The effect of distance from injection site to the brainstem using spinal sufentanil

Citation
Jd. Swenson et al., The effect of distance from injection site to the brainstem using spinal sufentanil, REG ANES PA, 26(4), 2001, pp. 306-309
Citations number
18
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
REGIONAL ANESTHESIA AND PAIN MEDICINE
ISSN journal
1098-7339 → ACNP
Volume
26
Issue
4
Year of publication
2001
Pages
306 - 309
Database
ISI
SICI code
1098-7339(200107/08)26:4<306:TEODFI>2.0.ZU;2-E
Abstract
Background and Objectives: Intrathecal (IT) sufentanil is commonly used in parturients to provide rapid onset of labor analgesia without motor block. This practice, although widely used, has been associated with severe respir atory depression in some patients. The mechanism of this respiratory depres sion is unclear, however, rapid cephalad movement and interaction with pare nteral opioids are 2 frequently cited explanations for this complication. B ecause this complication has occurred only in women with heights between 15 0 and 157 cm, we elected to study the effect of the distance from injection site to the cisterna. magna (CM) on peak brainstem cerebrospinal fluid (CS F) concentrations. Methods: Ten adult ewes were injected with IT sufentanil (0.3 mug/kg) at a mean distance of either 71 cin (65 to 78 cm) from the brainstem. (pelvic gr oup) or 37 cm (34 to 42 cm)from the brainstem (thoracic group). CSF was the n sampled at 5-minute intervals from the CM. Results: Measurable CM concentrations of sufentanil were noted in the brain stem at 20 and 25 minutes, respectively, for the thoracic and the pelvic gr oups. Peak sufentanil concentrations from the thoracic group were nearly 10 -fold higher (0.553 +/- 0.43 ng/mL) compared with the pelvic group (0.064 /- 0.002 ng/mL) when measured in the CM (P = .023) Conclusions: Our results suggest that sufentanil migrates relatively large distances in the IT space. Injection site (distance from the brainstem) app ears to be a prominent factor in determining brainstem concentrations and s ubsequent respiratory depression after spinal administration.