psd-502 and Cyanosis

With growing awareness of the importance of pain control in all procedures, the use of lidocaine-prilocaine cream (EMLA) for all ages is increasing. Lidocaine-prilocaine cream has been implicated as a cause of methemoglobinemia. Diagnostic clues may be oxygen-resistant cyanosis and an oxygen "saturation gap" between arterial blood saturation and pulse oximetry. Treatment with intravenous methylene blue is often effective. Since EMLA is often mistakenly considered risk-free it is routinely applied by medical staff in the emergency room. Subsequent to the case of EMLA-induced methemoglobinemia in an 8 year old girl we wish to alert the medical community to this phenomenon, and in this work review the relevant literature.

Topics: Anesthetics, Combined; Anesthetics, Local; Child; Cyanosis; Enzyme Inhibitors; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Methylene Blue; Oximetry; Oxygen; Prilocaine

The case of an infant who had received EMLA(R) for local pain therapy after scalding to 5% of the body surface with boiling water is reported. Due to the application of EMLA(R) on the injured skin and exceeding the recommended doses of prilocaine and lidocaine the child developed symptomatic methemoglobinemia. During surgical wound dressing the boy showed cyanosis, decreased peripheral oxygen saturation and potentially suffered a general seizure. With a symptomatic therapy including mechanical ventilation and anticonvulsive drugs the methemoglobinemia normalized within 9 h. The child recovered without any neurological impairment after wound treatment was completed.

Topics: Administration, Topical; Anesthetics, Local; Bandages; Burns; Cyanosis; Diagnosis, Differential; Humans; Iatrogenic Disease; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Methemoglobinemia; Ointments; Oxygen; Prilocaine; Respiration, Artificial; Tolonium Chloride