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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

DOI: 10.2344/anpr-69-02-01

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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A Prospective, Randomized, Double-Blind Comparison of 2% Lidocaine With 1 : 100,000 Epinephrine, 4% Prilocaine With 1 : 200,000 Epinephrine, and 4% Prilocaine for Maxillary Infiltrations

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

DOI: 10.2344/0003-3006-57.2.45

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

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Methemoglobin Levels in Generally Anesthetized Pediatric Dental Patients Receiving Prilocaine Versus Lidocaine

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

DOI: 10.2344/0003-3006-60.3.99

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

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Effect of Lidocaine- and Prilocaine-Based Topical Anesthetics on the Inflammatory Exudates in Subcutaneous Tissue of Rats

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

DOI: 10.2344/11-23.1

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

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A Case of Methemoglobinemia Thought to Have Been Caused by the Combined Use of Propitocaine and Nitroglycerin During General Anesthesia

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

DOI: 10.2344/anpr-67-03-06

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

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Comparing the Efficacy of a Compound Topical Anesthetic Versus Benzocaine: A Pilot Study

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

DOI: 10.2344/anpr-66-03-05

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

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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

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.

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)

Daniel E Becker and

Kenneth L Reed

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)