Rabies vaccine and neuraxial anaesthesia

Abstract

This case report of neuraxial anaesthesia for emergency orthopaedic surgery serves to highlight the dilemma faced by anaesthetists when surgical intervention becomes necessary in a patient on anti-rabies vaccine. The two issues of importance are the possible reduction in the ef cacy of vaccination by an immunosuppressive effect of anaesthesia and surgery, and the possible need to avoid local anaesthetics for the provision of postoperative analgesia to assist in the early detection of any neurological de cit.Peer reviewed.

Acute flaccid paralysis following spinal anaesthesia , A diagnostic dilemma

“…The key issues of importance are the possible reduction in the efficacy of the vaccine and the possible need to avoid local anaesthetic for post-operative analgesia to assist in the early detection of any neurological deficits. 5 Apart from a number of reasons contributing to post-exposure prophylaxis failure, ketamine anaesthesia has been mentioned as an additional risk factor for treatment failure. 5 The main concern in this patient was the probability of reduction in the efficacy of the vaccine due to immunosuppressive effect of anaesthesia and surgery.…”

“…5 Apart from a number of reasons contributing to post-exposure prophylaxis failure, ketamine anaesthesia has been mentioned as an additional risk factor for treatment failure. 5 The main concern in this patient was the probability of reduction in the efficacy of the vaccine due to immunosuppressive effect of anaesthesia and surgery.…”

“…However, the use of regional anaesthesia needs further evaluation in patients receiving anti-rabies treatment. 5 The use of neuraxial anaesthesia in a patient on rabies post exposure prophylaxis could have medico-legal implications. It is known that rabies may present with a paralytic or "Guillian Barre" like syndrome, without the typical excitation, spontaneous inspiratory spasms and hydrophobia.…”

Anesthetic Management of a 9-day-old Neonate with Intestinal Evisceration due to Dog Bite

“…5 Nasogastric tube is essential for gastric decompression and remained on suction during induction and intubation to minimize the amount of gastric contents in the oropharynx. 2,6,7 Neonates coming for emergency surgery pose risk for anesthesia. Thorough understanding of physiological and pharmacological changes in neonates is important.…”

Dog bite and antirabies vaccination: What the anaesthesiologist needs to know

“…However, neuraxial anaesthesia may have medicolegal implications. V. Rewari et al .,[ 5 ] reported a case of intertrochanteric fracture femur done under neuraxial anaesthesia in a patient who was receiving ARV. The authors concluded that use of regional anaesthesia in patients receiving ARV needs further evaluation.…”