HYPOXEMIA AND HYPOTENSION AFTER INTRAVENOUS CODEINE PHOSPHATE

This report describes a case of accidental intravenous administration of codeine phosphate (1 mg.kg(-1) to a previously healthy five-year-ol d boy, who was undergoing strabismus surgery. Hypoxaemia (SpO(2) 85% w ith FIO2 of 1) and hypotension (systolic BP 65 mmNg) resulted, which r esponded to resuscitation with lactated Ringers' (20 ml.kg(-1) and phe nylephrine (2 mu g.kg(-1)). The degree of hypoxaemia observed in this case was severe, but was not associated with clinical evidence of bron chospasm. Possible mechanisms for this reaction might have included di rect myocardial depression and histamine release. This case adds furth er support to the recommendation that codeine phosphate should never b e administered intravenously.