1
|
Harras YE, Messaoud O, Berrada K, Fikri M, Kettani NEC, Jiddane M, Touarsa F. Cervico-occipital junction infectious osteoarthritis complicated with atlantoaxial dislocation, cervical abscesses and epiduritis: A case report and review of the literature. Radiol Case Rep 2024; 19:4375-4379. [PMID: 39165319 PMCID: PMC11334557 DOI: 10.1016/j.radcr.2024.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 08/22/2024] Open
Abstract
Craniocervical junction infections are considered a rare condition and can be associated with degradation of the odontoid ligaments and, the risk of a subsequent atlantoaxial subluxation or dislocation. Osteomyelitis at this level is often seen in immunocompromised patients with, intravenous drug use or infective endocarditis. Atlantoaxial subluxation associated with pharyngeal infection or its surrounding tissues is called Grisel's syndrome. We report the case of a 29-year-old man diagnosed with infectious cervico-occipital osteoarthritis complicated by atlantoaxial dislocation, abscesses located in the retropharyngeal space, and the prevertebral space as well as upper cervical epiduritis. Our purpose is to highlight the role of radiologists in diagnosing this rare yet deadly condition.
Collapse
Affiliation(s)
- Yahya El Harras
- Neuroradiology department, Hospital of specialties, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Ola Messaoud
- Neuroradiology department, Hospital of specialties, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Kenza Berrada
- Neuroradiology department, Hospital of specialties, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Meryem Fikri
- Neuroradiology department, Hospital of specialties, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Najwa Ech-cherif Kettani
- Neuroradiology department, Hospital of specialties, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Mohamed Jiddane
- Neuroradiology department, Hospital of specialties, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Firdaous Touarsa
- Neuroradiology department, Hospital of specialties, Ibn Sina University Hospital Center, Rabat, Morocco
| |
Collapse
|
2
|
Wesley SR, Vates GE, Thornburg LL. Neurologic Emergencies in Pregnancy. Obstet Gynecol 2024; 144:25-39. [PMID: 38626451 DOI: 10.1097/aog.0000000000005575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/29/2024] [Indexed: 04/18/2024]
Abstract
Neurologic emergencies in pregnancy require prompt evaluation and early, focused intervention to improve neurologic outcomes for the affected person and to avoid further injury. Neurologic events in pregnancy, although rare, present a time of extreme risk of permanent injury for the person who is pregnant. Therefore, obstetric clinicians should be well versed in the risk factors for potential neurologic events and understand the symptoms and events that should prompt evaluation for a neurologic event. In addition, they should support other specialties in aggressive and early neurologic care for the patient to improve outcomes while assessing fetal well-being and care optimization for the dyad. Obstetric clinicians can uniquely provide knowledge of changes in pregnancy physiology that can increase the risk of neurologic events, as well as change the treatment of these events. For all patients with neurologic events, "time is brain." Therefore, it is important to be aware of changes in common presenting pregnancy concerns that should prompt evaluation for other pathogeneses. Finally, pregnancy care teams should be prepared to begin the initial stabilization and management of acute neurologic emergencies, including seizure, stroke, and meningitis, while seeking aid from other medical and neurologic specialists who can support their care and interventions. Early and aggressive interventions for individuals with neurologic events during pregnancy and postpartum are critical to the overall well-being of the dyad.
