Risk factors for prilocaine-induced methaemoglobinaemia following peripheral regional anaesthesia

Vasters, F. G.; Eberhart, Leopold; Koch, T.; Kranke, Peter; Wulf, Hinnerk; Morin, A. M.

doi:10.1017/s0265021506000913

Cited by 44 publications

(37 citation statements)

References 19 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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“…Repeated doses were not necessary. Mean recovery time was 10.2±3.5 [4][5][6][7][8][9][10][11][12][13][14][15][16] hours. The plasma G6PD levels were normal in all neonates.…”

Section: Resultsmentioning

confidence: 99%

“…Prilocaine is widely used in children and adults as a local anesthetic agent, and its metabolite o-toluidine can cause methemoglobinemia. The dose of prilocaine and the age of the infant are the most important predictive factors for higher MetHb formation [7]. Infants are more vulnerable to methemoglobinemia because they have higher gastric pH than that in older children, and this causes greater bacterial proliferation of the intestinal flora that can convert the ingested nitrate to nitrite [6].…”

Section: Mutlu Et Al Acquired Methemoglobinemia In Infantsmentioning

confidence: 99%

Acquired methemoglobinemia in infants

Mutlu¹,

Erduran²,

Aslan³

2011

Turk J Hematol

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Objective: This study aimed to determine the etiologic factors of acquired methemoglobinemia in infants younger than three months in our region. Material and Methods: This study was carried out retrospectively in infants with methemoglobinemia admitted to Karadeniz Technical University, Pediatric Clinic, during the period 2000-2009. Infants with methemoglobinemia were identified according to the medical records or ICD-10 code. Results: Nine infants with acquired methemoglobinemia (8 male, 1 female) were included in the study. Seven cases were associated with the use of prilocaine for circumcision, one case with the use of prilocainelidocaine for local pain therapy, and one case with neonatal sepsis caused by Staphylococcus aureus. Conclusion: Prilocaine should not be used in infants less than three months of age because of the risk of methemoglobinemia. Ascorbic acid is an effective therapy if methylene blue is not obtained. It should not be forgotten that sepsis caused by S. aureus may cause methemoglobinemia in infants. (Turk J Hematol 2011; 28: 131-4) Key words: Methemoglobinemia, infant, local anesthetics, sepsis

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“…However, there has been little research conducted on methemoglobin formation associated with the administration of injectable local anesthetics for dental treatment. [13][14][15] Based on the widespread use of local anesthetics in dentistry and their ability to potentially cause methemoglobinemia, dental practitioners need more information on the disorder and its toxic manifestations. It is particularly important that dental clinicians treating pediatric dental patients use dosing guidelines that preclude clinical toxicity.…”

mentioning

confidence: 99%

“…5,8,[13][14][15] In the human body, prilocaine is metabolized into o-toluidine and nitrosotoluidine, both of which are responsible for the oxidation of hemoglobin to methemoglobin. 4 According to a retrospective study by Guay,5 prilocaine was associated with 68 out of 242 (28%) of the literature's documented episodes of acquired methemoglobinemia.…”

mentioning

confidence: 99%

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

Gutenberg

Chen

Trapp

2013

Anesthesia Progress

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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.

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Risk factors for prilocaine-induced methaemoglobinaemia following peripheral regional anaesthesia

Cited by 44 publications

References 19 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

Acquired methemoglobinemia in infants

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

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