Transcutaneous carbon dioxide levels and oxygen saturation following caesarean section performed under spinal anaesthesia with intrathecal opioids

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• 作者：S. Dalchow ; O. Lubeigt ; G. Peters ; A. Harvey ; T. Duggan ; A. Binning
• 关键词：Transcutaneous carbon dioxide ; Respiratory depression ; Caesarean section ; Opioid
• 刊名：International Journal of Obstetric Anesthesia
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：22
• 期：3
• 页码：217-222
• 全文大小：195 K

文摘

Background

Intrathecal opioids can be associated with respiratory depression which may have serious consequences. We describe the use of a non-invasive monitor (TOSCA) to measure transcutaneous carbon dioxide levels and percentage of haemoglobin oxygen saturation in post-caesarean section patients in two hospitals which used different intrathecal opioids.

Methods

Eighty-nine women undergoing caesarean section were monitored postoperatively until 08.00 h on the first postoperative day. In addition to hyperbaric bupivacaine, patients from Hospital 1 received intrathecal diamorphine 300 ¦Ìg: those from Hospital 2 received intrathecal fentanyl 15 ¦Ìg and postoperative intramuscular morphine 10 mg and were given morphine patient-controlled analgesia. Data from TOSCA were analysed the following day. Respiratory depression was defined as oxygen saturations <90 % or transcutaneous carbon dioxide levels >7 kPa for >2 min or the need for medical intervention for clinical respiratory depression.

Results

Sustained hypercapnia was recorded in 8/45 (17.8 % ) patients from Hospital 1 and 3/44 (6.8 % ) from Hospital 2. Sustained oxygen saturations <90 % were recorded in one patient from Hospital 2 and none from Hospital 1. The overall incidence of respiratory depression was 17.8 % in Hospital 1 and 9.1 % in Hospital 2. The median duration of hypercapnia was 9 min [IQR 5.8-12.4] in Hospital 1 and 11.5 min [IQR 7-32.8] in Hospital 2. No patient required medical intervention.

Conclusions

The incidence of opioid-induced respiratory depression detected by TOSCA is higher than previously reported by other monitoring methods. TOSCA may have a role in detecting subclinical respiratory depression in the obstetric population. Further studies with a control population are needed.