Abstract
A case of respiratory depression which occurred following administration of epidural meperidine during Caesarean section is described. Epidural meperidine, 75 mg (10 mg · ml−1) was given after delivery of the infant to provide postoperative analgesia. Oxygen desaturation (SaO2 90%) and a decrease in respiratory rate (4 · min−1) were noted 30 min after epidural meperidine was administered. Naloxone, 0.1 mg, was given iv which resulted in prompt improvement in both respiratory rate and oxygen saturation. Vascular absorption of meperidine from the epidural venous plexus is the most probable explanation for this case of early respiratory depression. We recommend a maximum bolus dose of 50 mg of epidural meperidine for pain management after Caesarean section. It is also important to monitor oxygen saturation continuously during the intraoperative period, and to monitor the patient closely in the recovery room for at least one hour for evidence of respiratory depression.
Résumé
Un cas de dépression respiratoire qui est survenu après administration épidurale de mépéridine durant une césarienne est décrit. Du mépéridine par voie épidurale 75 mg (10 mg · ml−1) est administré après l’accouchement afin de fournir une analgésie postopératoire. La désaturation en oxygène (SaO2 90%) et la diminution de la fréquence respiratoire (4 · min−1) furent notées 30 minutes après administration épidurale de mépéridine. Du naloxone 0,1 mg fut administré par voie intraveineuse, ce qui a amené une amélioration de temps de la fréquence respiratoire et de la saturation en oxygène. L’absorption vasculaire de mépéridine à travers le plexus veineux épidural est l’explication la plus probable de ce cas de dépression respiratoire précoce. On recommande une dose maximale de bolus de 50 mg de mépéridine épidurale pour le soulagement de la douleur après césarienne. Il est aussi important de surveiller continuellement la saturation en oxygène durant la période peropératoire et de surveiller le patient étroitement dans la salle de réveil pour au moins une heure afin de mettre en évidence une dépression respiratoire.
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Rosaeg, O.P., Suderman, V. & Yarnell, R.W. Early respiratory depression during Caesarean section following epidural meperidine. Can J Anaesth 39, 71–74 (1992). https://doi.org/10.1007/BF03008677
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DOI: https://doi.org/10.1007/BF03008677