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Year 2018, Volume 3 , Issue 1, Pages 69 - 71 2018-04-12

Methemoglobinemia after local anesthetic (prilocaine) application: a case report
Lokal anestezik (prilokain) uygulamasına bağlı gelişen methemoglobinemi: Olgu sunumu

Gulsen YALCİN [1] , Onder KİLİCASLAN [2] , Aybars OZKAN [3] , Kenan KOCABAY [4]

Abstract

Introduction: Circumcision is a surgical procedure performed by many societies for religious, medical and cultural purposes. One of the agents used during this procedure is prilocaine, a commonly used local anesthetic. In the literature, cases of methemoglobinemia which can be developed with the application of prilocaine in normal dose have been reported. Oxidation of hemoglobin with various oxidative stresses is called methemoglobinemia when the divalent iron in its content is converted into its trivalent form. This reaction

 leads to hypoxaemia in the tissue and a clinical picture of cyanosis occurs at varying degrees.

Case Report: Two-and-a-half-month-old patient was referred to my hospital by a physician because of the complaint of bruising after local anesthesia with prilocaine and the measured oxygen saturation was 79%. Physical examination revealed cyanosis in the peroral region, hands and feet. It was decided that methylene blue should be administered considering the fact that the patient was given prilocaine as a local anesthetic, due to the inability to find an underlying respiratory and cardiac cause, and because of the high value of methemoglobin in blood gas. Methylene blue 2 mg/kg was given orally. About an hour later, cyanosis disappeared. The control methhemoglobin level was found to be 2.7%.

Conclusion: Methemoglobinemia should be considered in the differential diagnosis of cyanosis after local anesthetic application and local anesthetics with less side effects should be preferred in early infancy. In this case report, it was aimed to discuss the differential diagnosis and treatment methods of methemoglobinemia after local anesthesia with prilocaine.

Giriş: Sünnet, pek çok toplum tarafından dini, tıbbi ve de kültürel amaçlarla yapılan cerrahi işlemdir. Bu işlem esnasında kullanılan ajanlardan birisi olan prilokain sık kullanılan bir lokal anestezik ilaçtır. Literatürde normal dozda prilokainin uygulaması ile gelişebilen methemoglobinemi vakaları bildirilmiştir. Hemoglobinin çeşitli oksidatif streslerle oksitlenmesi sonucu, içeriğindeki iki değerli demirin, üç değerli haline dönüşmesine methemoglobinemi denir. Bu reaksiyon, dokuda hipoksemiye yol açar ve değişen derecelerde siyanozla kendini gösteren klinik tablo oluşur.

Olgu Sunumu: İki buçuk aylık olgu, prilokain ile lokal anestezi uygulaması sonrası ortaya çıkan morarma şikayeti ve ölçülen oksijen satürasyonu %79 olması nedeniyle hastanemize doktor tarafından sevki yapıldı. Geliş fizik muayenesinde peroral bölgede, el ve ayaklarda siyanozu vardı. Hastaya lokal anestezik olarak prilokain verildiğinin öğrenilmesi, altta yatan solunumsal ve kardiyak bir nedenin bulunamaması ve kan gazında methemoglobin değerinin yüksekliği nedeniyle, ilaca bağlı methemoglobinemi düşünülerek metilen mavisi verilmesine karar verildi. Metilen mavisi 2 mg/kg oral verildi. Yaklaşık bir saat sonra siyanoz kayboldu. Kontrol methemoglobin düzeyi %2,7 olarak saptandı.

Sonuç: Lokal anestezik uygulaması sonrası gelişen siyanozun ayırıcı tanısında methemoglobinemi mutlaka düşünülmeli ve erken süt çocukluğu döneminde yan etkileri daha az olan lokal anestezikler tercih edilmelidir. Bu olgu sunumunda prilokain ile lokal anestezi uygulaması sonrası ortaya çıkan methemoglobinemide ayırıcı tanı ve tedavi yöntemlerinin tartışılması amaçlandı.

