-3.
- 4. Sivasli E, Gursoy T, Yurdakok M. Which local anesthesia should be used in neonatal circumcision in newborns? Saudi Med J 2005;26:690-1.
- 5. LiaoYP,HungDZ,YangDY.Hemolyticanemiaaftermethylene blue therapy for aniline-induced methemoglobinemia. Vet Hum Toxicol 2002;44:19-21.
- 6. Kara A, Yiğit S, Aygün C, Oran O. Toxic methemoglobinemia after injection of prilocaine in a newborn. A case report. Turk J Pediatr 1998;40:589-92.
- 7. Bristol I, Brown J, Slomovitz BM, Shannon VR, Eifel PJ. Methemoglobinemia induced by topical vaginal sulfanilamide cream in a patient with cervical cancer: a case report. Gynecol Oncol 2005;97:953-6.
- 8. Armstrong C, Burak KW, Beck PL. Benzocaine-induced methemoglobinemia: a condition of which all endoscopists should be aware. Can J Gastroenterol 2004;18:625-9.
- 9. Bayard M, Farrow J, Tudiver F. Acute methemoglobinemia after endoscopy. J Am Board Fam Pract 2004;17:227-9.
- 10. Kumar AR, Dunn N, Naqvi M. Methemoglobinemia associated with a prilocaine-lidocaine cream. Clin Pediatr 1997;36:239-40.
- 11. Gülgün M, Kul M, Sarıcı S. Prilocaine-induced methemoglobinemia: report of two cases and review of literature. Erciyes Medical Journal 2007;29:322-5.
- 12. Aydoğan M, Toprak DG, Türker G ve ark. Prilokaine bağlı toksik methemaglobinemide intravenöz askorbik asit kullanımı: İki vaka takdimi. Çocuk Sağlığı ve Hastalıkları Dergisi 2005;48:65-8.
- 13. Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesth Analg 2009;108:837-45.
- 14. Sinisterra S, Miravet E, Alfonso I, Soliz A, Papazian O. Methemoglobinemia in an infant receiving nitric oxide after the use of eutectic mixture of local anesthetic. J Pediatr 2002;141:285-6.
- 15. Hahn IH, Hoffman RS, Nelson LS. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004;26:85-8.
- 16. Gunter JB. Benefit and risks of local anesthetics in infants and children. Paediatr Drugs 2002;4:649-72.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | June 1, 2014 |
| Published in Issue | Year 2014 Volume: 12 Issue: 1 |