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Hypoxaemia and hypotension after intravenous codeine phosphate
1Department of Anaesthesia, Alberta Children's Hospital, Calgary.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|December 1, 1994
Summary
Accidental intravenous codeine phosphate administration caused severe hypoxemia and hypotension in a child. This case highlights the risks and supports avoiding intravenous codeine phosphate due to potential adverse reactions.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
Background:
- Codeine phosphate is an opioid analgesic commonly used for pain management.
- Intravenous administration routes require careful consideration due to rapid systemic effects.
Observation:
- A five-year-old boy undergoing strabismus surgery experienced severe hypoxemia (SpO2 85%) and hypotension (systolic BP 65 mmHg) after accidental intravenous codeine phosphate (1 mg/kg).
- The patient responded to fluid resuscitation with lactated Ringer's and phenylephrine.
- No clinical signs of bronchospasm were observed despite severe hypoxemia.
Findings:
- The adverse event suggests potential direct myocardial depression or histamine release as mechanisms for the observed hypoxemia and hypotension.
- The reaction underscores the unpredictable and severe consequences of unintended intravenous codeine administration.
Implications:
- This case strongly supports the established recommendation against the intravenous use of codeine phosphate in any patient population.
- Clinicians should exercise extreme caution and adhere strictly to recommended administration routes for codeine phosphate to prevent similar adverse events.