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LETTERS TO THE EDITOR

Epidural Opioids and Respiratory Arrests

M. Th. Rennotte, MD^*, Ph. Baele, MD, FCCP^*, G. Aubert, MD, PhD, and D. O. Rodenstein, MD, PhD

Departments of *Anesthesiology, Neurology, and Pneumology Clin. Univ. St. Luc Université Catholique de Louvain Brussels, Belgium

We read with interest the article by Ostermeier et al. (1). We agree with the principle of adopting a high degree of suspicion toward the possibility of obstructive sleep apnea syndrome (OSAS) in the presence of certain risk factors. However, we were very surprised at the authors’ advice of treating related conditions instead of the actual disease (OSAS) itself.

We reported 16 patients with OSAS undergoing surgery: 14 were accustomed to wearing a nasal continuous positive airway pressure (nCPAP) device, which they used soon after tracheal extubation postoperatively. No complications were experienced by this group of patients (2).

In their review, Ostermeier et al. only included 3 of our 16 patients, 2 of whom had complications. By doing so, the figures obtained were significantly different from what they should have been. In fact, 32 cases have been reported so far (1–4). Sixteen patients experienced no major complications, all of whom had their airway kept open mechanically in some way—either by nCPAP or tracheotomy (p < 0.001, Fisher exact test). Therefore, an important conclusion has been missed, i.e., that ensuring continuous mechanical prevention of airway obstruction allows for safe anesthesia in patients with OSAS.

However, because of the small numbers reported so far, further research is required to confirm this finding.

References

1. Ostermeier AM, Roizen MF, Hautkappe M, et al. Three sudden postoperative respiratory arrests associated with epidural opioids in patients with sleep apnea. Anesth Analg 1997;85:452–60.[Web of Science][Medline]
2. Rennotte MT, Baele P, Aubert G, et al. Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest 1995;107:367–74.[Abstract/Free Full Text]
3. Vandercar DH, Martinez AP, De Lisser EA. Sleep apnea syndromes: a potential contraindication for patient-controlled analgesia. Anesthesiology 1991;74:623–24.[Web of Science][Medline]
4. Boushra NN. Anaesthetic management of patients with sleep apnoea syndrome. Anaesth 1996;43:599–616.

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