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


CONCLUSIONS
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.
Norman
Elisabeth
E
Department of Pediatrics, Hospital for Children and Adolescence, Lund University Hospital, Lund, Sweden. elisabeth.norman@med.lu.se
Malmqvist
Ulf
U
Westrin
Per
P
Fellman
Vineta
V
D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose; D017707:Erythrocyte Transfusion; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010102:Oxygen Inhalation Therapy; D012016:Reference Values; D013874:Thiopental / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics*; D014474:Unconsciousness / Q000139:chemically induced
D013874:Thiopental