Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA -
Faculty of Health, Universidad del Valle School of Medicine, Cali, Colombia -
Minerva Anestesiol. 2018 Mar;84(3):363-377. doi: 10.23736/S0375-9393.17.11920-6. Epub 2017 Nov 6.
Neuraxial anesthesia in the form of spinal and epidural are two of the most frequent forms of regional anesthesia. We aimed to describe and compare the relevant epidemiological, clinical and microbiological characteristics of all reported cases of septic meningitis associated with the use of spinal and epidural anesthetics.
We performed a systematic review of septic meningitis associated with neuraxial anesthesia. We included all relevant case-reports and observational studies in which authors described septic meningitis in association with spinal, epidural or combined neuraxial anesthesia using local anesthetics.
A total of 234 cases of septic meningitis were reported following review of 71 case-report articles and 22 epidemiological studies. In total, there have been 199, 25 and 10 reported cases of septic meningitis associated to spinal, epidural and combined neuraxial anesthesia, respectively. The lack of use of surgical masks was the most common risk factor (41, 16.7%). Streptococcus salivarius was the most common bacteria (17.0%) related to spinal anesthesia and Staphylococcus aureus (26.7%) was the most common one related to epidural. The time to symptom onset was significantly reduced in spinal (median time, 24 hours IQR [8-72] vs. 96 hours IQR [84-240]; P=0.003) compared to epidural anesthesia. The overall mortality rate is 15.3% and 13.3% for reported cases related to spinal and epidural anesthesia, respectively.
While the true incidence remains speculative, this review suggests that given increasing indications for spinals and epidurals, septic meningitis remains an important associated with neuraxial anesthesia.
椎管内麻醉包括脊髓麻醉和硬膜外麻醉，是最常见的两种区域麻醉方式。本研究旨在描述和比较与使用脊髓和硬膜外麻醉相关的所有化脓性脑膜炎的相关流行病学、临床和微生物学特征。
我们对与神经轴麻醉相关的化脓性脑膜炎进行了系统评价。我们纳入了所有相关的病例报告和观察性研究，这些研究的作者描述了与脊髓、硬膜外或联合使用局部麻醉药的神经轴麻醉相关的化脓性脑膜炎。
通过对 71 篇病例报告文章和 22 项流行病学研究的回顾，共报道了 234 例化脓性脑膜炎病例。共有 199、25 和 10 例化脓性脑膜炎与脊髓、硬膜外和联合神经轴麻醉相关，分别。未使用手术口罩是最常见的危险因素（41.7%）。化脓性脑膜炎与脊髓麻醉相关的最常见细菌是唾液链球菌（17.0%），与硬膜外麻醉相关的最常见细菌是金黄色葡萄球菌（26.7%）。与硬膜外麻醉相比，化脓性脑膜炎的症状发作时间明显缩短（中位数时间，24 小时 IQR[8-72] vs. 96 小时 IQR[84-240]；P=0.003）。脊髓麻醉相关化脓性脑膜炎的总死亡率为 15.3%，硬膜外麻醉相关化脓性脑膜炎的总死亡率为 13.3%。
虽然真实的发病率仍存在推测，但本综述表明，随着脊髓麻醉和硬膜外麻醉的适应证不断增加，化脓性脑膜炎仍然是与神经轴麻醉相关的一个重要并发症。
