Nav: Home

Warning over codeine use after tonsillectomy

August 19, 2009

A report out of The University of Western Ontario, published in the New England Journal of Medicine, warns the use of codeine to treat pain following a tonsillectomy could prove fatal for some children. Dr. Gideon Koren, who holds the Ivey Chair in Molecular Toxicology at Western, zeroed in on the danger after investigating the death of a two year old boy following a relatively easy operation to remove his tonsils.

Koren is a pediatrics professor at both Western and the University of Toronto, and the Director of the Motherisk program at the Hospital for Sick Children in Toronto. Enlarged tonsils are usually treated with antibiotics, but Koren says tonsillectomies are still performed in the case of sleep apnea, where the child stops breathing while asleep.

In this particular case, the toddler had a history of snoring and sleep-study-confirmed sleep apnea. He was taken to an outpatient clinic, had the operation, and was taken home. The mother was given syrup of codeine and instructed how to administer it to her child for pain relief. On the second night after surgery, the child developed a fever and wheezing, and was found dead the next morning. Tests later showed the mother had given the proper dosage, and yet the child's body was found to have high levels of morphine. The coroner asked Koren to look at the case.

"The sudden death of a healthy child was quite sobering because tonsillectomies are done every day, all over North America," says Koren. "And more and more of them are done on an outpatient basis, with the child going home the same day." The child was found to have the ultra-rapid metabolism genotype which causes the body to metabolize codeine at a faster rate, producing significantly higher amounts of morphine.

Last year Koren published research showing how mothers who are given codeine for pain following childbirth, can pass toxic levels of morphine to their babies though their breastmilk, if they carry this genotype. It's estimated just over one per-cent of Caucasians carry this gene, but the incidence could be as high as 30% in those of African origin.

Koren has another concern about giving codeine to children following a tonsillectomy for sleep apnea. "If the apnea doesn't go away, codeine will also suppress the child's breathing. This demonstrates the need to keep children in hospital under surveillance for at least 24 hours to see if the apnea persists."

Western graduate student Catherine Ciszkowski co-authored the paper with Koren. The Ivey Chair in Molecular Toxicology studies why drugs can be safe for most people, and yet life-threatening to some, and tries to find ways to predict those situations.
-end-


University of Western Ontario

Related Sleep Apnea Articles:

More cancer cases among women with sleep apnea
Women with severe sleep apnea appear to be at an elevated risk of getting cancer, a study shows.
New evidence on the association of shortened sleep time and obstructive sleep apnea with sleepiness and cardiometabolic risk factors
A new study in the journal CHEST® may change the way we think about sleep disorders.
Synthetic cannabis-like drug reduces sleep apnea
A synthetic cannabis-like drug in a pill reduced apnea and daytime sleepiness in the first large multi-site study of a drug for apnea.
Inflammation may precede sleep apnea, could be treatment target
Inflammation is traditionally thought of as a symptom of sleep apnea, but it might actually precede the disorder, potentially opening the door for new ways to treat and predict sleep apnea, according to researchers.
Concerns that sleep apnea could impact healthspan
The number of people with obstructive sleep apnea has steadily increased over the past two decades.
More Sleep Apnea News and Sleep Apnea Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...