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Details

Primary Language en
Subjects Health Care Sciences and Services
Published Date Apr 2018
Journal Section Case Report
Authors

Orcid: 0000-0002-5938-2619
Author: Gulsen YALCİN (Primary Author)
Institution: Duzce University, School of Medicine, Department of Pediatric Emergency, Duzce
Country: Turkey

Orcid: 0000-0002-9311-006X
Author: Onder KİLİCASLAN
Institution: Duzce University, School of Medicine, Department of Pediatrics, Duzce
Country: Turkey

Orcid: 0000-0003-0214-4203
Author: Aybars OZKAN
Institution: Duzce University, School of Medicine, Department of Pediatric Surgery, Duzce

Orcid: 0000-0002-4030-1145
Author: Kenan KOCABAY
Institution: Duzce University, School of Medicine, Department of Pediatrics, Duzce
Country: Turkey
Dates

Application Date : August 25, 2017
Acceptance Date : November 16, 2017
Publication Date : April 12, 2018

Cite

Bibtex @case report { fppc336135, journal = {Family Practice and Palliative Care}, issn = {2458-8865}, eissn = {2459-1505}, address = {}, publisher = {SERNEV}, year = {2018}, volume = {3}, pages = {69 - 71}, doi = {10.22391/fppc.336135}, title = {Methemoglobinemia after local anesthetic (prilocaine) application: a case report}, key = {cite}, author = {Yalci̇n, Gulsen and Ki̇li̇caslan, Onder and Ozkan, Aybars and Kocabay, Kenan} }
APA Yalci̇n, G , Ki̇li̇caslan, O , Ozkan, A , Kocabay, K . (2018). Methemoglobinemia after local anesthetic (prilocaine) application: a case report . Family Practice and Palliative Care , 3 (1) , 69-71 . DOI: 10.22391/fppc.336135
MLA Yalci̇n, G , Ki̇li̇caslan, O , Ozkan, A , Kocabay, K . "Methemoglobinemia after local anesthetic (prilocaine) application: a case report" . Family Practice and Palliative Care 3 (2018 ): 69-71 <http://www.fppc.com.tr/en/pub/issue/36461/336135>
Chicago Yalci̇n, G , Ki̇li̇caslan, O , Ozkan, A , Kocabay, K . "Methemoglobinemia after local anesthetic (prilocaine) application: a case report". Family Practice and Palliative Care 3 (2018 ): 69-71
RIS TY - JOUR T1 - Methemoglobinemia after local anesthetic (prilocaine) application: a case report AU - Gulsen Yalci̇n , Onder Ki̇li̇caslan , Aybars Ozkan , Kenan Kocabay Y1 - 2018 PY - 2018 N1 - doi: 10.22391/fppc.336135 DO - 10.22391/fppc.336135 T2 - Family Practice and Palliative Care JF - Journal JO - JOR SP - 69 EP - 71 VL - 3 IS - 1 SN - 2458-8865-2459-1505 M3 - doi: 10.22391/fppc.336135 UR - https://doi.org/10.22391/fppc.336135 Y2 - 2017 ER -
EndNote %0 Family Practice and Palliative Care Methemoglobinemia after local anesthetic (prilocaine) application: a case report %A Gulsen Yalci̇n , Onder Ki̇li̇caslan , Aybars Ozkan , Kenan Kocabay %T Methemoglobinemia after local anesthetic (prilocaine) application: a case report %D 2018 %J Family Practice and Palliative Care %P 2458-8865-2459-1505 %V 3 %N 1 %R doi: 10.22391/fppc.336135 %U 10.22391/fppc.336135
ISNAD Yalci̇n, Gulsen , Ki̇li̇caslan, Onder , Ozkan, Aybars , Kocabay, Kenan . "Methemoglobinemia after local anesthetic (prilocaine) application: a case report". Family Practice and Palliative Care 3 / 1 (April 2018): 69-71 . https://doi.org/10.22391/fppc.336135
AMA Yalci̇n G , Ki̇li̇caslan O , Ozkan A , Kocabay K . Methemoglobinemia after local anesthetic (prilocaine) application: a case report. Fam Pract Palliat Care. 2018; 3(1): 69-71.
Vancouver Yalci̇n G , Ki̇li̇caslan O , Ozkan A , Kocabay K . Methemoglobinemia after local anesthetic (prilocaine) application: a case report. Family Practice and Palliative Care. 2018; 3(1): 69-71.
IEEE G. Yalci̇n , O. Ki̇li̇caslan , A. Ozkan and K. Kocabay , "Methemoglobinemia after local anesthetic (prilocaine) application: a case report", Family Practice and Palliative Care, vol. 3, no. 1, pp. 69-71, Apr. 2018, doi:10.22391/fppc.336135
Authors of the Article
Gulsen YALCİN [1]
Onder KİLİCASLAN [2]
Aybars OZKAN [3]
Kenan KOCABAY [4]
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