SOAP: Consensus Recommendation for Prevention and Detection of Respiratory Depression Associated with

Neuraxial Morphine Administration for Cesarean Delivery Analgesia

Epidural Dosing Spinal Dosing

Patient Risk Factors Ultra Low Dose
• Obesity (BMI > 40) • Low Risk Healthy Patients
• Known or suspected < 1 mg • No additional respiratory monitoring < 0.05
OSA beyond Routine Institutional Post-Op mg
• Chronic Opiate Cesarean Delivery Monitoring
Use/Abuse (RIPOCDM)
• Cardiopulmonary/neur
>1 and <3 mg Low Dose >0.05-< 0.15 mg
ologic comorbidity
• Low Risk Healthy Patients
• Hypertension
• RIPOCDM plus respiratory rate and
Peri/postoperative Risk
sedation monitoring every 3 hours for 12
Factors
hours
• General anesthesia
• Additional sedative > 3 mg High Dose or Any High Risk Patient > 0.15 mg
medications RIPOCDM plus ASA/ASRA recommendations
• IV opiates • Respiratory rate and sedation
• Benzodiazepines • Every hour for first 12 hours
• Sleep aids • Every 2 hours for next 12 hours
• Intra-op/post-op • Continuous pulse oximetry when
respiratory events appropriate, vs continual intermittent LINK:SOAP Consensus
• Magnesium infusion pulse oximetry Recommendations
• Especially those with Obstructive
Sleep Apnea (OSA), or at risk for
OSA LINK:ASRA Practice
Guidelines