TY - JOUR
KW - Analgesia/adverse effects/methods/standards/trends
KW - Analgesics, Opioid/pharmacology/therapeutic use
KW - Anesthesia/adverse effects/methods/standards/trends
KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
KW - Child
KW - Clinical Protocols
KW - Codeine/pharmacology/therapeutic use
KW - Cytochrome P-450 CYP2D6/genetics
KW - Genotype
KW - Humans
KW - Hypoxia, Brain/chemically induced
KW - Opioid-Related Disorders/etiology/genetics/prevention & control
KW - Pain Management/adverse effects/methods/standards/trends
KW - Pain, Postoperative/drug therapy
KW - Perioperative Care/adverse effects/methods
KW - Polymorphism, Genetic
KW - Practice Guidelines as Topic
KW - Respiratory Insufficiency/chemically induced
KW - Risk Factors
KW - Sleep Apnea, Obstructive/complications
KW - Tonsillectomy/adverse effects
AU - V. Chidambaran
AU - S. Sadhasivam
AU - M. Mahmoud
A1 - 
AB - PURPOSE OF REVIEW: Use of perioperative opioids for surgical pain management of children presents clinical challenges because of concerns of serious adverse effects including life-threatening respiratory depression. This is especially true for children with history of obstructive sleep apnea. This review will explore current knowledge of clinically relevant factors and genetic polymorphisms that affect opioid metabolism and postoperative outcomes in children. RECENT FINDINGS: Within the past several years, an increasing number of case reports have illustrated clinically important respiratory depression, anoxic brain injuries and even death among children receiving appropriate weight-based dosages of codeine and other opioids for analgesia at home setting particularly following tonsillectomy. Several national and international organizations have issued advisories on use of codeine in pediatrics, based on cytochrome P450 family 2 subfamily D type 6 (CYP2D6) pharmacogenetics. We have discussed the pros and cons of alternatives to codeine for pain management. SUMMARY: Although routine preoperative genotyping to identify children at risk and personalized opioid use for pediatric perioperative pain management is still a distant reality, current known implications of CYP2D6 pharmacogenetics on codeine use shows that pharmacogenetics has the potential to guide anesthesia providers on perioperative opioid selection and dosing to maximize efficacy and safety.
AD - Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
BT - Current opinion in anaesthesiology
C5 - Opioids & Substance Use
CP - 3
CY - United States
DO - 10.1097/ACO.0000000000000455
IS - 3
JF - Current opinion in anaesthesiology
M1 - Journal Article
N2 - PURPOSE OF REVIEW: Use of perioperative opioids for surgical pain management of children presents clinical challenges because of concerns of serious adverse effects including life-threatening respiratory depression. This is especially true for children with history of obstructive sleep apnea. This review will explore current knowledge of clinically relevant factors and genetic polymorphisms that affect opioid metabolism and postoperative outcomes in children. RECENT FINDINGS: Within the past several years, an increasing number of case reports have illustrated clinically important respiratory depression, anoxic brain injuries and even death among children receiving appropriate weight-based dosages of codeine and other opioids for analgesia at home setting particularly following tonsillectomy. Several national and international organizations have issued advisories on use of codeine in pediatrics, based on cytochrome P450 family 2 subfamily D type 6 (CYP2D6) pharmacogenetics. We have discussed the pros and cons of alternatives to codeine for pain management. SUMMARY: Although routine preoperative genotyping to identify children at risk and personalized opioid use for pediatric perioperative pain management is still a distant reality, current known implications of CYP2D6 pharmacogenetics on codeine use shows that pharmacogenetics has the potential to guide anesthesia providers on perioperative opioid selection and dosing to maximize efficacy and safety.
PP - United States
PY - 2017
SN - 1473-6500; 0952-7907
SP - 349
EP - 356
EP - 
T1 - Codeine and opioid metabolism: implications and alternatives for pediatric pain management
T2 - Current opinion in anaesthesiology
TI - Codeine and opioid metabolism: implications and alternatives for pediatric pain management
U1 - Opioids & Substance Use
U2 - 28323671
U3 - 10.1097/ACO.0000000000000455
VL - 30
VO - 1473-6500; 0952-7907
Y1 - 2017
Y2 - Jun
ER -