Methemoglobinemia induced by lidocaine-prilocaine cream.
With growing awareness of the importance of pain control in all procedures, the use of lidocaine-prilocaine cream (EMLA) for all ages is increasing. Lidocaine-prilocaine cream has been implicated as a cause of methemoglobinemia. Diagnostic clues may be oxygen-resistant cyanosis and an oxygen "saturation gap" between arterial blood saturation and pulse oximetry. Treatment with intravenous methylene blue is often effective. Since EMLA is often mistakenly considered risk-free it is routinely applied by medical staff in the emergency room. Subsequent to the case of EMLA-induced methemoglobinemia in an 8 year old girl we wish to alert the medical community to this phenomenon, and in this work review the relevant literature.
Oded
O
Shamriz
Inbal
I
Cohen-Glickman
Shimon
S
Reif
Eyal
E
Shteyer
D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D003490:Cyanosis / Q000209:etiology; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D000077442:Lidocaine, Prilocaine Drug Combination; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D010092:Oximetry; D010100:Oxygen / Q000008:administration & dosage; D011318:Prilocaine / Q000008:administration & dosage / Q000009:adverse effects*
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D004791:Enzyme Inhibitors; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine; D010100:Oxygen; D008751:Methylene Blue