Is Neuraxial Anesthesia Safe in Patients Undergoing Surgery for Treatment of Periprosthetic Joint Infection?

Rasouli, Mohammad R.; Cavanaugh, Priscilla K.; Restrepo, Camilo; Ceylan, Hasan Hüseyin; Maltenfort, Mitchell; Viscusi, Eugene R.; Parvızı, Javad

doi:10.1007/s11999-015-4175-3

Cited by 11 publications

(12 citation statements)

References 30 publications

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“… 99 Handle catheters carefully to avoid contamination, reduce breakage of closed systems, and use and exchange bacterial filters. 100 Professionals assisting the anesthesiologist in regional anesthesia procedures should routinely wear surgical masks. 75 Prophylactic single-dose antibiotics should be administered before or shortly after the insertion of epidural catheters.…”

Section: Factors Associated With Infectious Complications In Regional...mentioning

confidence: 99%

SBA 2020: Regional anesthesia safety recommendations update

Azi

Fonseca

Linard

2020

Brazilian Journal of Anesthesiology (English Edition)

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Section: Factors Associated With Infectious Complications In Regional...mentioning

confidence: 99%

SBA 2020: Regional anesthesia safety recommendations update

Azi

Fonseca

Linard

2020

Brazilian Journal of Anesthesiology (English Edition)

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“…Infection is a risk factor that cannot be negated in procedures where anesthesia is necessary. In patients with periprosthetic joint infection, patients given neuraxial anesthesia had lower odds of systemic infection versus general anesthesia with rates of infection at 4% and 12% respectively [2]. While it may be the nature of the joint infection itself, it is worthwhile to consider potentially contraindicate general anesthesia if neuraxial anesthesia is a viable alternative in the event of infection.…”

Section: Special Issue: Anesthesia and Postoperative Effectsmentioning

confidence: 99%

“…In the event of sepsis, anesthesia is traditionally contraindicated to prevent systemic disease. However, recent research shows that this may not be the case [2].…”

mentioning

confidence: 98%

Food: A Causal Nexus for Acute Respiratory Distress Syndrome

Pun¹

2015

SOJAPM

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Acute respiratory distress syndrome is an unfortunate occurrence and once diagnosed, outlook is bleak with survival rates of approximately 60%. As such, it is of great interest to determine the standard of care and possible novel treatments for the future. Novel treatments of interest include mesenchymal stem cells, ghrelin and high-frequency ventilation. In a phase 1 clinical trial, mesenchymal stem cells have shown great promise in efficacy while being welltolerated in patients. In addition, while ghrelin has only shown to be effective in animal models, it shows promise for further studies. At the same time, the effectiveness of corticosteroids, which has been the standard of care along with antibiotics, has been questioned with studies indicating success while others demonstrate a lack of efficacy.

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“…Answers to these questions may become clear as we learn more about the COVID-19 virus and its pathophysiology. It is worthwhile to note that there have been numerous articles reviewing specific patient populations and implying that the risk of a new CNS infection related to a neuraxial procedure or intervention, while possible, is extremely low, ranging from 0.007% to 0.6% with ongoing bacteremia (8,9). In patients with documented bacteremia, such as chorioamnionitis, there were no patients who developed CNS infection after neuraxial procedures (10)(11)(12).…”

mentioning

confidence: 99%

“…In patients with documented bacteremia, such as chorioamnionitis, there were no patients who developed CNS infection after neuraxial procedures (10)(11)(12). Review of patients with known or highly suspected orthopedic localized joint infections and neuraxial anesthesia likewise did not report any new neuraxial infectious process (8,9). In patients with HIV, a blood patch after dural tap does not predispose for neurological disease progression (13).…”

mentioning

confidence: 99%

Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19

et al. 2020

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Background: A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood. Objectives: In this article we pose the questions of how to manage PDPH in the COVID-19 positive patient and more specifically, the use of epidural blood patch (EBP). Methods: Literature review. Results: EBP is usually considered after the failure of conservative and pharmacological treatments. Because of the additional risks of EBP in COVID-19 patients it is important to also consider less traditional pharmacological treatments such as theophylinnes and cosyntropin that may offer some additional benefit for COVID-19 patient. Finally, other interventions other than EBP should also be considered including occipital nerve blocks, sphenopalatine ganglion blocks (infratemporal or transnasal). Limitations: A narrative review with paucity of literature. Conclusion: Going forward, an effective treatment for COVID-19 or a safe vaccine and a deeper understanding of the pathophysiology of the virus will certainly change the risk calculus involved in performing an EBP in a COVID-19 patient. Key words: COVID-19; PDPH; Epidural Blood Patch; Post-dural Puncture Headache

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Is Neuraxial Anesthesia Safe in Patients Undergoing Surgery for Treatment of Periprosthetic Joint Infection?

Abstract: Background There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory.

Cited by 11 publications

References 30 publications

SBA 2020: Regional anesthesia safety recommendations update

SBA 2020: Regional anesthesia safety recommendations update

Food: A Causal Nexus for Acute Respiratory Distress Syndrome

Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19

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