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Apnea in a child after oral codeine: A genetic variant - An ultra-rapid metabolizer
Journal article   Peer reviewed

Apnea in a child after oral codeine: A genetic variant - An ultra-rapid metabolizer

Polina Voronov, Henry J. Przybylo and Narasimhan Jagannathan
Paediatric Anaesthesia, Vol.17(7)
2007
DOI: https://doi.org/10.1111/j.1460-9592.2006.02182.x

Abstract

Acetaminophen Adenoidectomy Analgesics, Non-Narcotic Analgesics, Opioid Child, Preschool Codeine Cytochrome P-450 CYP2D6 Humans Male Polymorphism, Genetic Sleep Apnea Syndromes Tonsillectomy Variation (Genetics) benzodiazepine cocodamol cytochrome P450 2D6 fentanyl hydrocortisone morphine naloxone narcotic agent nitrous oxide ondansetron oxygen sevoflurane adenotonsillectomy apnea article brain injury breathing rate case report cerebellum cortex computer assisted tomography drug metabolism elective surgery emergency care general anesthesia genetic polymorphism genetic variability human male neuroimaging nuclear magnetic resonance imaging pharmacogenomics preschool child priority journal pulse oximetry recurrent disease sedation tonsillitis urinalysis vital sign white matter
We present a case of a 29 months old previously healthy child who experienced apnea resulting in brain injury following a dose of acetaminophen and codeine 2 days after an uneventful anesthetic for tonsillectomy. A genetic polymorphism leading to ultra-rapid metabolism of codeine into morphine resulted in narcosis and apnea. This paper discusses the use of codeine for pain relief, obstructive sleep apnea, the alteration of the CYP2D6 gene and the resulting effect on drug metabolism. © 2007 The Authors.

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