Reactions 1421 - 29 Sep 2012

SBupivacaine/fentanyl

Drowsiness, respiratory depression andobstructive sleep apnoea after intrathecaladministration: case report

A 53-year-old woman developed drowsiness, respiratorydepression and obstructive sleep apnoea (OSA) afterreceiving intrathecal bupivacaine/fentanyl.

The woman, who was morbidly obese, had a history oftype 2 diabetes mellitus and hypertension. She also hadsymptoms suggestive of obstructive sleep apnoea;however, this diagnosis had not been confirmed. She wasscheduled to undergo a total abdominal hysterectomy,with regional anaesthesia planned. She received spinalanaesthesia with intrathecal bupivacaine 10mg/fentanyl25µg; a maximum T5/T6 sensory level was achieved after5 minutes. During surgery, she was very drowsy [time toonset not stated], with a RAMSAY Sedation Score of 5,corresponding to "sluggish response to stimulus". She hadperiods of obstructive apnoea, with moderate respiratorydepression and hypoxaemia, despite receiving oxygen bymask.

An oropharyngeal airway was inserted, and the womancontinued to receive oxygen. Her drowsiness subsidedafter completion of surgery and her symptoms resolved.Her postoperative analgesia was managed with diclofenacand paracetamol [acetaminophen], and she was dischargedon postoperative day 9.

Author comment: "[Obstructive sleep apnoea] may bereplicated following a high spinal anaesthesia as the de-afferentation of peripheral stimuli results in an altered level ofarousal. This is an important consideration in our patient asthe disease could have manifested itself for the first timeduring the course of anaesthesia."Fyneface-Ogan S, et al. Anaesthetic management of a super morbidly obese patientfor total abdominal hysterectomy: A few more lessons to learn. African HealthSciences 12: 181-185, No. 2, Jun 2012. Available from: URL: http://dx.doi.org/10.4314/ahs.v12i2.16 - Nigeria 803077682

1

Reactions 29 Sep 2012 No. 14210114-9954/10/1421-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved