Reactions 666 - 30 Aug 1997

SBupivacaine/fentanyl/sufentanil

Maternal respiratory insufficiency and hypotensionand fetal distress: 2 case reports

Two women who were in labour developed respiratoryarrest and 1 also developed severe hypotension, after theyreceived intrathecal sufentanil and bupivacaine following IVfentanyl. Fetal distress also occurred in both cases.

The first patient, aged 19 years, was admitted to hospital inlabour and received 3 doses of IV fentanyl 100µg over a 2-hourperiod. She requested spinal epidural analgesia 3.5 hours afteradmission and was given sufentanil 10µg and bupivacaine2.5mg in 2ml of saline intrathecally.

Five minutes later, she developed apnoea and cyanosis andlost consciousness. A pulse oximeter read 54%, the maternalHR was 45 beats/min, BP was 108/47mm Hg and fetal HR was60 beats/min. She was given assisted ventilation with a bag andmask and 100% oxygen and her BP, HR and fetal HR improved.The patient was treated with IV naloxone and regainedconsciousness. Two minutes later, the maternal HR was 91beats/min, maternal BP was 136/71mm Hg and maternaloxygen level was 98%; the fetal HR was 130 beats/min. Analoxone infusion was started to prevent a recurrence ofrespiratory depression. No further adverse effects occurredafter a continuous infusion of bupivacaine 0.0625% at 10 ml/hwas started. A healthy baby was delivered 9 hours after thepatient’s admission.

The second patient, aged 22 years, was admitted to hospitalin labour and was given 2 doses of IV fentanyl 50µg,approximately 2 hours apart. Two hours later, she receivedintrathecal sufentanil 10µg and bupivacaine 2.5mg in 2 mlsaline. Approximately 10 minutes later, she developed thesame symptoms as the first patient. The maternal HR was 40beats/min and the fetal HR was 60 beats/min. The patientrequired resuscitation, including chest compressions whenher pulse was not palpable. She was given IV naloxone andafter her SaO2 increased from 50 to 95%, she rapidly regainedconsciousness. An infusion of naloxone was initiated andbupivacaine 0.0625% at 10 ml/h was infused uneventfully. Ahealthy baby was delivered 4 hours later.

Author comment: ‘Previous administration of intravenousfentanyl may have increased the respiratory depressionassociated with administration of intrathecal sufentanil andbupivacaine.’Lu JK, et al. Maternal respiratory arrests, severe hypotension, and fetal distressafter administration of intrathecal, sufentanil, and bupivacaine after intravenousfentanyl. Anesthesiology 87: 170-172, Jul 1997 - USA 800552292

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Reactions 30 Aug 1997 No. 6660114-9954/10/0666-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved