Emergency Medicine: Open Access
Open Access

Abstract

Post-frenotomy Methemoglobinemia Associated with Mepivacaine Use in a 3 Day Old

Jahn T Avarello, Amit Gupta and Robert A Silverman

Background: With the increased numbers of babies breast-feeding over the last 10 years, there has been a higher incidence of frenotomies performed to increase the success of breast feeding. Frenotomies are often performed after administering topical or local injections of anesthetic agents.

Objective: To report a case of methemoglobinemia after a procedure that has become more prevalent in the neonatal age group.

Case report: We report a 3 day old male who presented with methemoglobinemia shortly after the amide anesthetic mepivacaine was used in performing a frenotomy. The infant had classic signs of methemoglobinemia and treatment was successfully administered with favourable outcomes.

Summary: Neonates have lower amounts and activity of NADH-cytochrome b5 reductase (methemoglobin reductase) therefore putting them at more risk for methemoglobinemia when exposed to oxidizing chemicals such as topical or injectable anesthetics. After the use of local anesthetics for a minor procedure, clinicians should be aware of the risks for developing methemoglobinemia in this age group.