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Post spinal meningitis and asepsis
Rogerio L R Videira1, P P Ruiz-Neto, M Brandao Neto
1Clínica Médica e Anestesiológica/Hospital e Maternidade São Luiz, Sao Paulo, Brazil. rogeriovideira@aol.com
Background:
Post spinal meningitis (PSM) is a complication still currently being reported. After two PSM cases in our hospital an epidemiological study was initiated, which included a survey of techniques for asepsis that are applied in our department.
Methods:
Cases defined as PSM comprised meningitis within a week after spinal anesthesia. Anesthesia records, anesthesia complication files and the records of the Hospital Commission for Infection Control from 1997 to 2000 were reviewed. Asepsis techniques applied were surveyed by a questionnaire answered by all our department's anesthesiologists. The equipment and procedures for spinal anesthesia were listed. Current anesthesia textbooks were reviewed for recommendations regarding asepsis techniques in conjunction with spinal anesthesia.
Results:
Three cases of PSM were identified following 38,128 spinal anesthesias whereas none was observed in 12,822 patients subjected to other types of regional or general anesthesia (P>0.05). Culture of cerebrospinal fluid yielded Streptococcus in two patients and was negative in the other patient. The asepsis technique applied by the anesthesiologists varied considerably. The literature review showed that aspects on asepsis for spinal anesthesia are poorly covered.
Conclusion:
The incidence of meningitis was similar in patients subjected to spinal anesthesia and in those subjected to other anesthetic techniques. Asepsis techniques were found to differ considerably among our staff members, reflecting the lack of well-defined published standards for this procedure. We recommend that asepsis for spinal anesthesia should not be less rigorous than for surgical asepsis.
Insights
Post spinal meningitis (PSM) is a rare complication. While the incidence of PSM following spinal anesthesia was similar to other anesthetic techniques, varying asepsis practices highlight the need for standardized protocols.
Area of Science:
- Anesthesiology
- Infectious Disease Epidemiology
Background:
- Post spinal meningitis (PSM) remains a reported complication.
- An epidemiological study was initiated following two PSM cases to investigate aseptic techniques.
Observation:
- Three cases of PSM occurred after 38,128 spinal anesthesias.
- No PSM cases were observed after 12,822 other anesthetic procedures.
- Cerebrospinal fluid cultures identified Streptococcus in two PSM patients.
Findings:
- Aseptic techniques among anesthesiologists varied significantly.
- Literature review indicated poor coverage of asepsis for spinal anesthesia.
- No statistically significant difference in PSM incidence between spinal and other anesthesia types was found.
Implications:
- Standardized, rigorous aseptic techniques for spinal anesthesia are recommended, akin to surgical asepsis.
- Addressing variations in practice can potentially reduce PSM incidence.
- Further research into optimal aseptic protocols for neuraxial anesthesia is warranted.