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
References (126)
On spinal narcosis during labour. Special centennial article
Int J Obstet Anesth
(2000)- et al.
Serious non fatal complications associated with extradural block in obstetric practice
Br J Anaesth
(1990) - et al.
Serious complications associated with epidural/spinal blockade
Int J Obstet Anesth
(1995) - et al.
Neurological problems associated with pregnancy
Br J Anaesth
(1995) - et al.
Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10995 cases
Int J Obstet Anesth
(1998) - et al.
The safety and efficacy of combined spinal and epidural analgesia/anesthesia (6,002 blocks) in a community hospital
Reg Anesth Pain Med
(1999) - et al.
Paraesthesiae and nerve damage following combined spinal epidural and spinal anaesthesia
Int J Obstet Anesth
(2000) - et al.
Neurological complications in obstetric regional anaesthesia
Int J Obstet Anesth
(2000) - et al.
An unusual presentation of meningitis as a consequence of inadvertent dural puncture
Int J Obstet Anesth
(1991) - et al.
Bacterial meningitis following spinal anaesthesia for Caesarean section
Br J Anaesth
(1991)