Methemoglobinemia due to application of prilocaine during circumcision and the effect of ascorbic acid

Boran, Perran; Tokuç, Gülnur; Yegin, Zeliha

doi:10.1016/j.jpurol.2008.04.004

Cited by 34 publications

(36 citation statements)

References 6 publications

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“…In a study, the EMLA cream was found to be more effective compared to a bonain mixture for eardrum anesthesia (14). However, it was found that prilocaine has a high propensity to cause methemoglobinemia (15)(16)(17). Thus, it became important to search for more compounds that could form a eutectic mixture with lidocaine and thereby, improve its effectiveness (18).…”

Section: Introductionmentioning

confidence: 99%

Characterization and Comparison of Lidocaine-Tetracaine and Lidocaine-Camphor Eutectic Mixtures Based on Their Crystallization and Hydrogen-Bonding Abilities

et al. 2014

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Abstract. Eutectic mixtures formed between active pharmaceutical ingredients and/or excipients provide vast scope for pharmaceutical applications. This study aimed at the exploration of the crystallization abilities of two eutectic mixtures (EM) i.e., lidocaine-tetracaine and lidocaine-camphor (1:1 w/w). Thermogravimetric analysis (TGA) for degradation behavior whereas modulated temperature differential scanning calorimetry (MTDSC) set in first heating, cooling, and second heating cycles, was used to qualitatively analyze the complex exothermic and endothermic thermal transitions. Raman microspectroscopy characterized vibrational information specific to chemical bonds. Prepared EMs were left at room temperature for 24 h to visually examine their crystallization potentials. The degradation of lidocaine, tetracaine, camphor, lidocaine-tetracaine EM, and lidocaine-camphor EM began at 196.56, 163.82, 76.86, 146.01, and 42.72°C, respectively, which indicated that eutectic mixtures are less thermostable compared to their individual components. The MTDSC showed crystallization peaks for lidocaine, tetracaine, and camphor at 31.86, 29.36, and 174.02°C, respectively (n=3). When studying the eutectic mixture, no crystallization peak was observed in the lidocaine-tetracaine EM, but a lidocaine-camphor EM crystallization peak was present at 18.81°C. Crystallization occurred in lidocaine-camphor EM after being kept at room temperature for 24 h, but not in lidocaine-tetracaine EM. Certain peak shifts were observed in Raman spectra which indicated possible interactions of eutectic mixture components, when a eutectic mixture was formed. We found that if the components forming a eutectic mixture have crystallization peaks close to each other and have sufficient hydrogen-bonding capability, then their eutectic mixture is least likely to crystallize out (as seen in lidocaine-tetracaine EM) or vice versa (lidocainecamphor EM).

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Section: Introductionmentioning

confidence: 99%

Characterization and Comparison of Lidocaine-Tetracaine and Lidocaine-Camphor Eutectic Mixtures Based on Their Crystallization and Hydrogen-Bonding Abilities

et al. 2014

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“…En sık lokal anestezik ilaçlar, sülfonamidler ve nitrat içeren maddelerin MH'ye neden olduğu bildirilmektedir (3,4). Erken bebeklik döneminde, lokal anesteziklerin en sık kullanım alanı sünnet uygulamasıdır.…”

Section: Discussionunclassified

“…Prilokain, dozdan bağımsız olarak, özellikle 6 ay altı infantlarda, metaboliti olan o-toluidin ile MH yapabilmektedir ve bundan dolayı aynı yaş grubunda kullanılmaması gerektiği bildirilmektedir (9,10). Yaşamın ilk 6 aylık döneminde, MH redüktaz aktivitesinin düşük olması, fetal hemoglobinin daha kolay oksitlenmesi nedeniyle MH'ye yatkınlık söz konusudur (4,9,11,12). Literatürde sünnet uygulaması sırasında prilokain verilip MH gelişen, 6 aydan küçük çok sayıda olgu bildirilmiştir (4,5,(7)(8)(9)(10)(11)13).…”

