Maternal Respiratory Arrests, Severe Hypotension, and Fetal Distress after Administration of Intrathecal, Sufentanil, and Bupivacaine after Intravenous Fentanyl 

Respiratory arrest following intrathecal injection of sufentanil and bupivacaine in a parturient

“…Despite this, only six other cases of respiratory depression/arrest with intrathecal sufentanil have been reported. [2][3][4][5][6] We report the second case of respiratory arrest and fetal bradycardia in an opioid-free patient receiving 10 lag intrathecal sufentanil. We verified the intrathecal sufentanil dose by laboratory investigation.…”

“…1 However, there have been cases of maternal respiratory depression and/or arrest with the use ofintrathecal opioids in labour. [2][3][4][5][6][7] In most of these, the patient had received previous parenteral opioids or a larger dose of sufentanil than did our patient. We report a case of respiratory arrest after initiation of a CSE in a labouring parturient who had not been exposed to opioids.…”

The role of combined spinal epidural analgesia for labour: is there still a question?

“…The doses of IT opioid medications were higher in all these cases than presently recommended and, in three cases, the patients had received iv opioids within the preceding two to three hours. 14,15 Whether CSE poses an increased risk of fetal bradycardia compared to a standard epidural has not been well-addressed in the literature, mainly because the majority of reported CSE studies involve relatively small patient cohorts. Uterine hypertonus appears to be a specific complication of IT opioid use, and more frequently, is the cause of the bradycardia rather than maternal hypotension.…”

“…Dans tous ces cas, les doses d'opiacés IT étaient supérieures aux doses actuellement recommandées et, dans trois cas, les patientes avaient reçu des opiacés intraveineux dans les deux ou trois heures précédentes. 14,15 La question de savoir si la RPC comprend davantage de risque de bradycardie foetale qu'une péridurale standard a été mal adressée dans la littérature, et ce principalement parce que la majorité des études portant sur la RPC relatées ne concernent que des groupes relativement petits de patientes. L'hypertonie utérine semble être une complication spécifique à l'utilisation des opiacés IT et est plus fréquemment la cause de bradycardie que l'hypotension maternelle.…”

Severe maternal bradycardia and asystole after combined spinal-epidural labor analgesia in a morbidly obese parturient

“…In contrast to spinal and epidural anesthesia, [1][2][3][4][5][6][7][8] little to date has been reported on maternal bradycardia or asystole after combined spinal-epidural (CSE) labor analgesia. Here we present such a case in a morbidly obese parturient, which was followed by successful resuscitation and vaginal delivery by forceps.…”