Neurological Infections After Neuraxial Anesthesia
Section snippets
Incidence
Expectant mothers often ask about the incidence of complications of neuraxial anesthesia, but there is, in truth, no such thing as “an incidence” of meningitis or epidural abscess, accurate or otherwise. The incidence of problems varies widely, depending on the skill and training of the practitioners concerned, as well as on the risk factors in the population. The frequent occurrence of case clusters gives the lie to any attempt to measure a true incidence. Anesthesiologists, nevertheless, have
Meningitis
Meningitis may follow diagnostic lumbar puncture and myelography as well as neuraxial anesthesia. Despite the paucity of cases that are detected in surveys of neuraxial anesthesia, case reports abound. Thirty-eight concerning obstetric patients are summarized in Table 2 [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46]. There is one case of viral meningitis (case 8 [24]) and one
Epidural abscess and related infection
Epidural abscess is a recognized complication of epidural catheterization, but it may also occur spontaneously [18]. It arises infrequently among obstetric patients, as it is seen with greatest frequency among the elderly and immunocompromised [3], [4]. Cases have been reported sporadically following neuraxial blockade in obstetric patients [40], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65]; they are summarized in Table 3. One was reported as
Measures to prevent neuraxial infection
Measures to prevent neuraxial infection have now happily become the focus of increased attention, with several reviews in recent years that repay attention [77], [83], [96], [97], [98]. It is frequently mourned that measures we are asked to use are not evidence-based. Unlike infection related to surgical wounds or central venous catheterization, neuraxial infection is too rare for evidence about its prevention to be obtainable from randomized trials. Extrapolation from other fields (often
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2022, American Journal of Emergency MedicineMaterial and sedation-analgesia in the neonatal lumbar puncture procedure
2021, Anales de PediatriaA survey of international antisepsis procedures for neuraxial catheterisation in labour
2018, International Journal of Obstetric AnesthesiaCitation Excerpt :Cost issues of gowning for every procedure have also been raised, but the cost of a sterile gown may offset a far greater cost of treating an established epidural abscess or meningitis.13 Advocates of sterile gowning base their position on inferred evidence, logic and caution in the absence of data to the contrary.10,13 The majority (88%) of respondents chose a chlorhexidine-based skin preparation.
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