The Evaluation of the Patients with Methemoglobinemia Due to Prilocaine

INTRODUCTION: This study aims to present the results and treatment of prilocaine-induced methemoglobinemia at three different hospital pediatric surgical clinics.
METHODS: The data were obtained from hospital information systems at the University of Health Sciences Umraniye Training and Research Hospital, Prof. Dr. İlhan Varank Training and Research Hospital and Inonu University Medical Faculty Pediatric Surgery clinics between 2009 and 2019. The patients with prilocaine-induced methemoglobinemia in pediatric surgery clinics were evaluated retrospectively.
RESULTS: A total of 11 cases were identified (10 male and 1 female). The mean age was 4.60 months (max/min: 1-12) and the mean weight was 5.570 g (max/min: 3600-11000). Local prilocaine (Citanest®), at doses 1-3 mg/kg, was injected to eight cases of circumcision, two cases of bilateral inguinal hernia and one case of undescended testicle + circumcision. In all cases, cyanosis in the skin and mucous membranes and methemoglobin in the blood gases were high (10-30%). 300 mg/kg ascorbic acid was applied to the patients for treatment, and 24 hours of methemoglobin levels were normal (1-3%).
DISCUSSION AND CONCLUSION: Methemoglobinemia should be suspected in cases where prilocaine is used as a local anesthetic, especially prilocaine should not be used in infants younger than six months of age, and alternative local anesthetics for prilocaine should be considered.