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Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia.
Anesth Analg. 2019 08; 129(2):458-474.A&A

Abstract

The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Bauchat JR
From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Weiniger CF
Division of Anesthesiology & Critical Care & Pain, Sourasky Medical Center, Tel Aviv, Israel.
Sultan P
Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, United Kingdom.
Habib AS
Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
Ando K
Department of Anesthesiology, Aichi Medical University, Aichi, Japan.
Kowalczyk JJ
Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Kato R
Division of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan.
George RB
Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
Palmer CM
Department of Anesthesiology, University of Arizona College of Medicine, Tucson, Arizona.
Carvalho B
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.

MeSH

Analgesia, ObstetricalAnalgesics, OpioidCesarean SectionConsensusDrug Administration ScheduleFemaleHumansLungMorphinePain, PostoperativePregnancyRespirationRespiratory InsufficiencyRisk AssessmentRisk FactorsTreatment Outcome

Pub Type(s)

Journal Article
Practice Guideline
Systematic Review

Language

eng

PubMed ID

31082964

Citation

Bauchat, Jeanette R., et al. "Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia." Anesthesia and Analgesia, vol. 129, no. 2, 2019, pp. 458-474.
Bauchat JR, Weiniger CF, Sultan P, et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. Anesth Analg. 2019;129(2):458-474.
Bauchat, J. R., Weiniger, C. F., Sultan, P., Habib, A. S., Ando, K., Kowalczyk, J. J., Kato, R., George, R. B., Palmer, C. M., & Carvalho, B. (2019). Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. Anesthesia and Analgesia, 129(2), 458-474. https://doi.org/10.1213/ANE.0000000000004195
Bauchat JR, et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. Anesth Analg. 2019;129(2):458-474. PubMed PMID: 31082964.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. AU - Bauchat,Jeanette R, AU - Weiniger,Carolyn F, AU - Sultan,Pervez, AU - Habib,Ashraf S, AU - Ando,Kazuo, AU - Kowalczyk,John J, AU - Kato,Rie, AU - George,Ronald B, AU - Palmer,Craig M, AU - Carvalho,Brendan, PY - 2019/5/15/pubmed PY - 2020/2/6/medline PY - 2019/5/15/entrez SP - 458 EP - 474 JF - Anesthesia and analgesia JO - Anesth Analg VL - 129 IS - 2 N2 - The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/31082964/Society_for_Obstetric_Anesthesia_and_Perinatology_Consensus_Statement:_Monitoring_Recommendations_for_Prevention_and_Detection_of_Respiratory_Depression_Associated_With_Administration_of_Neuraxial_Morphine_for_Cesarean_Delivery_Analgesia_ DB - PRIME DP - Unbound Medicine ER -