Abstract
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.
MeSH terms
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Anesthetics, Combined / administration & dosage
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Anesthetics, Combined / adverse effects
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Anesthetics, Local / administration & dosage
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Anesthetics, Local / adverse effects*
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Child
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Cyanosis / etiology
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Enzyme Inhibitors / therapeutic use
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Female
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Humans
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Lidocaine / administration & dosage
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Lidocaine / adverse effects*
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Lidocaine, Prilocaine Drug Combination
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Methemoglobinemia / chemically induced*
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Methemoglobinemia / diagnosis
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Methemoglobinemia / drug therapy
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Methylene Blue / therapeutic use
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Oximetry
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Oxygen / administration & dosage
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Prilocaine / administration & dosage
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Prilocaine / adverse effects*
Substances
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Anesthetics, Combined
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Anesthetics, Local
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Enzyme Inhibitors
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Lidocaine, Prilocaine Drug Combination
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Prilocaine
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Lidocaine
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Oxygen
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Methylene Blue