Methemoglobinemia after Local Anesthesia with Prilocaine in a Newborn after Aortic Coarctation Repair: A Case Report

Abstract

Prilocaine, widely used local anesthetic, can cause methemoglobinemia in pediatric patients even in therapeutic doses. Although complications related to local anesthesia are rare, it may occur especially in pediatric population when used in large doses exceeding the safe limits. Local anesthetic agent oxidizes hemoglobin and may cause methemoglobinemia. Methemoglobinemia manifests with clinical findings such as cyanosis without typical signs of respiratory failure.In this case report; we present methemoglobinemia that has occured secondary to 2 mg/kg 2% (6.5 mg) prilokaine which was used as intercostal injection for postoperative analgesia for the 3-days-old, 3250 gram, newborn baby who underwent aortic coarctation repair with left thoracotomy. Ascorbic acid was used for the treatment of methemoglobinemia. Physicians using local anesthetics should always keep methemoglobinemia in mind especially in pediatric patients with unexpected cyanosis even after the use of normal doses of local anesthetics.