Mehmet TEKİN, Zalal KAHRAMANER, Mehmet ÇOBAN, Yeliz MAHANOĞLU, Mehmet TURGUT, Çapan KONCA

Prilokain Kullanımı Sonrası Gelişen Edinsel Methemoglobinemi

Özet Prilokain, pek çok alanda kullanılan lokal anestetik bir ajandır, ancak hayatı tehdit edebilen bir yan etki olan methemoglobinemiye neden olabilmektedir. Methemoglobinin O2 taşıma kapasitesi düşüktür ve doku düzeyinde hipoksiye neden olabilir. Sünnet operasyonundan iki saat sonra ağız bölgesinde, ellerinde ve ayak parmaklarında morarma yakınması ile acil servise başvuran 54 günlük bebeğin fizik muayenesinde mevcut durumu açıklayacak patoloji saptanmadı. Oksijen tedavisine yanıtsız olan hasta yoğun bakım ünitesine alındı. Sünnet işlemi öncesi 2 mg/kg prilokain yapıldığı öğrenilen, oksijen tedavisine rağmen satürasyon değerleri düşük seyreden ve kan gazı incelemesinde methemoglobin düzeyi %24,7 saptanan hastaya methemoglobinemi tanısı konuldu. Hastaya 300 mg/kg/doz askorbik asit başlandı ve 24 saatlik izlem sonrası şifa ile taburcu edildi. Cerrahi girişim sonrasında siyanoz gelişen ve SaO2 ile pO2 değerleri arasında uyumsuzluk saptanan hastalarda methemoglobinemi düşünülmeli ve gelişebilecek problemler açısından tam donanımlı çocuk yoğun bakım ünitelerinde izlenmelidirler. (Güncel Pediatri 2014;1:55-8)

Methemoglobinemi Acquired Methemoglobinemia After Application of Prilocaine

Abstract Prilocaine is a local anesthetic agent and is widely used in most of ambulatory procedures, but it can cause methemoglobinemia which is a life-threatening condition. Methemoglobinemia may cause hypoxia of tissue because methemoglobin has less oxygen carrying capability than hemoglobin. A 54-day- old boy who developed cyanosis around his mouth, on his hands and toes two hours after the circumcision operation was admitted to the emergency department. No abnormality was established on his physical examination except for cyanosis. Cyanosis did not improve with oxygen administration and the patient was admitted to intensive care unit. His history revealed that prilocaine hydrochloride (2 mg/ kg) was administered subcutaneously as local anesthesia prior to circumcision operation. Diagnosis of methemoglobinemia was established in the patient in whom saturation levels were low in spite of the oxygen therapy and in whom methemoglobinemia level was 24.7%. His cyanosis completely disappeared after administration of intravenous ascorbic acid (300 mg/kg/dose) and he was discharged after a 24-hour follow-up period with recovery. Methemoglobinemia should be considered in cases with cyanosis and inconsistency between oxygen saturation and partial arterial oxygen pressure. These cases should be monitored in pediatric intensive care units for lethal complications. (The Journal of Current Pediatrics 2014;1:55-8)

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