Clinical case report: respiratory depression following intrathecal opioid administration

  • Adriana Paola Barriga Second-year anesthesia student. Bogotá, Colombia
  • José Ricardo Navarro Vargas Professor of Anesthesiology, National University of Colombia. Bogotá, Colombia Service Review - Anesthesia Unit - National University, Bogotá, Colombia
Keywords: Respiratory Insufficiency, Morphine, Postoperative Period, Anesthesia, Conduction

Abstract

Objective: Description of a case of respiratory depression during the late post-operative period in an obstetrics patient who received regional subarachnoidal anesthesia using a local anesthetic and intrathecal morphine.

Methods: The clinical case review, during the monthly review meeting at the Anesthesiology Unit of the National University of Colombia, discusses a clinical case of interest, in accordance with a sequence of topics, e.g.: third delay, when the patient is admitted and the clinical history is taken; fourth delay, when the patient is scheduled for surgery and the anesthesiologist performs the pre-anesthesia assessment, including the anesthetic evaluation and management, monitoring analysis, potential complications and their management, etc.

Result: Each case must generate a clinical discussion based on evidence in the literature and must be part of a competencies approach, including knowledge, know-how and communication skills. This particular case illustrates a sequence of errors that resulted in incidents and even adverse events. The physical evaluation and the considerations pertaining to the anesthetic and surgical procedures must be carefully recorded in the anesthesia record. Likewise, it is important to foresee conditions such as respiratory depression, which is one of the side effects of opioid administration and requires close monitoring and appropriate management.

References

1. Hajenius PJ, Mol F, Mol BWJ, Bossuyt PMM, Ankum WM, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD000324.

2. Miller R, Eriksson L, Fleisher L. Preoperative Evaluation. En: Miller's Anesthesia, Cap. IV: Anesthesia Management, 34. 7 ed. Elsevier; 2009. p. 69-72.

3. American Society of Anesthesiologists. ASA Physical Status Classification System. 1995-2011. Disponible en: URL: http://www.asahq.org Revisado en octubre de 2011.

4. Beck-Schimmer B, Bonvini J. Bronchoaspiration: incidence, consequences and management. Eur J Anaesthesiol. 2011;28:78-84.

5. Mace S. Challenges and advances in intubation: airway evaluation and controversies with intubation. Emerg Med Clin N Am. 2008;26:977-1000.

6. Fischer B. Benefits, risks, and best practice in regional anesthesia, do we have the evidence we need? Reg Anesth Pain Med. 2010;35:545-8.

7. Gulur P, Nishimori M, Ballantyne J. Regional anaesthesia ver-sus general anaesthesia, morbidity and mortality. Best Pract Res Clin Anaesthesiol. 2006;20:249-63.

8. Breen P, Park KW. General Anesthesia versus Regional Anesthesia. Int Anesthesiol Clin. 2002;40:61-71.

9. Hanna M, Murphy J, Kumar K, Wu C. Regional techniques and outcome: what is the evidence? Curr Opin Anaesthesiol. 2009;22:672-7.

10. Tziavrangos E, Schug S. Regional anaesthesia and perioperative outcome. Curr Opin Anaesthesiol. 2006; Mosby. 19:521-5.

11. Carvalho B. Respiratory depression after neuraxial opioids in the obstetric setting. Anesth Analg. 2008;107:956-61.

12. Ruan X. Drug-related side effects of long-term intrathecal morphine therapy. Pain Physician. 2007;10:357-65.

13. Gehling M., Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009;64:643-51.

14. Nolana J, Soarb J, Zideman D, Biarent D, Bossaert L, Deakin C, et al. European Resuscitation Council Guidelines for Resuscitation 2010, Section 1. Executive summary. Resuscitation. 2010;81:1219-76.

15. Field J, Hazinski M, Sayre M, Chameides L, Schexnayder S, Hemphill R, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122;S640-56.

16. Kern K, Sasaoka T, Higashi H, Hilwig R, Berg R, Zuercher M. Post-resuscitation myocardial microcirculatory dysfunction is ameliorated with eptifibatide. Resuscitation. 2011;82:85-9.

17. Aehlert B. Myocardial ischemia, injury, and infarction. En ACLS. Quick Review Study Guide. 2 ed. St Louis, (MS): Mosby;2005. p. 285.

18. Shapiro A, Zohar E, Zaslansky R, Hoppenstein D, Shabat S, Fredman B. The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine. J Clin Anesth. 2005;17:537-42.
How to Cite
1.
Barriga AP, Navarro Vargas JR. Clinical case report: respiratory depression following intrathecal opioid administration. Colomb. J. Anesthesiol. [Internet]. 2012 Jan. 1 [cited 2024 Jun. 17];40(1):82-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/871

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Published
2012-01-01
How to Cite
1.
Barriga AP, Navarro Vargas JR. Clinical case report: respiratory depression following intrathecal opioid administration. Colomb. J. Anesthesiol. [Internet]. 2012 Jan. 1 [cited 2024 Jun. 17];40(1):82-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/871
Section
Case Report / Case Series

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