Emla cream warning

[Guest guest]

The Canadian Nurse, August 1994, pp. 5-6

[Material in brackets added. CIRP]

Editor's note: Recently we received a copy of the following

letter from

Grace Boudreau, RN, Director of Quality Assurance, G. R. Baker Memorial

Hospital, Quesnel, B.C. [british Columbia, Canada].

The letter was sent to all general practitioners, hospitals and

pharmacies in Northern British Columbia on March 28, 1994. We have

permission from the letter's author, Dr. Marie Hay, to print the letter

in its entirety (bold type represents emphasis expressed in original

letter.)

Dear Doctor,

The Department of Paediatrics at Prince Regional Hospital

recently discussed the unfortunate case of a 21-day-old male child who

was circumcised using Prilocaine as a local anesthetic agent. A few

hours after the circumcision the baby developed significant

Methaemo-globinaemia [reaction with the blood] due to the

Prilocaine anesthetic.

The department of Paediatrics is issuing a strong warning to all

physicians who perform circumcisions. We strongly advise that

Prilocaine local anesthetic not be used under any circumstances for

neonatal circumcision.

It is also interesting to note that EMLA cream contains 2.5%

Prilocaine. It also therefore should not be used on the mucous

membranes of newborns when they are circumcised.

It is the Department of Paediatrics' recommendation that

no infant under the age of 3 months gets Prilocaine or EMLA cream in

any form because of the serious risk of Methaemo-globinaemia.

I understand from speaking with an Intensivist at B.C.

Children's Hospital that two other cases of Methaemo-globinaemia due to

Prilocaine have also been noted in B.C. in the past recent months. As

you know Methaemoglobinaemia can cause brain damage and death in small

infants.

Signed, Marie Hay

Head of Paediatrics

Prince Regional Hospital

Prince , B.C.