A 4-year-old child has a history of difficult intravenous (I.V.) access and a fear of needles. A eutectic mixture of local anesthetic (EMLA) cream is applied to both hands and both feet and then covered with an occlusive dressing by the parents 90 minutes prior to arriving for a scheduled outpatient radiologic procedure under sedation. On arrival the child is noted to be lethargic and cyanotic. A pulse oximetry measurement reads 85 percent. Which of the following is the most likely explanation?

A eutectic mixture of local anesthetic (EMLA) cream is a mixture of 2.5 percent lidocaine and 2.5 percent prilocaine that is applied to intact skin for local anesthetic effects. Topical application has been shown to significantly reduce pain and can be particularly useful in infants and children undergoing dermal procedures. The beneficial effects of EMLA cream require...

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