Severe methemoglobinemia after dental anesthesia: a warning about propitocaine-induced methemoglobinemia in neonates

Abstract

Methemoglobinemia is a fatal complication of local anesthesia. We describe a case report of female neonate who developed severe methemoglobinemia after extraction of neonatal teeth conducted with general anesthesia plus local injection of Citanest-Octapressin(®) (propitocaine of approximately 10 mg/kg). Central cyanosis appeared within an hour after surgery. The percentage of methemoglobin reached up to 43.9%. Not only pediatric dentists but also anesthesiologists generally agree with the idea that local anesthesia provides various benefits in painful procedures in neonates. However, this case may serve as a warning when using Citanest-Octapressin(®), which is still commercially available for neonatal patients.

Comparative Assessment of the Effects of Three Local Anesthetics: Lidocaine, Prilocaine, and Mepivacaine on Blood Pressure Changes in Patients with Controlled Hypertension

“…Although felypressin has not systemic effects of epinephrine; it has some cardiovascular effects (Bronzo, Cardoso, Ortega, & Mion, 2012). Prilocaine has also been found to have a number of side effects including methemoglobinemia (Doko et al, 2010). Another alternative is mepivacaine, which has not a vasoconstrictor and thus has shorter anesthetic effects probably (Barberich et al, 2009;Ding et al, 2012).…”

“…8, No. 10;2016 not pursue it due to the patients' lack of cooperation, which may comprise one of the limitations of the study and is recommended to be further examined in future studies.…”

“…Currently, the prilocaine-felypressin combination and mepivacaine are used as alternatives to lidocaine with epinephrine. However prilocaine has potential to cause methemoglobinemia and increase the risk of paresthesia (Doko et al, 2010). Mepivacaine, on the other hand is a short acting anesthetic, although there are controversy.…”

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations

“…[8][9][10][12][13][14][15][16][17][18][19][20][21][22]24,25,[27][28][29][31][32][33][34][36][37][38][40][41][42][43][51][52][53][54][55][56][57][58]60,61 Twelve percent of the cases developed in an office, 30,39,45,46,[48][49][50] whereas another 4% occurred in other locations, including the patient's home. Finally, 15% of the authors did not specify the hospital setting where the LA was administered.…”

“…8,16,23,27,32,35,37,49 With regard to local field anesthesia, lidocaine was used in nearly 80% of the cases, occasionally combined with other LAs. Articaine, 49 propitocaine, 20 and bupivacaine 38 were used alone in 1 case each.…”