Transcutaneous Carbon Dioxide Measurements in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Prospective Observational Study

Bauchat, Jeanette R.; McCarthy, Robert J.; Fitzgerald, Paul C.; Kolb, Stephen J.; Wong, Cynthia A.

doi:10.1213/ane.0000000000001751

Cited by 20 publications

(8 citation statements)

References 27 publications

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“…Our findings are consistent with the 32% incidence of hypercapnic events (transcutaneous CO 2 >50 mmHg for ≥2 min) in post-cesarean delivery patients who had received ITM 150 μg. 12 Our results are also consistent with other studies in which delayed respiratory depression occurred 4 to 12 hours after the administration of ITM. 13,14 …”

Section: Discussionsupporting

confidence: 93%

A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150 μg

Ladha

Kato

Tsen

et al. 2017

International Journal of Obstetric Anesthesia

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Introduction Delayed respiratory depression is a feared complication of intrathecal morphine in patients undergoing cesarean delivery. The incidence, timing and risk factors for hypoxia in this population are not known. Methods Patients undergoing cesarean delivery under spinal anesthesia at a tertiary care center from October 2012 to March 2016 were included in the study. The Berlin sleep apnea Questionnaire was completed before surgery. Oxygen saturation was recorded every second for 24 hours after the initiation of spinal anesthesia. Desaturation events were defined as a median saturation of <90% (mild) or <85% (severe) across a 30 second period. Multivariable logistic regression was used to determine predictors of a desaturation event. Results A total of 721 patients were included in the analysis. Within this cohort, 169 women (23%) experienced at least one mild desaturation event, 91 (13%) experienced two or more mild desaturations, and 26 (4%) suffered a severe desaturation event. After the administration of intrathecal morphine, the median times to first mild or first severe desaturation were 7.4 (IQR 4.1–13.5) h and 12.0 (IQR 5.4–19.6) h, respectively. Patients who screened positive for sleep apnea had increased odds of having a mild desaturation event (OR 2.31, 95% CI: 1.40 to 3.79, P=0.001), as did patients who were obese (OR 1.80, 95% CI 1.05 to 3.09, P=0.033). Conclusions Mild hypoxemia occurred frequently in women receiving intrathecal morphine 150 μg for post-cesarean analgesia. Desaturations were observed most frequently 4–8 hours after administration of intrathecal morphine. Obesity and a positive Berlin questionnaire were risk factors for hypoxemic events.

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Section: Discussionsupporting

confidence: 93%

A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150 μg

Ladha

Kato

Tsen

et al. 2017

International Journal of Obstetric Anesthesia

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“…Morphine is another opioid that had been used most commonly as an adjutant to intrathecally administered local anesthetics for pain control after cesarean delivery (20). There is more doubt regarding the anti-shivering effect of intrathechal morphine in comparison to meperidine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Intrathecal Meperidine and Morphine on Incidence and Intensity of Shivering After Caesarean Sections Under Spinal Anesthesia: A Randomized Controlled Trial

Nasseri

Ghaderi

Khezripour

2017

Iran Red Crescent Med J

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“…119 A recent study of postcesarean delivery patients who received NM showed that a significant number of healthy women (median BMI = 29 kg/m 2 [27–32 interquartile range]) had sustained hypercapnia (measured by a transcutaneous carbon dioxide monitor). 120 The only predictive factor for hypercarbia was elevated baseline transcutaneous carbon dioxide level; age, BMI, total opioid consumption, and STOP-BANG scores did not correlate with hypercarbia. The study group was not compared to women who did not receive NM, and experienced no clinically significant events, so it is difficult to draw conclusions from this regarding patient management.…”

Section: Peripartum Management Of Osamentioning

confidence: 83%

Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management

Dominguez¹,

Krystal

Habib³

2018

Anesthesia &Amp; Analgesia

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Among obese pregnant women, 15%-20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.

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Transcutaneous Carbon Dioxide Measurements in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Prospective Observational Study

Abstract: Hypercapnia events (>50 mm Hg for ≥2-minute duration) occurred frequently in women receiving 150 μg intrathecal morphine for postcesarean analgesia. Higher baseline TcCO2 readings were observed in women who had hypercapnia events.

Cited by 20 publications

References 27 publications

A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150 μg

A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150 μg

Comparison of the Effects of Intrathecal Meperidine and Morphine on Incidence and Intensity of Shivering After Caesarean Sections Under Spinal Anesthesia: A Randomized Controlled Trial

Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management

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