Investigation of methemoglobinemia incidence among children undergoing circumcision using prilocaine.

Abstract

Introduction:Methemoglobinemia is a clinical entity characterized by substitution of ferrous iron (Fe++) in the hemoglobin structure by ferric iron that lacks oxygen carrying capacity. Acquired methemoglobinemia may occur due to oxidant substances and drugs, of which local anesthetics constitute an important group. In this study the incidence of prilocaine-induced methemoglobinemia was studied.

 

Materials and Method:This study was performed on children who presented to the urology department for circumcision. Methemoglobin levels were measured prior to and after prilocaine injection.

 

Results:The study enrolled 74 children aged 6 months to 12 years. Of the cases, 19.7% were found to have methemoglobinemia but none had symptoms. Mean preoperative and postoperative incidences of methemoglobinemia were 0.71% and 1.80%, respectively. Methemoglobin level was reduced as age of the patient increased.

 

Conclusion:The risk of methemoglobinemia should be considered with local anesthetic agents widely used in clinical practice, particularly in small age groups.

Giriş:Methemoglobinemi, hemoglobindeki  ferröz demirin (Fe++) yerini oksijen taşıma kapasitesi olmayan ferrik demirin (Fe+3) alması ile karakterize bir klinik durumdur. Edinsel methemoglobinemi, oksidan maddeler ve ilaçlara bağlı olarak ortaya çıkabilirken, lokal anestezikler ilaçlar arasında önemli bir grubu oluşturur. Bu çalışmada prilokaine bağlı methemoglobinemi sıklığı araştırılmıştır. 

Materyal Metod:Çalışma 2013 yılında üroloji polikliniğine sünnet amacıyla başvuran çocuklar arasında yapıldı. Prilokain öncesi ve sonrası methemoglobin düzeyleri araştırıldı. 

Bulgular:Çalışmaya yaşları 6 ay ile 12 yaş arasında değişen 74 çocuk dahil edildi. Olguların %19.7’sinde methemoglobinemi saptanırken semptomatik olan olgu saptanmadı. Methemoglobinemi ortalaması preoperatif %0.71, postoperatif  %1.80 olarak saptandı. Yaşın artışına parelel olarak methemoglobin düzeyinin azaldığı gözlendi.

Sonuçlar:Günlük pratikte sıklıkla kullanılan lokal anesteziklerin kullanımı ile özellikle küçük yaş grubunda methemoglobinemi riski göz önünde bulundurulmalıdır.

Keywords

• Prilocaine,methemoglobinemia,,circumcised children,Prilokain,methemoglobinemi

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