Meningitis after combined spinal-extradural anaesthesia in obstetrics

Abstract

We report two cases of meningitis which developed after combined spinal-extradural procedures for obstetric analgesia. The first case was thought to be caused by aseptic or chemical meningitis and the second was a case of bacterial meningitis in a patient who also received an extradural blood patch. It is important that meningitis is considered as a differential diagnosis in patients who present with headache after spinal anaesthesia and that antibiotic therapy is selected to cover unusual organisms.

Méningite après rachianesthésie

“…Les méningites peuvent être d'origine infectieuse; le plus souvent bactérienne, ou dues à une irritation locale: méningite aseptique. Il est impossible de trancher entre une méningite aseptique et méningite décapitée [5, 6]. Les méningites aseptiques sont dues à une réaction méningée lors de l'introduction des substances ou de corps étranger irritants dans l'espace sous arachnoïdien [7].…”

Intrathecal opioids versus epidural local anesthetics for labor analgesia: A meta-analysis☆

“…Because several cases of neuraxial infections have been reported after intrathecal opioid injections, future studies should evaluate the risk of these potentially serious complications. 14,15 Although reports of maternal respiratory depression have also been noted, especially when intrathecal opioids follow parenteral opioid administration, the true incidence of respiratory depression is unknown. 13,41,42 In addition, insufficient data limited our ability to evaluate the incidence of hypotension and fetal heart rate changes.…”

“…[4][5][6][7] Other reported complications include hypotension, [8][9][10] fetal heart rate changes, 8,10,11 respiratory depression, 12,13 and neuraxial infection. [14][15][16] Epidural local anesthetic administration results in improved analgesia when compared with parenteral and epidural opioids alone. 17,18 Epidural local anesthetic administration avoids opioid-related side effects, 7,19 but may be associated with a higher incidence of motor block.…”

Two cases of chemical meningitis following spinal anesthesia

“…In the last 3 years, only a single case of aseptic meningitis in a child has been reported [3]. For the cases of aseptic meningitis, previous reports [1,[4][5][6][7][8] incriminated cleansing agents and antiseptics that adhere to the syringes and puncture needles for spinal anesthesia and called the resultant condition chemical meningitis. We examined the glass syringe that was cleansed and sterilized at our hospital and used for spinal anesthesia by ninhydrin color reaction using thin-layer chromatography.…”