Toxic methaemoglobin concentrations in premature infants after application of a prilocaine-containing cream and peridural prilocaine

Frey, Bernhard; Kehrer, B.

doi:10.1007/s004310051204

Cited by 48 publications

(23 citation statements)

References 9 publications

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“…94 There is a risk of methemoglobinemia after use of topical lidocaine-prilocaine cream in certain situations. 95,96 The risks can be minimized if used no more than once daily, on intact skin only, and not with other drugs known to cause methemoglobinemia. 97,98 Prolonged Mechanical Ventilation Many preterm neonates receiving intensive care undergo prolonged mechanical ventilation, and its use defines a population of patients experiencing numerous minor painful procedures as described previously.…”

Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

420

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

420

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“…CitanestOctapressin Ò contains propitocaine (relates to prilocaine) as an anesthetic and felypressin as a vasopressor. Case reports indicate that local injection of prilocaine as well as application of lidocaine-prilocaine cream (EMLA) has the possibility of causing methemoglobinemia in infants, especially in neonates [3][4][5][6][7]. According to the literature review regarding prilocaine-induced methemoglobinemia in dental surgeries, cyanosis appeared a couple of hours after local injection of prilocaine (approximately 8-10 mg/kg), and the percentages of methemoglobin ranged between 10% and 38% [3].…”

Section: Discussionmentioning

confidence: 96%

“…EMLA has been suggested to ameliorate procedural pain, such as central venous catheterization, circumcision, and heel lance [14,15]. On the other hand, an overdose with EMLA has been reported to cause methemoglobinemia in neonates [4,5,7].…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2010

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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.

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“…Consequently, drug absorption may be altered [33,34]. Another important clinical limitation of using EMLA with children is that prilocaine toxicity results in methemoglobinemia [35,36]. For these reasons, it is preferable to avoid the use of EMLA for LMWH administration.…”

Section: How To Improve Compliancementioning

confidence: 97%

A Practical Approach to the Use of Low Molecular Weight Heparins in VTE Treatment and Prophylaxis in Children and Newborns

Molinari

Banov

Bertamino

et al. 2014

Pediatric Hematology and Oncology

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Low-molecular weight heparins are currently the most commonly used anticoagulants in children and newborns. However, since thrombotic complications rarely occur outside large children's hospitals, physicians often encounter some practical problems in managing these treatments when a pediatric thrombosis specialist is not available. The drug of choice is enoxaparin, due to its favorable FXa/FIIa ratio and the availability of pharmacokinetic and pharmacodynamic data. The treatment of acute thrombosis should be started with two daily injections but when compliance is an issue, a single daily administration schedule could be chosen for secondary prophylaxis ensuring careful measurement of the post 24-hour anti-FXa activity. Furthermore, a subcutaneous device may be a useful tool and a topical dermal anesthetic could be effective in controlling pain without affecting anti-FXa levels. In neonate and toddlers, where mini doses are frequently needed, the dead space of syringes and needles could represent an issue and therefore the use of insulin syringes without dead space is advisable, while a dilution of the drug is useful with other syringes. This article derives from a nonsystematic review of the available literature, with special attention to recent international guidelines and expert recommendations, combined to authors' clinical practice in large tertiary pediatric hospitals and will provide concise and practical information for the use of low-molecular weight heparin in childhood and infancy in a sort of "answering frequently asked questions."

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Toxic methaemoglobin concentrations in premature infants after application of a prilocaine-containing cream and peridural prilocaine

Abstract: Whereas local skin application of prilocaine to premature babies is safe, peridural administration is not because premature infants are more sensitive to methaemoglobin inducing agents and tolerate methaemoglobinaemia less well.

Cited by 48 publications

References 9 publications

Prevention and Management of Pain in the Neonate: An Update

Prevention and Management of Pain in the Neonate: An Update

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

A Practical Approach to the Use of Low Molecular Weight Heparins in VTE Treatment and Prophylaxis in Children and Newborns

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