Neurological Infections After Neuraxial Anesthesia

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Infection is the commonest cause of serious neurologic sequelae of neuraxial anesthesia. The incidence depends on operator skill and patient population. Meningitis, a complication of dural puncture, is usually caused by viridans streptococci. The risk factors are dural puncture during labor, no mask and poor aseptic technique, vaginal infection and bacteremia. Epidural abscess is a complication of epidural catheterization, route of entry the catheter track and the organism usually the staphylococcus. Principal risk factors are prolonged catheterization, poor aseptic technique and traumatic insertion. Prevention includes wearing a mask, using a full sterile technique, avoiding prolonged catheterization and prescribing antibiotics in a high-risk situation.

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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