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Scott Mandel, MD
The Doernbecher Memorial Hospital for Children Oregon Health Sciences University Portland

JAMA. 1989;261(5):702.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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 . . . [Full Text PDF of this Article]

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