Methemoglobinemia induced by lidocaine-prilocaine cream

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 "s...

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Bibliographic Details
Published in:The Israel Medical Association journal 2014-04, Vol.16 (4), p.250-254
Main Authors: Shamriz, Oded, Cohen-Glickman, Inbal, Reif, Shimon, Shteyer, Eyal
Format: Article
Language:English
Subjects:
Anesthetics, Combined - administration & dosage
Anesthetics, Combined - adverse effects
Anesthetics, Local - administration & dosage
Anesthetics, Local - adverse effects
Child
Cyanosis - etiology
Enzyme Inhibitors - therapeutic use
Female
Humans
Lidocaine - administration & dosage
Lidocaine - adverse effects
Methemoglobinemia - chemically induced
Methemoglobinemia - diagnosis
Methemoglobinemia - drug therapy
Methylene Blue - therapeutic use
Oximetry
Oxygen - administration & dosage
Prilocaine - administration & dosage
Prilocaine - adverse effects
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Summary: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.
ISSN:1565-1088