Investigation of methemoglobinemia incidence among children undergoing circumcision using prilocaine.

Introduction: Methemoglobinemia is a clinical entity characterized by substitution of ferrous iron (Fe++) in the hemoglobin structure by ferric iron that lacks oxygen carrying capacity. Acquired methemoglobinemia may occur due to oxidant substances and drugs, of which local anesthetics constitute an important group. In this study the incidence of prilocaine-induced methemoglobinemia was studied. Materials and Method: This study was performed on children who presented to the urology department for circumcision. Methemoglobin levels were measured prior to and after prilocaine injection. Results: The study enrolled 74 children aged 6 months to 12 years. Of the cases, 19.7% were found to have methemoglobinemia but none had symptoms. Mean preoperative and postoperative incidences of methemoglobinemia were 0.71% and 1.80%, respectively. Methemoglobin level was reduced as age of the patient increased. Conclusion: The risk of methemoglobinemia should be considered with local anesthetic agents widely used in clinical practice, particularly in small age groups. Giris: Methemoglobinemi, hemoglobindeki  ferroz demirin (Fe++) yerini oksijen tasima kapasitesi olmayan ferrik demirin (Fe+3) almasi ile karakterize bir klinik durumdur. Edinsel methemoglobinemi, oksidan maddeler ve ilaclara bagli olarak ortaya cikabilirken, lokal anestezikler ilaclar arasinda onemli bir grubu olusturur. Bu calismada prilokaine bagli methemoglobinemi sikligi arastirilmistir.  Materyal Metod: Calisma 2013 yilinda uroloji poliklinigine sunnet amaciyla basvuran cocuklar arasinda yapildi. Prilokain oncesi ve sonrasi methemoglobin duzeyleri arastirildi.  Bulgular: Calismaya yaslari 6 ay ile 12 yas arasinda degisen 74 cocuk dahil edildi. Olgularin %19.7’sinde methemoglobinemi saptanirken semptomatik olan olgu saptanmadi. Methemoglobinemi ortalamasi preoperatif %0.71, postoperatif  %1.80 olarak saptandi. Yasin artisina parelel olarak methemoglobin duzeyinin azaldigi gozlendi. Sonuclar: Gunluk pratikte siklikla kullanilan lokal anesteziklerin kullanimi ile ozellikle kucuk yas grubunda methemoglobinemi riski goz onunde bulundurulmalidir.