Prilocaine (citanest) is an intermediate-acting amino amide that is pharmacologically similar to lidocaine, except that it causes little vasodilation and thus can be used without a vasoconstrictor if desired, and its increased volume of distribution reduces its cNs toxicity, making it suitable for intravenous regional blocks (see below). As a consequence of the metabolism of the aromatic ring to o-toluidine, prilocaine can cause methehemoglobinemia. Development of methemoglobinemia is dose dependent, usually appearing after a dose of 8 mg/kg. Methemoglobinemia usually is not a problem in healthy adults but is more common in neonates due to decreased resistance of fetal hemoglobin to oxidant stresses and the immaturity of enzymes that convert methemoglobin back to the ferrous state.
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