Methemoglobinemia presenting in a circumcised baby following application of prilocaine: a case report

Abstract (provisional)

Introduction

Local anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is rare but potentially lethal complication of local anesthetics.

Case presentation

We report a case of a 40 day old boy who presented with cyanosis after receiving local anesthesia with prilocaine. Methemoglobin level revealed severe methemoglobinemi (methemoglobin=44%). His cyanosis resolved after intravenous administration of methylene blue.

Conclusion

Even though the association between prilocaine use and methemoglobinemia has generally restricted prilocaine use in infants, it is still widely used in ambulatory procedures, expecially during circumcision in the neonatal period. Prilocaine should not be used in infants less than 3 months of age because the risk of methemoglobinemia and alternative local anesthetics may be considered among this age group. Furthermore general anesthesia by mask ventilation may be favored for infants less than 3 months of age instead of local anesthetics.