Methemoglobinemia presenting in a circumcised baby following application of prilocaine: a case report.
BACKGROUND
Local anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics.


METHODS
We report the case of a 40-day-old Turkish boy who presented with cyanosis after receiving local anesthesia with prilocaine. His methemoglobin level revealed severe methemoglobinemia (methemoglobin = 44%). His cyanosis resolved after intravenous administration of methylene blue.


CONCLUSIONS
Although the association between prilocaine use and methemoglobinemia has generally restricted the use of prilocaine in babies, it is still widely used in ambulatory procedures, especially during circumcision in the neonatal period. Prilocaine should not be used in babies who are less than 3 months old because of the risk of methemoglobinemia; other local anesthetics may be used for this age group. Furthermore, general anesthesia by mask ventilation may be favored for babies less than 3 months of age instead of local anesthetics.
Ozdogan
Hatice
H
Department of Anesthesiology and Reanimation, Dişkapi Yildirim Beyazit Training and Research Hospital, Ulus Dişkapi, Ankara, Turkey. drgozdeaydin@yahoo.com.
Osma
Selcan
S
Aydin
Gozde B
GB
Dinc
Avni
A
Ozgun
Gulten
G