Thiopental pharmacokinetics in newborn infants: a case report of overdose.

Summary, in English

Abstract Thiopental may be used for sedation before intubation in newborn infants. A boy, born at 33 weeks of gestation (gw); birth weight 2435 g, was prescribed thiopental 3 mg/kg before intubation. He developed temporary hypotension and oxygen desaturation, and remained unconscious for longer than expected with a suppressed electroencephalography for 48 h. Serum thiopental concentration was 82, 59, 42 and 32 mumol/L after 20 min and 6, 24 and 68 h respectively. Serum concentrations from five newborn infants at the same time points after intubation with the same thiopental dose were used as reference values, and indicated a 10-fold overdose in the index case. The cause of the overdose could not be identified. The infant recovered; cerebral magnetic resonance imaging at the age of 42 gw and psychomotor development at 2 years were normal. These results show that thiopental concentrations are variable in neonates and there is a high risk of dosage error as no specific paediatric formulation is available. Conclusion: Well-designed procedures and continuous education are required to prevent errors and adverse events during drug delivery to newborn infants. To develop a safe method of administration for thiopental, an extended pharmacokinetic and pharmacodynamic study in neonates is warranted.

• Author: Elisabeth Norman; Ulf Malmqvist; Per Westrin; Vineta Fellman
• Department/s: Paediatrics (Lund); Division of Clinical Chemistry and Pharmacology; Anesthesiology and Intensive Care
• Publishing year: 2009
• Language: English
• Pages: 1680-1682
• Publication/Series: Acta paediatrica
• Volume: 98
• Links: http://www.ncbi.nlm.nih.gov/pubmed/19583708?dopt=Abstract; http://dx.doi.org/10.1111/j.1651-2227.2009.01394.x
• Document type: Journal article
• Publisher: Wiley-Blackwell
• Topic: Pediatrics
• Status: Published
• ISBN/ISSN/Other: ISSN: 1651-2227