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Low oxygen saturation recorded by pulse oximeter (SpO2) is a clinical finding which can indicate multiple causes that can occur in the perioperative period. However, pre-induction SpO2 <90% in an asymptomatic healthy child poses a great diagnostic and management challenge to the anaesthesiologist. We report the case of a 10-year-old male child who developed methaemoglobinaemia on exposure to EMLA cream. The methaemoglobinaemia was incidentally detected by standard monitoring in the pre-induction period.