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A 5-year-old girl developed methaemoglobinaemia following prilocaine overdose and following treatment with paracetamol for postoperative pain relief [frequencies and time to reaction onsets not stated].
The girl, who had pain in her mouth that persisted for a year, was diagnosed with rampant dental caries involving multiple teeth. She was referred to the paediatric dentistry department in Japan where, restoration of 8 teeth and 4 extractions were scheduled under general anaesthesia. At 4 months of age, she was diagnosed with pulmonary valve stenosis and hypertrophic cardiomyopathy. Also, she was diagnosed with Noonan syndrome at 4 years of age that was suspected to have been caused by wound dehiscence of the coronal suture. Moreover, she had a history of loud snoring. Physical examination revealed grade-II palatine tonsil hypertrophy and was categorized as Mallampati class II. Before surgery, food intake was prohibited, after which she was allowed to drink only clear liquids. Twenty minutes before entering the operating room she received midazolam....