Elective oral tracheal intubation in cervical spine-injured adultsThe optimal mode of tracheal intubation in the patient with an unstable cervical spine is controversial. Turner and Joyce criticized the use of both oral tracheal intubation and in-line stabilization for cervical spine immobili-1991 / 38:6 t pp785-9

A case of respiratory depression which occurred following administration of epidural meperidine during Caesarean section is described. Epidural meperidine, was given after delivery of the infant to provide postoperative analgesia. Oxygen desaturation (SaO 2 90%) and a decrease in respiratory rate (4 "min -t ) Epidural opioids have gained popularity as effective analgesic agents for pain management following Caesarean section. However, the administration of epidural morphine with its low lipophilicity has been associated with several side-effects: late respiratory depression, pruritus, nausea and vomiting, urinary retention and recrudecence of peri-oral herpes simplex infection. t The incidence of late respiratory depression is low, but requires close nursing supervision and monitoring of respiratory rate for at least 12 hr after the administration of epidural morphine. 2'3 Therefore, several investigators have assessed the efficacy of more lipophilic drugs such as the phenyipiperidine derivatives meperidine and fentanyl. 4-7 Although these opioid analgesics have a shorter duration of action, it was considered that their lipophilic structure would result in a smaller quantity of drug being available for rostral spread in the CSF. Hence, late respiratory compromise following epidural administration of meperidine or fentanyl should occur less frequently. We describe a case of early respiratory depression after administration of epidural meperidine. This occured in a non-premedicated woman 30 min after delivery by Caesarean section and required treatment with intravenous naloxone. CAN J ANAESTH 1992 ! 39: I / pp71-4

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