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

Author(s): Norman E, Malmqvist U, Westrin P, Fellman V

Affiliation(s): Department of Pediatrics, Hospital for Children and Adolescence, Lund University Hospital, Lund, Sweden. elisabeth.norman@med.lu.se

Publication date & source: 2009-10, Acta Paediatr., 98(10):1680-2. Epub 2009 Jul 6.

Publication type: Case Reports; Research Support, Non-U.S. Gov't

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 micromol/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.

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