Penil Blok Sonrası Lokal Anestezi Toksisitesi
Özet
Sağlıklı 4 aylık 6 kg ağırlığında erkek bebek elektif sünnet için operasyona alındı. 120 mg %0.2 prilokain ile penil blok sonrası operasyon sorunsuz tamamlanarak ve hastanın vital bulgularının stabil olduğu gözlemlenerek hasta servise gönderildi. Anestezi operasyona dahil olmadı. Bir saat sonra siyanoz ve hipoksi gelişen hastada methemoglobinemi düşünüldü. Oksijen uygulaması başlandı. Hastaya askorbik asit verildi. Semptomları gerilemediği için metilen mavisi (1 mL kg-1 doz-1 %1'lik solüsyon) temin edilerek uygulandı. Kan gazında methemoglobin (MetHb) konsantrasyonu %0.3’e düşerek normale döndü, sekelsiz klinik düzelme gözlendi. Postoperatif 2. gün taburcu edildi. Rejyonel anestezinin kullanımı bebeklerde postoperatif analjezi amacı ile ya da tek başına genel anesteziye alternatif olarak kullanımı artmaktadır. Organ gelişimi tamamlanmadığı için 3 yaş altında lokal anestezi toksisitesi daha sık görülmektedir. Methemoglobinemi, prilokain kullanımın doza bağlı nadir bir komplikasyonudur. Sonuç olarak, infantlarda sünnet için lokal prilokain kullanımı sonrasında ciddi methemoglobinemi görülebilmektedir. Bu hasta grubunda lokal anestezinin güvenliğinin sağlanması için hastanın kilogramı yaşı mutlaka göz önünde bulundurulmalıdır.
A healthy 4-month-old male infant weighing 6 kg was taken to surgery for elective circumcision. Following a penile block with 120 mg of 0.2% prilocaine, the operation was completed without any complications, and the patient was transferred to the ward after confirming that his vital signs were stable. The anesthesia team was not involved in the operation. One hour later, the patient developed cyanosis and hypoxia, and methemoglobinemia was suspected. Oxygen administration was initiated. Ascorbic acid was administered to the patient. Since his symptoms did not regress, methylene blue (1% solution at a dose of 1 mL kg⁻¹) was procured and administered. The methemoglobin (MetHb) concentration in the blood gas decreased to 0.3%, returning to normal, and clinical improvement without sequelae was observed. The patient was discharged on the 2nd postoperative day. The use of regional anesthesia in infants is increasing for postoperative analgesia or as an alternative to general anesthesia alone. Since organ development is incomplete, local anesthesia toxicity is more frequently observed in children under 3 years of age. Methemoglobinemia is a rare, dose-dependent complication of prilocaine use. In conclusion, severe methemoglobinemia can be seen following the use of local prilocaine for circumcision in infants. To ensure the safety of local anesthesia in this patient group, the weight and age of the patient must be strictly taken into consideration.
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