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

THERE have been several reports of respiratory depression occurring in association with combined spinal epidural (CSE) analgesic techniques. 1-3 Intravenous fentanyl has been commonly administered in our institution to laboring women who either do not desire epidural analgesia or request analgesia before placement of an epidural catheter. The use of intrathecal sufentanil (ITS) plus low dose bupivacaine in CSE techniques for labor analgesia has become popular, although the use of CSE analgesia techniques may increase the risk of respiratory depression if administered after intravenous opioids have been previously given. We report one case of maternal respiratory arrest and one case of maternal respiratory arrest and severe hypotension, both accompanied by fetal distress, in two parturients who received ITS and bupivacaine after intravenous fentanyl.