Article

Safety of spinal and epidural anesthesia in parturients with chorioamnionitis.

Department of Anesthesiology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
Regional anesthesia 21(5):436-41.
Source: PubMed

ABSTRACT The safety of spinal and epidural anesthesia in patients with chorioamnionitis was explored.
A retrospective study was made of the charts of 517 parturients who had received epidural anesthesia and 14 who had received spinal anesthesia before delivery and whose placentas had subsequently been found to be positive for chorioamnionitis.
Of the 146 blood culture results that were reported, 13 were positive. Of these 13 blood cultures, 5 had been drawn within 6 hours after placement of the epidural block, and four of the five bacteremic patients did not receive antibiotics until after the regional anesthetic was administered. One quarter (11/45) of the patients who were febrile and three quarters (174/229) of those who had leukocytosis before their block received no antibiotics before the block was placed. After the epidural block was performed, the catheter was left in place for over 24 hours in 18% (46/260) of the women who spiked a fever and in 14% (18/130) of those who exhibited leukocytosis during that period. There was no report of an epidural or spinal abscess or of meningitis in any of the women in the study.
Conduction anesthesia may be safe in parturients with chorioamnionitis without prior antibiotic therapy.

0 Bookmarks
 · 
179 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Regionalanästhesiologische Verfahren gehören zu den effektivsten Maßnahmen der Akutschmerztherapie. Inwieweit rückenmarknahe bzw. periphere Verfahren bei Patienten mit infektiösen Vorerkrankungen, Immunsuppression oder anderen Risikofaktoren durchführbar sind, ist bisher nur unzureichend untersucht. Literaturübersichten und Kasuistiken zeigen eine insgesamt seltene Inzidenz von schweren entzündlichen Komplikationen nach Regionalanästhesie. Wenn sie jedoch auftreten, sind vermehrt Patienten mit Risikofaktoren wie beispielsweise Diabetes mellitus, Steroidtherapie oder Tumorerkrankungen betroffen. Insgesamt erscheint die strikte Ablehnung regionalanästhesiologischer Verfahren bei vorbestehender Infektion oder Immunsuppression nicht gerechtfertigt, notwendig ist jedoch eine individuelle Nutzen-Risiko-Abwägung.
    Der Anaesthesist 03/2013; 62(3). DOI:10.1007/s00101-012-2097-y · 0.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The rapid onset of analgesia and improved mobility with combined spinal-epidural (CSE) techniques has been associated with a higher degree of maternal satisfaction compared with conventional epidural analgesia. However, controversy exists in that initiation of labor analgesia with a CSE may be associated with an increased risk for nonreassuring fetal status (ie, fetal bradycardia) and a subsequent need for emergent cesarean delivery. Overall, both epidural and CSE techniques possess unique risk/benefit profiles, and the decision to use one technique rather than the other should be determined based on individual patient and clinical circumstances.
    Clinics in perinatology 09/2013; 40(3):373-84. DOI:10.1016/j.clp.2013.05.010 · 1.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory. We wished to determine whether neuraxial anesthesia (1) is associated with central nervous system infections in patients undergoing surgery for a PJI, and (2) increases the likelihood of systemic infection in these patients. All 539 patients who received neuraxial or general anesthesia during 1499 surgeries for PJI from October 2000 to May 2013 were included in this study; of these, 51% (n = 764) of the surgeries were performed in 134 patients receiving neuraxial anesthesia and 49% were performed in 143 patients receiving general anesthesia. Two hundred sixty-two patients received general and neuraxial anesthesia during different surgeries. We used the International Classification of Diseases, 9(th) Revision codes and the medical records to identify patients who had an intraspinal abscess or meningitis develop after surgery for a PJI. Multivariate analysis was used to assess the effect of type of anesthesia (neuraxial versus general) on postoperative complications. There were no cases of meningitis, but one epidural abscess developed in a patient after neuraxial anesthesia. This patient underwent six revision surgeries during a 42-day period. Patients who received neuraxial anesthesia had lower odds of systemic infections (4% versus 12%; odds ratio, 0.35; 95% CI, 023-054; p < 0.001). Central nervous system infections after neuraxial anesthesia in patients with a PJI appear to be exceedingly rare. Based on the findings of this study, it may be time for the anesthesiology community to reevaluate the risk of sepsis as a relative contraindication to the use of neuraxial anesthesia. Level III, therapeutic study.
    Clinical Orthopaedics and Related Research 02/2015; DOI:10.1007/s11999-015-4175-3 · 2.79 Impact Factor