Meningitis following spinal anaesthesia — a coincidental infection?

Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: A 23‐year survey in a district general hospital

“…Second, it shows that headache following a neuraxial block may be due to a cause other than PDPH. Finally, in a patient who has received prophylactic broad spectrum antibiotics following a caesarean section, bacterial growth may be slow, delaying the onset of meningitis [25].…”

Infection as a complication of neuraxial blockade

“…Nevertheless, judging by the numbers of published cases, it could be the second commonest neurological complication of neuraxial analgesia in labour, after paraesthesiae. Loo et al 6 found 20 cases, 31,[43][44][45][46][47][48][49][50][51][52][53][54] while at least seven others [55][56][57][58][59][60][61] and one case of Herpes simplex encephalitis 62 among parturients, and dozens more among non-obstetric patients, have been reported since.…”

“…pneumoniae or H. influenzae). 6 Among the 27 obstetric cases, 12 followed spinals, 14,[43][44][45]49,57,58 seven followed CSE analgesia, 51,53,54,56,60,61 two followed accidental dural puncture 46,48 (one the woman who had two blood patches) 46 and six followed apparently uncomplicated epidurals (see below). Dural puncture seems necessary to allow entry of the less pathogenic streptococci to the subarachnoid space.…”

“…Risks during spinal insertion are not necessarily the same as those for intravascular procedures. Among case reports of neuraxial infection, a mask is not mentioned, 48,56 not worn, 50,57,58,60 or mentioned in a strange order ("Following surgical scrub, the anesthesiologist put on sterilized gloves, a surgical gown, and a mask." 70 ).…”

Arachnoiditis: time to return to povidone‐iodine‐alcohol for skin preparation before neuraxial blockade?

“…This leaves us with a dilemma – most cases of meningitis following spinal anaesthesia are caused by organisms from the nasal passages of the attending anaesthetist , suggesting a failure of the other components of a good aseptic technique. We therefore question Bogod's dismissal of povidone‐iodine as opposed to aqueous povidone‐iodine as an antiseptic .…”