CANADIAN researchers are issuing fresh warnings that the routine practice of giving children codeine after tonsil surgery can be deadly.
In 2009, researchers from the University of Western Ontario in London and the Hospital for Sick Children in Toronto were the first in the world to report a fatal case of a toddler who died after receiving codeine following surgery for sleep apnea.
Now, the team is reporting on three more cases -- two deaths and a near-fatal reaction. Two of the cases occurred in Ontario. In the fatal cases, the children were found dead in their beds after receiving codeine.
Convinced that more cases are occurring but going undiagnosed, the researchers are warning doctors codeine can no longer be considered a safe painkiller for children following adenotonsillectomy -- surgery to remove tonsils and adenoids to treat sleep apnea, where children stop breathing temporarily during sleep.
"Clearly, there are many more cases not known to us," said Dr. Gideon Koren, director of the Motherisk Program at the Toronto hospital.
The risk is that some children are ultra-rapid metabolizers of codeine. When codeine enters the body and breaks down, or metabolizes, it changes to morphine, which can slow breathing. Some children are born with a genetic variation that causes their bodies to convert codeine to morphine far faster than most other children, leading to an overload of morphine that can be deadly, even when the child is given a recommended standard dose.
-- Postmedia News