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OBSTETRIC ANESTHESIOLOGY

Respiratory Depression After Neuraxial Opioids in the Obstetric Setting

From the Department of Anesthesia, Stanford University School of Medicine, Stanford, California.

Address correspondence to Brendan Carvalho, MBBCh, FRCA, Department of Anesthesia, H3580, Stanford University School of Medicine, Stanford, CA 94305. Address e-mail to bcarvalho{at}stanford.edu.

Abstract

Neuraxial opioids have contributed significantly to improved labor and postcesarean delivery analgesia. In the obstetric population, epidural and intrathecal opioids are associated with a very low risk of clinically significant respiratory depression. Although rare, respiratory depression is a serious risk; patients may die or suffer permanent brain damage as a consequence. This review discusses the mechanism and incidence, as well as the prevention, detection, and management of respiratory depression with morphine, extended-release epidural morphine, and lipophilic opioids in the labor and cesarean delivery setting.

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