Apnea in a child after oral codeine: a genetic variant - an ultra-rapid metabolizer.

We present a case of a 29 months old previously healthy child who experienced apnea resulting in brain injury following a dose of acetaminophen and codeine 2 days after an uneventful anesthetic for tonsillectomy. A genetic polymorphism leading to ultra-rapid metabolism of codeine into morphine resulted in narcosis and apnea. This paper discusses the use of codeine for pain relief, obstructive sleep apnea, the alteration of the CYP2D6 gene and the resulting effect on drug metabolism.

Acute psychosis after anesthesia: the case for antibiomania.

We report the case of a teenager who developed a postanesthesia acute psychosis (delusions, paranoia, and hallucinations) caused by a reaction to antibiotic therapy (amoxicillin and clarithromycin), so called 'Hoigne's syndrome' or 'antibiomania.' The differential diagnosis and a review of literature are presented. Our patient illustrates the importance of adding antibiomania as part of the differential diagnosis when altered postanesthesia behavior is observed in pediatric patients.

Mask fear in children presenting for anesthesia: aversion, phobia, or both?

Background: Anesthesia induction in children is commonly accomplished by introducing volatile agents by mask. Occasionally a child describes an excessive fear of the anesthesia facemask. Little is known of the cause of the fear or of the quality or magnitude of the feelings the child is experiencing.

Assessing behaviour in children emerging from anaesthesia: can we apply psychiatric diagnostic techniques?

Background: No standardized instrument exists for the systematic analysis of emergence behaviour in children after anaesthesia. Our purpose was to evaluate children's behaviour prior to anaesthetic induction and immediately upon emergence to develop an assessment tool using psychiatric terminology and techniques.

Methods: This prospective study evaluated 25 children from 2 to 9 years of age for preanaesthetic psychosocial factors that might affect behaviour.