title: Apnea and bradypnea in patients receiving epidural bupivacaine-morphine for postoperative pain relief as assessed by a new monitoring method.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Intensive Care, Lund University Hospital, Sweden. Per.Flisberg@skane.se
authors.forename: Per
authors.initials: P
authors.lastname: Flisberg
authors.forename: Jan
authors.initials: J
authors.lastname: Jakobsson
authors.forename: Johan
authors.initials: J
authors.lastname: Lundberg
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002245:Carbon Dioxide; D009020:Morphine; D002045:Bupivacaine