Collapse
Affiliation(s)
- Shaun R Wesley
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Division of Neuroendocrine Disorders, Department of Neurosurgery, University of Rochester, Rochester, New York
| | | | | |
Collapse
|
3
|
Elhamrawy A, Aepli S, Heydinger G, Tobias JD, Beltran RJ. Epidural Abscess Complicating Tunneled Caudal Epidural Catheter in an Infant for Postoperative Pain Management of Open Abdominal Surgery. J Med Cases 2024; 15:7-14. [PMID: 38328807 PMCID: PMC10846496 DOI: 10.14740/jmc4180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
Regional anesthesia is being used more frequently in pediatric anesthesia practice, including the perioperative care of neonates and infants. Adverse effects may be encountered during epidural needle placement, with catheter advancement, or subsequently during infusion of local anesthetic agents. Despite applying standard practice of care regarding placement of epidural catheter, epidural catheter-related infections may still occur. We present the rare occurrence of an epidural abscess in a 4-month-old infant after placement and subsequent use of a tunneled caudal epidural catheter for postoperative pain management following abdominal surgery. Magnetic resonance imaging (MRI) was the gold standard diagnostic imaging modality and was used to identify the abscess. Management included intravenous antibiotic therapy as well as hemilaminectomy with evacuation of the epidural abscess and hematoma. The patient continued to progress well with no deficits noted on neurological examination. There were no other postoperative concerns. When there is a concern for epidural catheter-related infection, the catheter should be removed immediately. The epidural catheter tip as well as any purulent discharge from the insertion site should be sent for culture and sensitivity. Urgent neurosurgical and infectious disease consultation is suggested to provide opinions regarding surgical intervention and antibiotic therapy.
Collapse
Affiliation(s)
- Amr Elhamrawy
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Savannah Aepli
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Grant Heydinger
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D. Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ralph J. Beltran
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
4
|
Halalmeh DR, Salama HZ, Molnar P, Moisi MD. Advanced Neck Dermatillomania Leading to Cervical Osteomyelitis and Epidural Abscess. Cureus 2023; 15:e48163. [PMID: 38046762 PMCID: PMC10693285 DOI: 10.7759/cureus.48163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Dermatillomania, a condition characterized by compulsive skin picking, can lead to tissue damage and severe infections of adjacent structures. This case report presents the first documented instance of dermatillomania-induced cervical osteomyelitis and epidural abscess. Herein, we describe the case of a 45-year-old male patient with a history of a non-healing posterior neck wound, which progressively worsened and extended to the posterior cervical spine. The patient subsequently experienced weakness and paresthesia in the left arm. Neuroimaging revealed cervical spine osteomyelitis and an associated epidural collection/phlegmon compressing the spinal cord. The abscess was evacuated via posterior laminectomy, followed by culture-guided antibiotic therapy. The presence of a chronic wound or ulcer in the setting of psychiatric comorbidities should raise suspicion of dermatillomania-induced complications. Early diagnosis is essential to guide management and prevent serious complications. Management involves a multidisciplinary approach that includes addressing behavioral abnormalities and concurrent psychiatric disorders.
Collapse
Affiliation(s)
- Dia R Halalmeh
- Neurosurgery, Hurley Medical Center, Flint, USA
- Surgery, Michigan State University College of Human Medicine, Grand Rapids, USA
| | | | | | - Marc D Moisi
- Neurosurgery, Hurley Medical Center, Flint, USA
- Surgery, Michigan State University College of Human Medicine, Grand Rapids, USA
| |
Collapse
|
5
|
Zhang W, Lai Y, Li T, Wang X, Mu W, Jiang Z. Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus constellatus Leads to Paraplegia in an Adult: A Case Report. Infect Drug Resist 2023; 16:1591-1598. [PMID: 36969946 PMCID: PMC10032216 DOI: 10.2147/idr.s405448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023] Open
Abstract
The incidence of a spinal epidural abscess (SEA), which can cause serious neurological complications, is low; however, the incidence of SEA caused by Streptococcus is even lower, most of which are reported in the thoracolumbar spine and lumbosacral segment. We reported a case of cervical SEA caused by Streptococcus constellatus infection, resulting in paralysis of the patient. The acute onset of SEA in a 44-year-old male led to decreased upper limb muscle strength, lower limb paralysis, and loss of bowel and bladder function, and imaging and blood tests suggested pyogenic spondylitis. Emergency decompression surgery and antibiotic therapy were given, the patient gradually recovered, and the muscle strength of the lower limbs gradually improved. This case report suggests the importance of early decompressive surgery and effective antibiotic therapy.
