title: Norpethidine accumulation and generalized seizure during pethidine patient-controlled analgesia.
abstract: A 35-year-old, 47 kg female presented for elective laparatomy, adhesiolysis and ileostomy formation. Pre-existing neurological problems precluded placement of an epidural and IV PCA was used for postoperative analgesia. A patient request for pethidine was allowed. Twenty-three hours postoperatively, a brief generalized seizure occurred without adverse sequelae. This had been immediately preceded by myoclonic-type jerking. The cumulative pethidine dose was 3,000 mg and the norpethidine level was 1.8 micrograms.ml-1. Avoidance of pethidine for IV PCA where large cumulative doses are anticipated is advised. Seizures associated with pethidine/norpethidine toxicity can occur early during pethidine usage, and there is considerable variation in measured norpethidine levels.
authors.affiliation: Department of Anaesthesia and Intensive Care, Palmerston North Hospital, New Zealand.
authors.forename: G J
authors.initials: GJ
authors.lastname: McHugh
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007813:Laparotomy; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000378:metabolism; D012640:Seizures / Q000139:chemically induced*
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine; C002752:normeperidine