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Anaesth Intensive Care. 1999 Jun;27(3):289-91.

Norpethidine accumulation and generalized seizure during pethidine patient-controlled analgesia.

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Department of Anaesthesia and Intensive Care, Palmerston North Hospital, New Zealand.


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 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.

[Indexed for MEDLINE]
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