Collapse
Affiliation(s)
- Wen Zhang
- Department of Spine Surgery, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
- Department of spine surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Yudong Lai
- Department of spine surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Tao Li
- Department of spine surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Xingpeng Wang
- Department of spine surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Weidong Mu
- Department of Traumatic Orthopaedics, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Zhensong Jiang
- Department of spine surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
- Correspondence: Zhensong Jiang; Weidong Mu, Email ;
| |
Collapse
|
6
|
Wydall S, Zolger D, Owolabi A, Nzekwu B, Onwochei D, Desai N. Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis. Can J Anaesth 2023; 70:406-442. [PMID: 36720838 DOI: 10.1007/s12630-022-02389-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE In labour, neuraxial analgesia is the standard in the provision of pain relief. However, the optimal mode of delivering epidural solution has not been determined, and some parturients may need an alternative to epidural analgesia. We sought to conduct a systematic review and network meta-analysis to compare continuous epidural infusion (CEI), programmed intermittent epidural bolus (PIEB), computer-integrated CEI, computer-integrated PIEB, patient-controlled epidural bolus (PCEA), fentanyl patient-controlled analgesia (PCA), and remifentanil PCA, either alone or in combination. METHODS We searched CENTRAL, CINAHL, Ovid Embase, Ovid Medline, and Web of Science for randomized controlled trials that included nulliparous and/or multiparous parturients in spontaneous or induced labour. The maintenance epidural solution had to include a low concentration local anesthetic and an opioid. Specific subgroups in the obstetric population such as preeclampsia were excluded. Network meta-analysis was performed with a frequentist method, and continuous and dichotomous outcomes are presented as mean differences and odds ratios, respectively, with 95% confidence intervals. RESULTS Overall, 73 trials were included. For the first coprimary outcome, the need for rescue analgesia, CEI was inferior to PIEB and PIEB + PCEA was superior to PCEA alone, with a low certainty of evidence given the presence of serious limitations and imprecision. The second coprimary outcome, the maternal satisfaction, was improved by PIEB + PCEA compared with CEI + PCEA and PCEA alone, with a low quality of evidence in view of the presence of serious limitations and imprecision. Fentanyl PCA increased the requirement for rescue analgesia and decreased maternal satisfaction relative to many methods of delivering epidural solution. In terms of secondary outcomes, PIEB increased analgesic efficacy compared with CEI, and PCEA reduced local anesthetic consumption at the expense of inferior analgesia relative to CEI and PIEB. PIEB + PCEA was superior to CEI + PCEA in regard to the pain score at 2 h and 4 h, consumption of local anesthetic, incidence of lower lower limb motor blockade and the rate of spontaneous vaginal delivery. Fentanyl and remifentanil PCA did not provide the same level of analgesia as all epidural methods, resulted in increasing analgesic ineffectiveness with time spent in labour, and predisposed to a higher incidence of side effects such as nausea and/or vomiting and sedation. Remifentanil PCA was superior to fentanyl PCA for analgesia at an early time point, and it increased the incidence of oxygen desaturation relative to other strategies of delivering epidural solution. CONCLUSIONS Opioid PCA did not provide the same level of analgesia as epidural methods with a higher incidence of side effects. We interpret the findings of our systematic review and network meta-analysis as suggesting PIEB + PCEA to be the optimal delivery mode of epidural solution. Nevertheless, the potential differing importance of the various maternal, fetal, and neonatal outcomes in determining which is optimal has not, to our knowledge, been elucidated yet. STUDY REGISTRATION PROSPERO (CRD42021254978); registered 27 May 2021.
Collapse
Affiliation(s)
- Simon Wydall
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Danaja Zolger
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adetokunbo Owolabi
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bernadette Nzekwu
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Desire Onwochei
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Neel Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| |
Collapse
|
7
|
Practice advisory on the prevention and management of complications of pediatric regional anesthesia. J Clin Anesth 2022; 79:110725. [DOI: 10.1016/j.jclinane.2022.110725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/20/2022]
|
8
|
Serino J, Galivanche AR, Grauer JN, Haynes M, Karas V, Della Valle CJ. General Versus Neuraxial Anesthesia in Revision Surgery for Periprosthetic Joint Infection. J Arthroplasty 2022; 37:S971-S976. [PMID: 35017049 DOI: 10.1016/j.arth.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/26/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare neuraxial and general anesthesia in revision surgery for periprosthetic joint infection (PJI). METHODS Patients undergoing revision arthroplasty for PJI were identified in the 2005-2019 American College of Surgeons National Surgical Quality Improvement Program databases. Thirty-day outcomes were compared between general and neuraxial anesthesia. Propensity-score matching and multivariate analysis were used to control patient and procedural variables. RESULTS Neuraxial anesthesia was used in 1511 (16.8%) cases and general anesthesia in 7468 (83.2%) cases. Neuraxial anesthesia had a lower risk of any adverse event (odds ratio [OR] 0.70, P < .001), serious adverse events (OR 0.77, P < .001), and minor adverse events (OR 0.66, P < .001). Among 875 reoperations and 1351 readmissions, two had a diagnosis of intraspinal abscess, both occurring after general anesthesia. CONCLUSIONS Neuraxial anesthesia was associated with a lower risk of adverse events when compared to general anesthesia in revision surgery for PJI.
