Regional Anesthesia in the Febrile or Infected Patient

Wedel, Denise J.; Horlocker, Terese T.

doi:10.1016/j.rapm.2006.04.003

Cited by 54 publications

(28 citation statements)

References 48 publications

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“…In this regard, the literature usefully supports the hypothesis that epidural blockade is of higher risk than spinal blockade, and that techniques performed in the peri‐operative period on adults more frequently result in injury compared with techniques in an obstetric, chronic pain or paediatric setting . Pre‐existing spinal canal deformity, abnormal coagulation, poor aseptic technique, immunosuppression and significant comorbidity also place patients at increased risk of injury arising from neuraxial techniques .…”

Section: Spinal Cord Injury Related To Neuraxial Techniquesmentioning

confidence: 93%

“…Patient immunocompromise around the time of epidural catheterisation, poor aseptic technique and traumatic insertion are recurrent themes in reports of spinal epidural abscesses . Pre‐existing, untreated active systemic infection and infection at the site of needle insertion, are widely considered to be an absolute contra‐indication to both spinal and epidural blockade . Patients who have treated systemic infections, or who are at risk of transient bacteraemia in the period following their neuraxial anaesthetic (e.g.…”

Section: Spinal Cord Injury Related To Neuraxial Techniquesmentioning

confidence: 99%

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Spinal cord injury arising in anaesthesia practice

2018

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SummarySpinal cord injury arising during anaesthetic practice is a rare event, but one that carries a significant burden in terms of morbidity and mortality. In this article, we will review the pathophysiology of spinal cord injury. We will then discuss injuries relating to patient position, spinal cord hypoperfusion and neuraxial techniques. The most serious causes of spinal cord injury -vertebral canal haematoma, spinal epidural abscess, meningitis and adhesive arachnoiditis -will be discussed in turn. For each condition, we draw attention to practical, evidence-based measures clinicians can undertake to reduce their incidence, or mitigate their severity. Finally, we will discuss transient neurological symptoms. Some cases of spinal cord injury during anaesthesia can be ascribed to anaesthesia itself, arising as a direct consequence of its conduct. The injury to a spinal nerve root by inaccurate and/or incautious needling during spinal anaesthesia is an obvious example. But in many cases, spinal cord injury during anaesthesia is not caused by, related to, or even associated with, the conduct of the anaesthetic. Surgical factors, whether direct (e.g. spinal nerve root damage due to incorrect pedicle screw placement) or indirect (e.g. cord ischaemia following aortic surgery) are responsible for a significant proportion of spinal cord injuries that occur concurrently with the delivery of regional or general anaesthesia. Pathophysiology of spinal cord injuryInjury to the spinal cord and its nerve roots occurs following a range of insults, including: compression; stretch; hypoperfusion; direct trauma; exposure to neurotoxic material; or a combination of these factors. Like peripheral nerves, the spinal cord responds poorly to ischaemia, which is the common histopathological endpoint of these insults.In contrast to peripheral nerve injury during anaesthesia, many cases of spinal cord injury have a clear aetiology. Certain predispositions may render patients more at risk of spinal cord injury during anaesthesia, including: spinal canal deformity; abnormal coagulation; abnormal vascular supply; or immunosuppression.Spinal canal stenosis is a common spinal canal deformity and can result from arthritic change, ankylosing spondylitis, Paget's disease or acromegaly. It is rarely caused by congenital malformations. Pre-existing stenosis may contribute to spinal cord injury because the narrower canal cross-sectional area in such patients renders them more at risk of nerve compression or

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Section: Spinal Cord Injury Related To Neuraxial Techniquesmentioning

confidence: 93%

Section: Spinal Cord Injury Related To Neuraxial Techniquesmentioning

confidence: 99%

Spinal cord injury arising in anaesthesia practice

2018

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“…Despite the low risk of central nervous system infection, which may potentially occur in any bacteraemic patient, the decision to proceed with neuraxial blockade in a febrile or infected patient must be carefully considered and made on a case by case basis…”

Section: Methodsmentioning

confidence: 99%

SOMANZ guidelines for the investigation and management sepsis in pregnancy

Bowyer

Robinson

Barrett

et al. 2017

Aust NZ J Obst Gynaeco

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“…There is ample evidence to suggest that regional anesthesia can be performed safely if antibiotic treatment of the infection has started prior to the placement of the regional block . It appears that serious central nervous system infections such as arachnoiditis, meningitis, and abscess are rare after neuroaxial anesthesia.…”

Section: Question 3b: Is There Evidence Against Neuraxial Blockade Inmentioning

confidence: 99%

Blood Conservation

2014

Journal Orthopaedic Research

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Question 1: Is blood transfusion associated with an increased risk of surgical site infection (SSI)/ periprosthetic joint infection (PJI)? Consensus Yes. Allogeneic blood transfusions is associated with an increased risk of SSI/PJI. The role of autologous transfusion in the risk of SSI/PJI remains inconclusive. Delegate VoteAgree: 91%, Disagree: 5%, Abstain: 4% (Strong Consensus) Justification Based on the Centers for Disease Control and Prevention (CDC) guideline, perioperative allogeneic blood transfusion in arthroplasty increases the risk of SSI/ PJI. The association between autologous blood transfusion and the risk of SSI/PJI is less clear.According to high-quality evidence from two randomized controlled trials (RCTs) and four observational studies, there is an increased risk of SSI with any blood transfusion (allogeneic, autologous, and autologous plus allogeneic blood transfusion data combined) as compared to no transfusion. This is further supported by both a meta-analysis of six studies (n ¼ 8,493) [odds ratio (OR): 1.56; 95% confidence interval (CI): 1.18-2.06; p ¼ 0.002] and a meta-analysis (n ¼ 7,484) of 4 observational studies (OR 1.59; 95% CI: 1.15-2.18; p ¼ 0.004).

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Regional Anesthesia in the Febrile or Infected Patient

Cited by 54 publications

References 48 publications

Spinal cord injury arising in anaesthesia practice

Spinal cord injury arising in anaesthesia practice

SOMANZ guidelines for the investigation and management sepsis in pregnancy

Blood Conservation

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