Bohnhorst Bettina, Hartmann Hans, Lange Matthias
Hanover Medical School, Hanover, Germany.
Eur J Paediatr Neurol. 2017 May;21(3):576-579. doi: 10.1016/j.ejpn.2016.12.011. Epub 2016 Dec 28.
Neonates and young infants are especially prone to develop drug-induced methemoglobinemia. Therefore, lidocaine is not licensed as local anesthetic in children below the age of 3 months. However, its systemic use is advocated for neonatal seizures. Cardiac arrhythmia has been reported as sole major side effect. Here we report a case of severe methemoglobinemia caused by continuous infusion of lidocaine in a term neonate with neonatal seizures. The increase of methemoglobin up to 13.8% was accompanied by hypoxemia and cyanosis, necessitating additional inspired oxygen and CPAP ventilation. After stopping lidocaine infusion methemoglobin levels fell and the neonate could be weaned from ventilation. Neonates treated with lidocaine for seizures must be monitored for the occurrence of methemoglobinemia.
新生儿和小婴儿特别容易发生药物性高铁血红蛋白血症。因此，利多卡因未被批准用于3个月以下儿童的局部麻醉。然而，对于新生儿惊厥，提倡全身性使用利多卡因。据报道，心律失常是唯一的主要副作用。在此，我们报告一例足月新生儿因惊厥持续输注利多卡因导致严重高铁血红蛋白血症的病例。高铁血红蛋白增加至13.8%，同时伴有低氧血症和发绀，需要额外吸氧和持续气道正压通气。停止输注利多卡因后，高铁血红蛋白水平下降，新生儿可撤机。接受利多卡因治疗惊厥的新生儿必须监测是否发生高铁血红蛋白血症。
