Methemoglobin Levels in Generally Anesthetized Pediatric Dental Patients Receiving Prilocaine Versus Lidocaine

Abstract

The purpose of this study was to measure and compare peak methemoglobin levels and times to peak methemoglobin levels following the use of prilocaine and lidocaine in precooperative children undergoing comprehensive dental rehabilitation under general anesthesia. Ninety children, 3–6 years of age, undergoing dental rehabilitation under general anesthesia were enrolled and randomly assigned into 3 equal groups: group 1, 4% prilocaine plain, 5 mg/kg; group 2, 2% lidocaine with 1 : 100,000 epinephrine, 2.5 mg/kg; and group 3, no local anesthetic. Subjects in groups 1 and 2 were administered local anesthetic prior to restorative dental treatment. Methemoglobin levels (SpMET) were measured and recorded throughout the procedure using a Masimo Radical-7 Pulse Co-Oximeter (Masimo Corporation, Irvine, Calif, RDS-1 with SET software with methemoglobin interface). Data were analyzed using chi-square, one-way analysis of variance (ANOVA), and Pearson correlation (significance of P < .05). Group 1 had a significantly higher mean peak SpMET level at 3.55% than groups 2 and 3 at 1.63 and 1.60%, respectively. The mean time to peak SpMET was significantly shorter for group 3 at 29.50 minutes than that of group 1 at 62.73 and group 2 at 57.50 minutes. Prilocaine, at 5 mg/kg in pediatric dental patients, resulted in significantly higher peak SpMET levels than lidocaine and no local anesthetic. In comparison to no local anesthetic, the administration of prilocaine and lidocaine caused peak SpMET levels to occur significantly later in the procedure.

Dental Sedation in Children

“…This is a particular concern in younger children who received benzocaine [65] or possibly prilocaine, due to an immature metabolite pathway. In children, peak methemoglobinemia concentrations of 3.6 % occur approximately 1 h after injection of 5 mg/kg prilocaine [66]. This was significantly greater than the concentration in those children who received 2.5 mg/kg of lidocaine (peak 1.6 %).…”

<i>In vitro</i> oral epithelium cytotoxicity and <i>in vivo</i> inflammatory inducing effects of anesthetic rice gel

“…Mild inflammation has been reported when the cream containing both anesthetics was inserted subcutaneously to rats (31). For side effect comparison between the two anesthetics, prilocaine has been reported to increase higher level of methemoglobin than lidocaine (32). Many mediators including TNF-α are released from the host cells during inflammatory process.…”

Perioperative intravenous lignocaine infusion for postoperative pain control in patients undergoing surgery of the spine: protocol for a systematic review and meta-analysis

“…► Bronchodilation at subtoxic doses; respiratory depression occurs at toxic dose ranges Other ► Methemoglobinemia may occur at doses exceeding 600 mg 65 on October 31, 2020 by guest. Protected by copyright.…”