Methemoglobinemia after Local Anesthesia with Prilocaine: A Case Report

Year 2016, Volume: 7 Issue: 2, 37 - 39, 01.04.2016

Halil Doğan Doğaç Niyazi Özüçelik Mehmet Koçak , Cem Şimşek Mustafa Yazıcıoğlu

Abstract

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

Keywords

Methemoglobinemia, methylene blue, local anesthesia

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