Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine

Abstract

SummaryA 19-vear-old obstetric patient had a respiratory arrest shortly after receii>ing intrathecal sufentanil and hupii>acaine as part of a combined epidurallspinal technqiue ,for pain relief' in labour.

Respiratory arrest following intrathecal injection of sufentanil and bupivacaine in a parturient

“…Despite this, only six other cases of respiratory depression/arrest with intrathecal sufentanil have been reported. [2][3][4][5][6] We report the second case of respiratory arrest and fetal bradycardia in an opioid-free patient receiving 10 lag intrathecal sufentanil. We verified the intrathecal sufentanil dose by laboratory investigation.…”

“…1 However, there have been cases of maternal respiratory depression and/or arrest with the use ofintrathecal opioids in labour. [2][3][4][5][6][7] In most of these, the patient had received previous parenteral opioids or a larger dose of sufentanil than did our patient. We report a case of respiratory arrest after initiation of a CSE in a labouring parturient who had not been exposed to opioids.…”

Epinephrine reduces the sedative side effects of epidural sufentanil for labour analgesia

“…1 3 The proposed mechanisms for these side effects include, 1) systemic uptake 2,7,11,21,22 or 2) cephalic spread in the CSF. 13,23 Individually or together, these two mechanisms can also lead to respiratory depression as sufentanil reaches opioid receptors in the respiratory centre.…”

“…However, lightheadedness and sedation were noted to be significant. Central nervous system (CNS) side effects 2,10 and respiratory depression, 11,12 have been described after intrathecal sufentanil. We postulated that this alteration in CNS status was due to systemic uptake of sufentanil via the epidural vasculature.…”

Avaliação do estado ácido-básico materno com o uso de sufentanil por via subaracnóidea em diferentes doses para cesarianas e suas repercussões sobre os recém-nascidos

“…Greenhalgh relatou depressão respiratória grave em pacientes que receberam 10 µg de sufentanil subaracnóideo para analgesia de parto em técnica combinada raqui-peridural. O quadro foi revertido com o emprego de 0,4 mg de naloxona e ventilação sob máscara facial 19 . Norris e col. encontraram aumento de P ET CO 2 na ordem de 13 mmHg em pacientes obstétricas que receberam 10 µg de sufentanil subaracnóideo, o mesmo não ocorrendo com o grupo que recebeu 5 ìg do opióide 20 .…”