Meningitis Post-Spinal Anaesthesia
Meningitis post-administration of a central neuraxial blockade is although a rare complication but a potentially fatal one. Breach in aseptic precautions leading to introduction of bacteria is considered the most probable cause and haematogenous spread due to microscopic vessel injury in symptomatic or asymptomatic bacteremia is also one of the etiologies. Mostly, a single anaesthesiologist may be seen with such cluster of cases. Sometimes defective drugs or faulty equipment used for the procedure may also lead to this complication. We report two cases where spinal anesthesia was performed by different anaesthesiologist’s in different operation theatres of the same hospital, which landed up with the complication of meningitis post procedure despite maximum sterile barrier maintenance during both the cases.
Iatrogenic meningitis post-spinal anesthesia is considered rare but is essentially a grave complication. The incidence of infectious complication post-central neuraxial blockade ranges from 0% to 0.04%. This complication can occur not only during spinal anesthesia but also after diagnostic lumbar puncture, epidural analgesia/anesthesia, myelography and other neurosurgical procedures involving spinal canal.
Various etiologies for post-spinal meningitis are breach in aseptic precautions, haematogenous spread when bacteremia is present and lumbar puncture is carried out and primary contamination of the drug as well as the equipment. A 48-years-old lady was posted for ureteroscopy (Left) for a 7 mm stone in the left proximal ureter. She was on treatment for Schizophrenia for past 8 years (Tab Clozapine 25 mg HS) and accepted in American Society of Anesthesiologist physical grade (ASA) II. In operation theatre (OT) after attaching regular monitoring (Heart rate, non-invasive blood pressure, electrocardiography, pulse oximetry) she received a sub arachnoid (SA) block with 12.5 mg bupivacaine in lateral position in lumbar interspace 3-4 with help of 26 G Quinckes’ needle. Standard strict aseptic precautions which included wearing cap, face mask, sterile gown, sterile hand gloves, cleansing agent to prepare the skin (2% povidone iodine and alcohol) and sterile drape were followed strictly.
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Anesthesiology Case Reports