Methemoglobinemia after Local Anesthesia with Prilocaine: A Case Report

Yıl 2016, Cilt: 7 Sayı: 2, 37 - 39, 01.04.2016

Halil Doğan Doğaç Niyazi Özüçelik Mehmet Koçak Cem Şimşek Mustafa Yazıcıoğlu

Öz

Introduction: Methemoglobinemia due to local anesthesia is a rare phenomenon. Grey–blue cyanosis that is unresponsive to oxygen therapy after the administration of local prilocaine should be considered with methemoglobinemia due to local anesthesia, and methylene blue should be considered for treatment.Case Report: A 19-year-old man was admitted to Bakırköy Dr. Sadi Konuk Training and Research Hospital emergency department with complaints of shortness of breath, bruising of the lips and nail, palpitations, and numbness in the extremities. Toenail shooting with local anesthesia was performed 3 h prior. On admission, he was restless. Cyanosis persisted on the limb and nails, and oxygen saturation was 78% by pulse oximetry under oxygen supplementation. We found the following results on physical examination: blood pressure, 115/77 mmHg; pulse, 123/min; and respiratory rate, 28/min. Arterial blood gas analysis revealed the following: methemoglobin level, 12.4%. Following the diagnosis of prilocaine-induced methemoglobinemia, he was treated using intravenous methylene blue, and his symptoms resolved.Conclusion: Methemoglobinemia, a rare clinical complication of local anesthesia, can be prevented by limiting the applied dose of local anesthesia. Treatment with methylene blue should be kept in mind along with supplemental oxygen therapy for patients with methemoglobinemia

Anahtar Kelimeler

Methemoglobinemia, methylene blue, local anesthesia

Kaynakça

• Turkmen E, Kocabay G, Yavuz AS, Ozturk S. Epilasyon Amacıyla Prilokain Uygulanan Bir Hastada Gelişen Methemoglobinemi. İstanbul Tıp Fakul- tesi Dergisi 2005; 68: 19-21.
• Barash M, Reich KA, Rademaker D. Lidocaine-Induced Methemoglobin- emia: A Clinical Reminder. The Journal of the American Osteopathic As- sociation 2015; 115: 94-8. [CrossRef]
• Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesthesia & Analgesia 2009; 108: 837-45. [CrossRef]
• Vasters FG, Eberhart LHJ, Koch T, Kranke P, Wulf H, Morin AM. Risk fac- tors for prilocaine-induced methemoglobinaemia following peripheral regional anesthesia. Eur J Anaesthesiol 2006; 23: 760-5. [CrossRef]
• Centers for Disease Control and Prevention: MMWR, Prilocaine-induced methemoglobinemia-Wisconsin 1993; 43: 655.
• Bayram M, Ozkocaman V, Yesilbursa D, Ozkalemkaş F, Ali R, Irmak G, et al. Transosefagial Ekokardiografi Sırasında Topikal Anestezi icin Lidokain Uygulanan Bir Hastada Gelişen Methemoglobinemi. Uludağ Universi- tesi Tıp Fakultesi Dergisi 2011; 37: 99-101.
• Tran AN, Koo JY. Risk of systemic toxicity with topical lidocaine/ prilo- caine: A Review. J Drugs Dermatol 2014; 13: 1118-22.
• Gulgun M, Kul M, Sarıcı SU, Alpay F. Prilocine-induced methenoglo- binemia: report of two cases and review of literature. Erciyes Medical Journal 2007; 29: 322-5.
• Vidyarthi V, Manda R, Ahmed A, Khosla S, Lubell DL. Severe methemo- globinemia after transesophageal echocardiography. Am J Ther 2003; 10: 225-7. [CrossRef]
• Ozturk E, Aktaş BT, Oztarhan K, Adal E. Lokal anestezik uygulaması sonrası gelişen methemoglobinemi. Jopp Rerg 2010; 2: 46-8.