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The sleep apnoea syndrome and epidural morphine
Canadian Anaesthetists' Society Journal
|March 1, 1986
Summary
Undiagnosed sleep apnoea syndrome (SAS) poses risks with epidural morphine. Post-operative respiratory depression occurred, highlighting the need for careful patient selection and monitoring in anaesthesia.
Area of Science:
- Anesthesiology
- Respiratory Medicine
- Pharmacology
Background:
- Combined epidural-general anesthesia is used for radical prostatectomy.
- Sleep apnoea syndrome (SAS) can present undiagnosed.
- Epidural analgesia with morphine is a common post-operative pain management strategy.
Observation:
- A patient with undiagnosed SAS received epidural morphine for post-prostatectomy pain.
- Severe respiratory depression manifested eight hours after morphine administration.
- Naloxone injections successfully reversed the respiratory depression.
Findings:
- Undiagnosed sleep apnoea syndrome (SAS) significantly increases the risk of severe respiratory depression following epidural morphine administration.
- Delayed onset of respiratory depression is a critical concern in SAS patients receiving epidural opioids.
- Early recognition and prompt administration of opioid antagonists like naloxone are crucial for managing this complication.
Implications:
- Anesthesiologists must consider the potential for undiagnosed SAS in patients undergoing procedures requiring epidural morphine.
- Pre-operative screening for SAS should be considered, especially in patients with risk factors.
- Enhanced post-operative respiratory monitoring is essential for patients receiving epidural morphine, particularly those with suspected or confirmed SAS.