Abstract
Background: Obesity, abdominal surgery, and intrathecal opioids are all factors associated with a risk for respiratory compromise. The aim of this observational study was to explore the use of portable respiratory polygraphy for monitoring of obese mothers for respiratory depression the first night after caesarean section (CS) with bupivacaine/morphine/fentanyl spinal anaesthesia. Methods: Consecutive obese (BMI >30 kg/m 2) mothers, ≥18 years, scheduled for CS with bupivacaine/morphine/fentanyl spinal anaesthesia were monitored with a portable polygraphy device Embletta /NOX on the first postoperative night. The apnoea-hypopnea index (AHI) was identified by clinical algorithm and assessed in accordance to general guidelines. Results: Forty mothers were invited to participate: 27 consented, 23 were included, but polysomnography registration failed in 3. Among the 20 mothers: 11 had an AHI <5; 7, AHI 5-15; and 2, AHI >15. The oxygen desaturation index (ODI) was on average 4.4, and eight patients had an ODI >5. Those mothers with a high AHI (15.3 and 18.2) did not show high ODI or signs of hypercapnia on transcutaneous CO 2 registration. Mean saturation was 94% (91-96), and four mothers had mean saturation between 90-94%, but none had a mean SpO 2 <90%. Mean nadir saturation was 71% (range, 49-81%). None of the mothers showed clinical signs or symptoms of severe respiratory depression, shown by routine clinical monitoring. Conclusion: We found portable polygraphy registration during early post-CS in moderately obese mothers having had intrathecal morphine/fentanyl cumbersome and although episodes of oxygen saturation decrease were noticed, obstructive events and episodes of desaturation were commonly not synchronised. Upper airway obstructions seem not be of major importance in this clinical setting. Monitoring of respiratory rate, SpO 2 and possibly transcutaneous CO 2 in mothers at high risk of respiratory distress warrants further studies. Preoperative screening in obese patients, at risk for sleep breathing disorder, is of course of value.
Highlights
In caesarean section (CS), intrathecal morphine (ITM) is associated with better postoperative course with less pain and shorter time to mobilisation[1]
It has been suggested that ITM in doses 0.3 mg, and a tendency to a lower risk as compared to systemic opioids[3,6]
Portable sleep test equipment and at-home polygraphy monitoring is commonly used for screening for obstructive sleep apnoea. This equipment assesses respiration, actual gas flow, and saturation, and transforms the information into indices: apnoeahypopnea index (AHI) and oxygen desaturation index (ODI) using defined algorithms. The aim of this observational study was to explore the use of portable respiratory polygraphy for monitoring of obese mothers for respiratory depression over the first night after CS with bupivacaine/morphine/fentanyl spinal anaesthesia
Summary
In caesarean section (CS), intrathecal morphine (ITM) is associated with better postoperative course with less pain and shorter time to mobilisation[1]. Comments: This study done on exploring the optimal monitoring device to diagnose respiratory depression with intrathecal morphine for LSCS in high BMI parturients, does not rule out undiagnosed OSA patients before abdominal surgery esp. Abdominal surgery, and intrathecal opioids are all factors associated with a risk for respiratory compromise The aim of this observational study was to explore the use of portable respiratory polygraphy for monitoring of obese mothers for respiratory depression the first night after caesarean section (CS) with bupivacaine/morphine/fentanyl spinal anaesthesia. Conclusion: We found portable polygraphy registration during early post-CS in moderately obese mothers having had intrathecal morphine/fentanyl cumbersome and episodes of oxygen saturation decrease were noticed, obstructive events and episodes of desaturation were commonly not synchronised. Preoperative screening in obese patients, at risk for sleep breathing disorder, is of value
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