Apnea and bradypnea in patients receiving epidural bupivacaine-morphine for postoperative pain relief as assessed by a new monitoring method.
OBJECTIVE
To evaluate postoperative breathing patterns with a new monitoring device in patients given bupivacaine-morphine epidural analgesia.


METHODS
Open explorative study.


METHODS
Inpatient anesthesia in a university hospital setting.


METHODS
15 ASA physical status I and II patients aged 28 to 87 years and scheduled for major abdominal surgery.


METHODS
All patients underwent abdominal surgery with epidural anesthesia combined with general anesthesia. Postoperatively, they continued with epidural analgesia consisting of bupivacaine and morphine. On the first postoperative night, the breathing pattern was studied with a new noninvasive monitoring device measuring respiratory frequency and apnea. Arterial blood gas analysis was performed in case of apnea or low respiratory frequency.


RESULTS
A total of 84 alarm events were registered in 11 patients. Twenty-one percent (18/84) of the alarms were associated with arterial carbon dioxide tension (PaCO2) levels greater than 48.8 mmHg. Three of the four patients with PaCO2 levels greater than 48.8 mmHg were older than 80 years of age.


CONCLUSIONS
The tested noninvasive monitoring device may detect abnormal respiratory breathing patterns in patients at risk for respiratory depression during epidural analgesia with bupivacaine-morphine.
Flisberg
Per
P
Department of Anesthesiology and Intensive Care, Lund University Hospital, Sweden. Per.Flisberg@skane.se
Jakobsson
Jan
J
Lundberg
Johan
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D001049:Apnea / Q000175:diagnosis / Q000209:etiology*; D002045:Bupivacaine / Q000009:adverse effects*; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009020:Morphine / Q000009:adverse effects*; D010149:Postoperative Pain / Q000517:prevention & control*; D012120:Respiration Disorders / Q000175:diagnosis / Q000209:etiology
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002245:Carbon Dioxide; D009020:Morphine; D002045:Bupivacaine