Schulich School of Medicine, University of Western Ontario, London, Canada.
Pediatrics. 2012 May;129(5):e1343-7. doi: 10.1542/peds.2011-2538. Epub 2012 Apr 9.
In 2009 we reported the fatal case of a toddler who had received codeine after adenotonsillectomy for obstructive sleep apnea syndrome. The child was an ultra-rapid metabolizer of cytochrome P4502D6 (CYP2D6). We now report 3 additional fatal or life-threatening cases from North America. In the 2 fatal cases, functional gene duplications encoding for CYP2D6 caused a significantly greater production of potent morphine from its parent drug, codeine. A severe case of respiratory depression in an extensive metabolizer is also noted. These cases demonstrate that analgesia with codeine or other opioids that use the CYP2D6 pathway after adenotonsillectomy may not be safe in young children with obstructive sleep apnea syndrome.
2009 年，我们报道了一例因阻塞性睡眠呼吸暂停综合征行腺样体扁桃体切除术并接受可待因治疗的幼儿死亡病例。该患儿为细胞色素 P4502D6（CYP2D6）超快代谢者。我们现在报告来自北美的另外 3 例致命或危及生命的病例。在 2 例致命病例中，编码 CYP2D6 的功能性基因重复导致母体药物可待因产生的强效吗啡明显增加。还注意到一名广泛代谢者出现严重呼吸抑制。这些病例表明，在患有阻塞性睡眠呼吸暂停综合征的幼儿中，手术后使用可待因或其他通过 CYP2D6 途径的阿片类药物进行镇痛可能不安全。
