RESPIRATORY DEPRESSION FOLLOWING EPIDURAL MORPHINE IN AN INFANT OF 3 MONTHS OF AGE

Epidural administration of combinations of opioids and a local anaesth etic provides prompt and effective analgesia and is increasingly used in paediatric anaesthesia. However, respiratory depression by rostral spread of opioid in the CSF is by far the greatest concern after epidu ral morphine. An infant of three months of age underwent portoenterost omy (Kasai's operation) for extrahepatic biliary duet atresia. A media n approach at the L(3)-L(4) epidural interspace was used and a dose of 1 ml . kg(-1) of 0.125% bupivacaine with adrenaline 1:400 000 mixed w ith 50 mu g . kg(-1) morphine was injected using a 19 gauge Tuohy need le. Six h after epidural morphine, the infant developed respiratory de pression with an increase in drowsiness, miosis and decreased respirat ory rate. Low arterial saturation (SpO(2)) was detected by pulse oxime try and confirmed by blood gas analysis. An intravenous bolus of 5 mu g . kg(-1) naloxone followed by a 3-h infusion of 2 mu g . kg(-1). h(- 1) resulted in complete reversal of signs and symptoms of respiratory depression. Epidural opioids should be limited to paediatric patients admitted to specialized recovery units for the first postoperative day .