Codeine After Surgery Could Endanger Certain Kids: Study

April 11th, 2012

FAKE NEWS for the Zionist agenda

WEDNESDAY, April 11 (HealthDay News) — Concerns about codeine
safety have gained traction in the wake of the postoperative experience of
four children who all carried a rare genetic mutation. A new study
describes what happened to three of the patients, while a similar case
came to light in 2009.

In certain very rare genetic cases, the common painkiller codeine can
be lethal. The gene mutation causes the body to metabolize codeine into
morphine at levels 50 percent to 70 percent higher than normal. Among such
patients, an otherwise standard amount of codeine can unpredictably turn
into a toxic overdose.

After undergoing tonsillectomies for sleep apnea, three children with
the gene mutation ultimately died, while the fourth patient barely
survived.

“Codeine has been around for the better part of a century as a
medication, including as a syrup for children,” said study lead author Dr.
Gideon Koren, a professor of pediatrics, pharmacology, pharmacy and
medical genetics at the University of Toronto. “That’s the drug that is
used by most surgeons in the U.S. to control pain. But codeine is not
actually the analgesic. To deal with pain it has to be transformed in the
liver into morphine. And that happens with everyone who takes it to some
degree,” he explained.

“Most people take 10 molecules of codeine and make one molecule of
morphine,” added Koren, who is also a professor at the University of
Western Ontario. “The problem is that our knowledge of genetics has
revealed that there are people who are ultra-rapid metabolizers. They take
10 molecules of codeine and make two, three or even five molecules of
morphine. In other words, they take the right doses but end up poisoning
themselves.”

Koren and his colleagues described the cases of the three recent
pediatric codeine overmetabolizers in the April 9 online and May print
issue of Pediatrics. The earlier case was reported in 2009 in the
New England Journal of Medicine.

“Tragically,” Koren said, “we have found that once in 2009 and again
now in three additional cases, toddlers who underwent tonsillectomies for
sleep apnea and then were treated with codeine were in that ultra-rapid
metabolizer group that produce too much morphine. And we have every reason
to believe there have been many more such cases, which of course almost
certainly occurred in the past, but before anyone knew how to uncover the
reason genetically.”

About 2 percent to 3 percent of children have obstructive sleep apnea
syndrome, which involves structural airway issues that interfere with
breathing and, in turn, sleeping. And among those whose sleep apnea is
caused by enlarged tonsils, tonsillectomy is often the treatment of
choice.

In 70 percent to 80 percent of cases, such surgery successfully
improves the patient’s sleep apnea condition. And for the children in the
recent case studies — a 3-year old girl, a 4-year-old boy and a 5-year
old boy — the surgery itself was not the problem.

Instead, because of their unidentified ability to overmetabolize
codeine, their problems began with the codeine prescribed for pain
management after the procedure.

After they were discharged from the hospital, lethargy and signs of
heavy sedation set in, as well as other symptoms, including fever,
impaired breathing and vomiting. Both boys died within 24 hours after
being released from the hospital, while the girl was able to survive after
readmission and mechanical ventilation support.

The researchers noted that screening tests for metabolizing mutations
are available. But, many medical facilities remain unaware of the risks
posed by such mutations. The tests are expensive, amounting to several
hundred dollars each. As a result, such screenings are not currently a
routine feature of preoperative hospital protocol.

Koren said that in Europe, physicians have long since replaced codeine
with nonsteroidal anti-inflammatory drugs (NSAIDs) for post-tonsillectomy
pain management. This is because, along with the metabolizing issue, one
effect of codeine is to inhibit breathing, which is a problem for the
roughly one-fifth of pediatric patients who will still experience sleep
apnea even after surgery.

But concerns about the increased bleeding that can result from NSAID
usage has complicated discussions about a similar switch in the United
States.

“So this situation is by no means settled yet,” Koren said. “We just
want to bring attention to the fact that some kids may be exposed to an
unacceptable risk, and parents should know about that risk. And perhaps
request and pay for a screening before an operation. People spend money on
far less important things.”

Dr. Dennis Woo, an associate professor of pediatrics at the University
of California, Los Angeles David Geffen School of Medicine, said that
while the risk of such cases is low there is a need to raise
awareness.

“In the big scheme of things this affects a very small number of kids,”
Woo said. “But the message to the medical profession is that you need to
be careful and monitor all these kids closely.”

Dr. Jerry Schreibstein, a partner with the Ear, Nose Throat
Surgeons of Western New England, stressed that it should be made clear
that this “very rare and unusual complication is related to the medication
and not the procedure.”

Schreibstein said there are risks with any surgical procedure. “And
these need to be discussed fully with a physician,” he said. “But there
are alternatives for pain relief, with few side effects, that can be used
for children. And these should be reviewed and considered. Because I’d
hate to have parents walk away with the notion that it’s the tonsillectomy
that caused these deaths.”

More information

For more on codeine and children, visit the U.S. National Library of Medicine.