Post operative monitoring following neuraxial opioids and cases of respiratory depression - An OAA approved survey of UK practice
Abstract Number: 43
Abstract Type: Original Research
Introduction: Respiratory depression is a well recognised complication of intrathecal and epidural opioid usage.1 There is still debate about post operative monitoring following intrathecal opioids 2 and although there are national guidelines on post operative monitoring 3 we wanted to establish current practice in the United Kingdom.
Methods: Following OAA approval (survey number 100) an email questionnaire was sent to 218 lead obstetric anaesthetists in september 2010. Questions were posed on neuraxial opioid usage, guidelines for post operative monitoring and duration. We also enquired about incidents of respiratory depression.
Results: Of the 218 invited participants 169 responded (77.5%) with 6 responses rejected. The majority of departments had guidelines on monitoring patients post administration of intrathecal opioids 76.4%, with 3% in the development stages. They were monitored post caesarean section on the ward 22.4%, a dedicated recovery area 69.7% and in the delivery ward 7.9%. Table 1 shows how long they remained in this area. The mean time to stay in this area was 6.47 hours, with 86.6% of departments staying for 6 hours or less.
The frequency of monitoring varied from every 5 min to every hour, with 50% of respondents monitoring every 15 minutes. Incidents of respiratory depression following neuraxial opioids were reported by 13 (7.9%) respondents, with 3 cases not in obstetric practice. Of the remaining 11 cases one included using remifentanyl for breakthrough pain following an epidural top up, one a dilution error of diamorphine, and one a delayed respiratory depression with 20mcg morphine intrathecally. The other cases were increased sensitivity to opioids.
Discussion: There is a low incidence of reported respiratory depression in UK practice despite wide variations in monitoring patients post administration of intrathecal and epidural opioids.
1. Gustafsson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: Report of a nationwide survey in Sweden British J Anaesth 1998;81:86-93
2. Smiley R. All parturients receiving neuraxial morphine should be monitored with continuous pulse oximetery Int J Obstet Anaesth 2010;19:204-208
3. NICE April 2004 Caesarean section CLinical Guideline