Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Respiratory Depression After Spinal Anesthesia


Case Synopses

Case 1

A 75-year-old man underwent total knee replacement under spinal anesthesia with local anesthetic and 300 μg of diamorphine or 100 μg of morphine. Late that evening he appears extremely sleepy and has oxygen saturation of 94% on nasal oxygen.

Case 2

A 60-year-old woman underwent a total vaginal hysterectomy under spinal anesthesia with local anesthetic and 300 μg of diamorphine. In the recovery room the patient complains of severe itching and nausea with vomiting. Her oxygen saturation is 98% on room air.

Problem Analysis

Definition

Epidural and intrathecal administration of opioids has been in practice for decades. Neuraxial opioids produce profound segmental antinociception in doses much smaller than would be required if administered systematically. The addition of fentanyl to spinal anesthesia prolongs the duration of sensory blockade without increasing the time to discharge, making it a popular choice in the ambulatory setting. Intrathecal opioids for labor analgesia have made it possible to lower the amount of local anesthetic used so that the mother can ambulate while the epidural is running (walking epidural).

Recognition

Side effects of intrathecal and epidural opioids are listed in Box 104.1 . The most common are as follows:

  • Respiratory depression

  • Sedation

  • Pruritus

  • Nausea and vomiting

BOX 104.1
Complications of Neuraxial Anesthesia

  • Respiratory depression

  • Sedation

  • Pruritus

  • Nausea and vomiting

  • Urinary retention

  • Gastrointestinal dysfunction

  • Anaphylaxis

  • Hyperalgesia

  • Behavioral problems

  • Dizziness or hypotension

  • Thermoregulatory dysfunction

In general the side effects associated with neuraxial opioids are similar to those seen with intravenous, intramuscular, or oral opioid use. However, the severity, incidence, and timing differ owing to the interaction of opioids with their receptors in the spinal cord and the brain. The most serious complication is respiratory depression, which can be early or delayed.

Risk Assessment

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts