Methemoglobinemia Following Neonatal Circumcision

Scott Mandel, MD
JAMA. 1989;261(5):702. doi:10.1001/jama.1989.03420050050036.
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To the Editor.—  Stang et al1 reported on the use of local lidocaine anesthesia for neonatal circumcision and found no significant complications after several hundred procedures. I recently encountered an infant who suffered from methemoglobinemia following circumcision using local prilocaine anesthesia.

Report of a Case. —  A healthy 11-day-old was circumcised with a dorsal penile nerve block using 0.2 mL of 4% prilocaine. Two hours later, when the baby was awakened from a nap, he was noted to be gray. He was admitted to the hospital, where results of physical examination were normal except for cyanosis and tachypnea. His arterial oxygen partial pressure (fraction of inspired oxygen, 70%) was 273 mm Hg. However, oxygen saturations (by pulse oximeter) were only 80% to 85%. The blood was noted to be dark and did not change color on exposure to air. After 12 hours of observation and oxygen support, oxygen saturations


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