Respiratory Depression Clinical Trial
Official title:
Difference in the Frequency of Episodes of Respiratory Depression Between Obese (BMI≥30) and Women With Normal BMI Receiving Spinal Anesthesia Combined With Intrathecal Morphine During Elective Caesarean Section
The study will examine whether there is a difference in the frequencies of respiratory
depression among obese women receiving spinal anesthesia combined with opioids compared to
women with normal BMI.
If such a risk exists further investigation will be required to establish the proper criteria
for the administration of morphine with spinal anesthesia to obese women.
Since 1979, intrathecal morphine combined with spinal anesthesia has been shown to provide
effective postoperative analgesia in a variety of surgeries and more specifically in
caesarean sections.
The advantages of addition of morphine to spinal analgesia are in prolonged analgesia during
the operation and post operatively. In addition the analgesia is provided using a single
injection during the time of surgery with no further need for complex and costly instruments
like an opioid pump .
The side effects and risks of intrathecal morphine include: nausea, vomiting, pruritus
urinary retention and the most severe being respiratory depression (immediate or delayed).
The mild side effects were higher postoperatively in patients receiving spinal anesthesia
combined with morphine. In a meta-analysis study of different surgeries performed under
spinal anesthesia, it has been shown that at low doses (<0.3mg) intrathecal morphine does not
increase the rate of respiratory depression. Nonetheless higher doses (>0.3mg) were
associated with more incidents of respiratory depression. In another study there was no
evidence of respiratory depression following caesarean section under spinal anesthesia
combined with morphine. Yet, in a prospective study that reviewed 856 cases of caesarean
sections under spinal anesthesia combined with morphine a rate of 8 incidences of respiratory
depression were found. In a retrospective study of 1915 cases of women undergoing caesarean
section with spinal anesthesia combined with morphine a rate of 0.25% of respiratory
depression was reported.
The definition of respiratory depression is the lack of response to hypercapnia and/or
hypoxia and it has been shown that intrathecal morphine depresses both responses. The common
parameters that are monitored in order to detect respiratory depression include respiratory
rate, sedation score, pulse oximetry, high PCo2 levels and the need for naloxone treatment.
However, the overall measurement of frequency of respiratory depression postoperatively is
variable. Accounting for this variability is the fact that hypercapnia may occur in patients
with normal respiratory rate, normal sedation score and normal oxygen saturation. In
addition, respiratory depression detected by high levels of PCo2 may be recognized earlier
than with other parameters.
The risk factors that were found to be associated with respiratory depression included high
BMI, prior opioid use, magnesium infusion and respiratory comorbidities In a study of 856
women 8 of them experienced oxygen desaturation during sleep. All of these women were
extremely obese with a prior history of deep snoring.
In this study the investigators would like to examine whether there is a difference in the
frequency of episodes of respiratory depression between obese (BMI≥30) and women with normal
BMI receiving spinal anesthesia combined with intrathecal morphine during elective caesarean
section. In previous studies it was reported that obese and non-obese women do not respond
differently to modest doses of spinal anesthesia. Hence in this study the investigators can
be certain that the investigators are examining the influence of addition of morphine to the
spinal anesthesia.
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