Section: Discussionunclassified

Metheboglobinemia Developing in Four Infants after Local Anesthesia

Yurtseven¹,

Saz²

2015

jpr

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Öz ABS TRACT GirişEritrosit yapısında bulunan hemoglobin, normal şartlarda ferro (Fe+2) formunda demir içeren ve dokulara oksijen taşınmasını sağlayan bir moleküldür. Hemoglobinin çeşitli oksidatif streslerle oksitlenmesi sonucu, içeriğindeki demirin, üç değerli ferrik (Fe+3) haline dönüşmesi ve dokulara oksijen taşınmasının bozulması sonucu hipoksi oluşmasına methemoglobinemi (MH) denir (1). MH patofizyolojisi Şekil 1'de belirtilmektdir. MH'nin kesin tanısı kan methemoglobin (MetHb) düzeyinin ölçülmesi ile konur (1,2). Normal fizyolojik durumda eritrosit enzim sistemleri olan NADH-MetHbredüktaz ve NADPH-MetHb-redüktaz enzimleri, MetHb değerini, hemoglobin değerinin %1'den daha az olacak şekilde tutar. MetHb konsantrasyonu %15'i geçtiğinde siyanoz, %30'u geçtiğinde taşikardi, halsizlik, bulantı, kusma, solunum sıkıntısı, %55'in üzerinde letarji, stupor ve senkop görülürken, %70'in üzerindeki değerlerde ise mortal seyredebilir (2,3). MH konjenital ve edinsel nedenlere bağlı olarak gelişebilir (1-3). Edinsel MH yaptığı belirlenen birçok kimyasal madde ve ilaç tanımlanmıştır. Çocukluk yaş grubunda özellikle lokal anestezikler MH gelişiminde en çok suçlanan ilaçlardır (4,5). Bu yazıda hastane ortamında, çocuk cerrahisi uzmanı tarafından yapılan sünnet öncesi prilokain uygulanan, sonrasında MH gelişen, yaşları 1-1,5 ay arasında değişen 4 olgu, sözel onam alınarak sunulmuştur. Olgu SunumlarıOlgu 1 Morarma ve huzursuzluk şikayeti ile acil servise getirilen 45 günlük erkek olgunun, 5 saat önce lokal anestezi (prilokainCitanest ® %0,5) eşliğinde sünnet olduğu öğrenildi. Fizik muayenesinde perioral siyanozu ve ajitasyonu olan, kardiyak Methemoglobinemia (MH) is defined as blood methemoglobin (Met-Hb) concentration >1%. Met-Hb is an abnormal form of hemoglobin in which iron is oxidized from the ferrous (Fe2+) to the ferric state (Fe3+). Since Met-Hb cannot bind and transport oxygen, increased levels of Met-Hb are associated with clinically severe symptoms. In this study, we presented 4 cases of MH, developed after the administration of prilocaine prior to the circumcision procedure.

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“…This effect impairs oxygen transport to tissues (Boran, 2008). MetHb is normally maintained at concentrations below 2% of total hemoglobin, due to the activity of NADH dehydrogenase which reduces metHb to hemoglobin.…”

Section: Adverse Effectsmentioning

confidence: 99%

“…Severe methemoglobinemia (concentrations above 25%) presents with seizures, cardiovascular collapse and coma. Severe methemoglobinemia represents an emergency; first-line antidote is methylene blue, a thiazide dye that accelerates the enzymatic reduction of metHb by NADHP reductase and also acts as scavenger for free radicals (Boran, 2008). However when methylene blue is not readily available, intravenous high doses of ascorbic acid may be used as an alternative.…”

Section: Adverse Effectsmentioning

confidence: 99%

The Use of Topical Cream Anesthetics in Office Procedures of the External Genitalia

Gyftopoulos¹,

Surgeon²

2012

Clinical Use of Local Anesthetics

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Methemoglobinemia due to application of prilocaine during circumcision and the effect of ascorbic acid

Cited by 34 publications

References 6 publications

Characterization and Comparison of Lidocaine-Tetracaine and Lidocaine-Camphor Eutectic Mixtures Based on Their Crystallization and Hydrogen-Bonding Abilities

Characterization and Comparison of Lidocaine-Tetracaine and Lidocaine-Camphor Eutectic Mixtures Based on Their Crystallization and Hydrogen-Bonding Abilities

Metheboglobinemia Developing in Four Infants after Local Anesthesia

The Use of Topical Cream Anesthetics in Office Procedures of the External Genitalia

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