Codeine, Ultrarapid-Metabolism Genotype, and Postoperative Death

To the Editor: Obstructive sleep apnea is not rare in children with hypertrophic tonsils, and the common curative procedure is adenotonsillectomy.1 Codeine is commonly prescribed for pain after adenotonsillectomy.2 The respiratory depressant effects of opioids may influence the occurrence of respiratory complications.3 An estimated one third of cases of apnea in children are not resolved after adenotonsillectomy.4 We report on the case of a healthy 2-year-old boy weighing 13 kg, with a history of snoring and sleep-study–confirmed sleep apnea, who underwent elective adenotonsillectomy. The outpatient surgery was uncomplicated, and 6 hours after surgery the boy received 10 mg of meperidine . . .