Abstract
Background: Obesity, abdominal surgery, and intrathecal opioids are all factors associated with a risk for respiratory compromise. The aim of this explorative trial was to study the apnoea/hypopnea index 1st postoperative night in obese mothers having had caesarean section (CS) in spinal anaesthesia with a combination of bupivacaine/morphine and fentanyl. 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 1 st postoperative night. The apnoea/hypopnea index (AHI) was identified by clinical algorithm and assessed in accordance to general guidelines; number of apnoea/hypopnea episodes per hour: <5 "normal", ≥5 and <15 mild sleep apnoea, ≥15 and <30 moderate sleep apnoea, ≥ 30 severe sleep apnoea. Oxygen desaturation events were in similar manner calculated per hour as oxygen desaturation index (ODI). Results: Forty mothers were invited to participate: 27 consented, 23 were included, but polysomnography registration failed in 3. Among the 20 mothers studied: 11 had an AHI <5 ( normal), 7 mothers had AHI ≥5 but <15 ( mild OSAS) and 2 mothers had AHI ≥15 ( moderate OSA), none had an AHI ≥ 30. The ODI was on average 4.4, and eight patients had an ODI >5. Mothers with a high AHI (15.3 and 18.2) did not show high ODI. Mean saturation was 94% (91-96%), and four mothers had mean SpO 2 90-94%, none had a mean SpO2<90%. Conclusion: Respiratory polygraphy 1 st night after caesarean section in spinal anaesthesia with morphine in moderately obese mothers showed AHIs that in sleep medicine terms are considered normal, mild and moderate. Obstructive events and episodes of desaturation were commonly not synchronised. Further studies looking at preoperative screening for sleep apnoea in obese mothers are warranted but early postop respiratory polygraphy recording is cumbersome and provided sparse important information.
Highlights
In caesarean section (CS), intrathecal morphine (ITM) is associated with better postoperative course with less pain and shorter time to mobilisation[1]
Patients were informed at the preanaesthetic consultation about spinal analgesia and that they would receive a mixture of local anaesthesia, bupivacaine, and two opioids, fentanyl and morphine, in order to optimize perioperative and postoperative anaesthesia, according to the standard routine at our department (Anaesthesia & Intensive Care Unit, Danderyd Hospital)
We did not find any apnoea/hypopnea index (AHI) defined as severe sleep apnoea in this at risk cohort; obese mothers 1st night after caesarean section in spinal anaesthesia including morphine and fentanyl
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. ○ I agree with the conclusion by authors that device is cumbersome with no reproducible results until proven otherwise by studying with large sample size in patients with preoperative screening in obese parturients (with already decreased respiratory reserve ) at risk of OSA and comparing with routine monitoring. Abdominal surgery, and intrathecal opioids are all factors associated with a risk for respiratory compromise The aim of this explorative trial was to study the apnoea/hypopnea index 1st postoperative night in obese mothers having had caesarean section (CS) in spinal anaesthesia with a combination of bupivacaine/morphine and fentanyl.
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