Related Experiment Video
Updated: May 23, 2026
05:07
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
More codeine fatalities after tonsillectomy in North American children
Lauren E Kelly1, Michael Rieder, John van den Anker
1Schulich School of Medicine, University of Western Ontario, London, Canada.
Pediatrics
|April 12, 2012
Summary
Codeine is not safe for children with obstructive sleep apnea after tonsillectomy. Genetic variations in cytochrome P4502D6 (CYP2D6) can lead to fatal morphine overdose.
Area of Science:
- Pharmacogenomics
- Pediatric Surgery
- Toxicology
Background:
- Codeine is commonly prescribed for pain management post-adenotonsillectomy.
- Obstructive sleep apnea syndrome (OSAS) is a known risk factor for respiratory complications in children.
- Cytochrome P4502D6 (CYP2D6) metabolizes codeine into morphine, its active analgesic form.
Observation:
- A previous report detailed a fatal case of codeine toxicity in a toddler with OSAS who was a CYP2D6 ultra-rapid metabolizer.
- Three additional cases of fatal or life-threatening respiratory depression following codeine use post-adenotonsillectomy in children with OSAS were identified.
- Two of these cases involved individuals with functional gene duplications of CYP2D6, leading to excessive morphine production.
Findings:
- Functional CYP2D6 gene duplications significantly increase the risk of codeine toxicity by enhancing morphine synthesis.
- Even extensive metabolizers can experience severe respiratory depression.
- These findings highlight the critical role of CYP2D6 genotype in codeine safety.
Implications:
- Codeine and other CYP2D6-metabolized opioids pose significant safety risks for young children with OSAS undergoing adenotonsillectomy.
- Routine genetic screening for CYP2D6 metabolizer status may be warranted in pediatric patients with OSAS before prescribing codeine.
- Alternative analgesics with a lower risk profile should be considered for this vulnerable population.
Related Concept Videos
01:26Tonsillitis II: Management
This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.
01:23Chronic Pharyngitis
Chronic pharyngitis refers to persistent inflammation of the pharyngial mucosa.
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:30Tonsillitis I: Introduction
Tonsillitis is inflammation of the tonsils, which are two lymphoid tissue masses at the back of the throat. This condition can cause discomfort and irritation in the throat.
Etiology
Three primary contributing factors have been identified.
Etiology
Three primary contributing factors have been identified.
01:29Drug Dosing: Infants and Children
Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
01:12Local Anesthetics: Adverse Effects
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Respiratory symptoms, such as congestion and cough, commonly accompany respiratory tract conditions. Various medications, such as antitussives, expectorants, and mucolytics, play crucial roles in providing relief.
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by anesthetizing...
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by anesthetizing...