Incidence of respiratory depression after epidural administration of morphine for cesarean delivery: findings using a continuous respiratory rate monitoring system

Terada, Shuhei; Irikoma, Shingo; Yamashita, Akihiro; Murakoshi, Takeshi

doi:10.1016/j.ijoa.2018.10.009

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…Respiratory depression was not assessed in the present study. In a previous study, ~50% of females who received epidural morphine (3 mg) experienced respiratory depression, but the severity was mild and none of the patients required treatment (38). It is not well known whether a synergistic effect on respiration exists with the combination of epidural dexmedetomidine and morphine.…”

Section: Discussionmentioning

confidence: 95%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).

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Section: Discussionmentioning

confidence: 95%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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“…29,30 Respiratory Depression at Birth is the presence of fast breathing (> 60 breath/second) or low breathing (<30 breath/second) or difficulty breathing in the first minute of life. [33][34][35] Data Processing and Analysis Data were coded, entered, cleaned on Epidata version 4.6, and exported and analyzed using Stata version 16. The outcome variables were neonatal NICU admission, absent neonatal reflexes, and neonatal death.…”

Section: Operational Definitionmentioning

confidence: 99%

Magnitude and Determinants of Immediate Adverse Neonatal Outcomes Among Babies Born by Cesarean Section in Public Hospitals in Harari Region, Eastern Ethiopia

Abdullahi¹,

Assefa²,

Roba³

2021

RRN

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Purpose: To determine the magnitude and determinants of immediate adverse neonatal outcomes among babies born by cesarean section in public hospitals in the Harari region, Eastern Ethiopia. Patients and Methods: A prospective follow-up study among 715 eligible babies born by cesarean section in Jegula and Hiwot Fana public hospitals in Harar. Neonate is said to have immediate adverse outcomes if one of the following were detected: (1) baby died, or (2) admitted to NICU, or (3) its primitive reflexes were absent within 24 hours after delivery Adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) were computed using modified Poisson regression. Results: During the follow-up period, a total of 44 babies died, 139 admitted to NICU, and 133 had absent neonatal reflexes. In general, 157 had an adverse neonatal outcome after CS. The following conditions were postively and statistically related with the outcome: estimated household income (ARR 2.19 CI 1.57-3.07), having no Antenatal care (ARR 1.46 1.08--1.97), history of medical or obstetric condition , having an absolute indication for delivery (ARR 1.71 CI 1.28-2.29), presence of meconium (ARR 1.61 CI 1.22-2.12), low birth weight (ARR 1.96 CI 1.42-2.70), and respiratory depression at birth . Conclusion:A fifth of babies developed immediate adverse outcomes after a cesarean section. Several maternal clinical factors were predictors for immediate adverse neonatal outcomes. Assessing previous clinical and obstetric conditions of the women during ANC would help properly plan in averting the occurrence of immediate adverse neonatal outcomes after birth.

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“…Evidence showed that approximately 50% women experienced mild respiratory depression after neuraxial morphine. [ 48 ] Recently, the SOAP committee developed a consensus statement to promote patient risk stratification and patient-centered respiratory monitoring after neuraxial morphine administration. [ 49 ] Opioids can also be given intravenously or intramuscularly.…”

Section: Role Of Anesthesiologist In Eracmentioning

confidence: 99%

Enhanced recovery after cesarean delivery: a challenge for anesthesiologists

Liu

Yao

2020

Chinese Medical Journal

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Enhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.

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Incidence of respiratory depression after epidural administration of morphine for cesarean delivery: findings using a continuous respiratory rate monitoring system

Cited by 8 publications

References 14 publications

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Magnitude and Determinants of Immediate Adverse Neonatal Outcomes Among Babies Born by Cesarean Section in Public Hospitals in Harari Region, Eastern Ethiopia

Enhanced recovery after cesarean delivery: a challenge for anesthesiologists

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