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Methemoglobinemia Induced by Prilocaine in a Child With Noonan Syndrome
Saori TakagiDDS, PhD,
Shinnosuke AndoDDS,
Ryoko KonoDDS,
Yuka OonoDDS, PhD,
Hiroshi NagasakaMD, PhD, and
Hikaru KohaseDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 69: Issue 3
Online Publication Date: Oct 06, 2022
Page Range: 25 – 29

INTRODUCTION Methemoglobin (MetHb) is an oxidized form of hemoglobin (Hb) in which heme iron configuration is in the ferric state (Fe 3+ ) instead of the ferrous state (Fe 2+ ). MetHb normally constitutes approximately 1% of all Hb. Several symptoms develop as the level of MetHb increases. Methemoglobinemia may be caused by a variety of substances that exert oxidative effects, such as nitrogen oxides, acetaminophen, and local anesthetics, most commonly prilocaine and benzocaine. 1 , 2 In Japan, there have been 3 case reports of

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Steven KatzDDS, MS,
Melissa DrumDDS, MS,
Al ReaderDDS, MS,
John NussteinDDS, MS, and
Mike BeckDDS, MA
Article Category: Research Article
Volume/Issue: Volume 57: Issue 2
Online Publication Date: Jan 01, 2010
Page Range: 45 – 51

Maxillary infiltration anesthesia is a common method of anesthetizing maxillary teeth. Previous studies 1 – 18 have evaluated the success of maxillary infiltrations using the electric pulp tester. With a volume of ≤1.8 mL and various anesthetic formulations, pulpal anesthetic success (ie, obtaining maximum output with an electric pulp tester) ranged from 62–100%. Four percent prilocaine with 1 : 200,000 epinephrine has been found to be equivalent to 2% lidocaine with 1 : 100,000 epinephrine for inferior alveolar nerve blocks. 19

Lauren L. GutenbergDDS, MSD,
Jung-Wei ChenDDS, MS, PhD, and
Larry TrappDDS, MS
Article Category: Other
Volume/Issue: Volume 60: Issue 3
Online Publication Date: Jan 01, 2013
Page Range: 99 – 108

treatment to be performed. 2 As with every medication, each local anesthetic has unique pharmacological properties and specific benefits and risks when selected for use in dental treatment. 3 An important risk with some injectable local anesthetics is the formation of methemoglobin. 4 , 5 There are currently 5 injectable local anesthetics prepared for and marketed to the dental profession: articaine, bupivacaine, lidocaine, mepivacaine, and prilocaine. 2 , 3 , 6 , 7 Lidocaine is the prototypical amide local anesthetic agent and remains the most commonly used

Márcia Thaís PochapskiDDS, PhD,
José Laufer NetoDDS, MSc,
Jocélia Lago JassenDDS, MSc, PhD,
Paulo Vitor FaragoDDS, MSc, PhD, and
Fábio André SantosDDS, MSc, PhD
Article Category: Research Article
Volume/Issue: Volume 59: Issue 2
Online Publication Date: Jan 01, 2012
Page Range: 57 – 61

combination of 2.5% lidocaine and 2.5% prilocaine in a eutectic mixture have been used to provide pain control in conjunction with periodontal scaling/root planing, following local application into the periodontal pockets. 1 , 5 EMLA cream 5% is a 1 ∶ 1 oil/water emulsion of a eutectic mixture of lidocaine (2.5%) and prilocaine (2.5%) bases. The eutectic mixture has a lower melting point (17°C) compared with the respective individual melting points of the lidocaine base (66–69°C) and the prilocaine base (36–38°C). This physical property allows the lidocaine/prilocaine

Takayuki HojoDDS, PhD,
Yukifumi KimuraDDS, PhD,
Daisuke OhiwaDDS, and
Toshiaki FujisawaDDS, PhD
Article Category: Brief Report
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
Page Range: 170 – 171

Acquired methemoglobinemia can occur following exposure to oxidizing agents including high doses of certain local anesthetics. 1 Many studies have investigated the dose at which each causative drug causes methemoglobinemia. However, few studies have reported methemoglobinemia being caused by the combined use of causative drugs or agents. 2 This is a report of a methemoglobinemia case presumably caused by the combined use of prilocaine (propitocaine in Japan) and nitroglycerin (NTG) during general anesthesia. CASE REPORT

Lydia ParkDDS,
James TomDDS,
Nicole BuiDDS,
Melissa WilsonPhD, and
Thomas TanbonliongDDS
Article Category: Research Article
Volume/Issue: Volume 67: Issue 1
Online Publication Date: Jan 01, 2020
Page Range: 9 – 15

orthodontic mini-implant placement. 10 – 12 Therefore, more research of the use of CTA as an adjunct to intraoral local anesthetic injections is warranted. The aim of this study was to evaluate the efficacy of a CTA using 10% lidocaine, 10% prilocaine, and 4% tetracaine, which has been trademarked as Profound ® , in comparison with 20% benzocaine. 13 METHODS The hypothesis for this pilot study was that use of a CTA comprising 10% lidocaine, 10% prilocaine, and 4% tetracaine would be more effective than a topical anesthetic with 20% benzocaine

Figure 1. ; Managing history of local anesthetic allergy. Carefully question the patient regarding the nature of the reaction. If allergist referral is elected, discuss the case history with the physician and request testing for plain lidocaine, which the allergist has available, along with plain prilocaine or mepivacaine, which you will need to provide. (Epinephrine cannot be included, as it inhibits autacoids and renders any testing invalid.) Also address the possibility of bisulfite allergy.
Daniel E. Becker
<bold>Figure 1.</bold>
Figure 1.

Managing history of local anesthetic allergy. Carefully question the patient regarding the nature of the reaction. If allergist referral is elected, discuss the case history with the physician and request testing for plain lidocaine, which the allergist has available, along with plain prilocaine or mepivacaine, which you will need to provide. (Epinephrine cannot be included, as it inhibits autacoids and renders any testing invalid.) Also address the possibility of bisulfite allergy.


Daniel E Becker and
Kenneth L Reed
Figure 6.
Figure 6.

Managing patients allergic to local anesthetics. Rule out common reactions misinterpreted as allergy, eg, syncope and tachycardia. Then establish that the nature of their reaction at least resembled a hypersensitivity reaction, eg, rash, pruritus, urticaria, or dyspnea. If the drug is known, choose another amide, free of vasopressor so no sulfites are present. Otherwise refer the patient to an allergist, for testing of sulfites and exemplary local anesthetics such as lidocaine, mepivacaine, and prilocaine. (Adapted from deShazo and Kemp.13)


Saori Takagi,
Shinnosuke Ando,
Ryoko Kono,
Yuka Oono,
Hiroshi Nagasaka, and
Hikaru Kohase

Lauren L. Gutenberg,
Jung-Wei Chen, and
Larry Trapp
<bold>Figure 1. </bold>
Figure 1. 

Masimo Radical-7 pediatric, nondisposable, pulse co-oximeter sensor.