# Prilocaine-Induced Methemoglobinemia During Surgically Assisted Rapid Palatal Expansion (SARPE) Under General Anesthesia: A Case Report

## TL;DR

A patient developed methemoglobinemia after receiving prilocaine during surgery, requiring oxygen treatment and highlighting the need for careful monitoring.

## Contribution

This case report highlights prilocaine-induced methemoglobinemia during surgery under general anesthesia and its management.

## Key findings

- Methemoglobinemia occurred after administering 3% prilocaine with feripressin during orthognathic surgery.
- Oxygen administration improved the patient's oxygen saturation and condition over time.
- Monitoring SpO2 levels is crucial for diagnosing and managing methemoglobinemia.

## Abstract

Methemoglobinemia is a condition in which methemoglobin levels in the blood increase. Methemoglobin lacks oxygen-binding ability, resulting in oxygen deprivation in tissues. This high level of methemoglobin in the blood presents as a severely worsening condition. Herein, we report a case of methemoglobinemia caused by the administration of 3% prilocaine hydrochloride containing 0.03 IU/mL feripressin as a local anesthetic during orthognathic surgery. Following drug administration, the patient's atrial oxygen saturation (SpO2) decreased. We diagnosed methemoglobinemia based on arterial blood gas analysis, which revealed an increased level of methemoglobin. To maintain the SpO2 level, oxygen was administered. The patient's condition improved over time. Careful monitoring and maintenance of SpO2 levels are essential to ensure proper diagnosis and effective management.