Collapse
Affiliation(s)
- Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Anoop R Galivanche
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT
| | - Monique Haynes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Vasili Karas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| |
Collapse
|
9
|
Further considerations regarding spinal epidural abscess in the ED setting. Am J Emerg Med 2022; 57:162-163. [DOI: 10.1016/j.ajem.2022.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 04/23/2022] [Indexed: 11/19/2022] Open
|
10
|
Long B, Carlson J, Montrief T, Koyfman A. High risk and low prevalence diseases: Spinal epidural abscess. Am J Emerg Med 2022; 53:168-172. [DOI: 10.1016/j.ajem.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023] Open
|
11
|
Waters JFR. Neurologic Complications of Obstetric Anesthesia. Continuum (Minneap Minn) 2022; 28:162-179. [DOI: 10.1212/con.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
12
|
Vieira L, Almeida C, Cunha P, Gomes A. Low-dose spinal block combined with epidural volume extension in a high-risk cardiac patient: A case-based systematic literature review. Saudi J Anaesth 2022; 16:383-389. [PMID: 36337410 PMCID: PMC9630677 DOI: 10.4103/sja.sja_740_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Anesthetic management of patients with severe cardiac disease can be challenging during prolonged surgical procedures. Thus, alternative neuraxial anesthetic techniques have been described to avoid general anesthesia in these patients. Methods: A case-based systematic literature review on low-dose spinal block combined with different methods of epidural block extension in high-risk cardiac patients was performed. Results: We describe the successful management of a patient with poor left ventricular function who underwent excision arthroplasty of an infected hip prosthesis under low-dose spinal block with levobupivacaine 5 mg and fentanyl 15 μg combined with saline epidural volume extension (EVE). Epidural ropivacaine 0.75% was administered as a bolus of 5 ml followed by an infusion at 5 ml/h later during the course of surgery. Conclusions: Although continuous spinal anesthesia (CSA) or epidural anesthesia may limit hemodynamic instability, the possibility of devastating central nervous system infection may prevent CSA use, and epidural block alone may be less reliable than CSA. Epidural block alone may require large volumes of concentrated local anesthetic to obtain sacral block, which may produce hemodynamic instability. The EVE, particularly using saline EVE, has rarely been described in high-risk cardiac patients as an alternative to CSA or epidural block alone, with the intention to avoid general anesthesia, but it has demonstrated efficacy and a low rate of complications. Hemodynamic stability was maintained in most cases.
Collapse
|
13
|
CHAN CH, DESAI SR, HWANG NC. Cerebrospinal Fluid Drains: Risks in Contemporary Practice. J Cardiothorac Vasc Anesth 2022; 36:2685-2699. [DOI: 10.1053/j.jvca.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 11/11/2022]
|
14
|
Shaabi A, Moshref RH. Epidural Abscess Following Epidural Evacuation in a Patient With Ventriculoperitoneal Shunt: A Case Report. Cureus 2021; 13:e19134. [PMID: 34868772 PMCID: PMC8627705 DOI: 10.7759/cureus.19134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Epidural abscess is considered one of the most common intracranial infections. We report a pediatric patient with chronic hematopoiesis and thick double periosteal layers who developed an epidural pus collection after epidural hematoma evacuation. This article highlights the importance of detecting complications from epidural hematoma evacuation, including intracranial abscess and pus formation. Therefore, it is crucial to treat such cases meticulously.
Collapse
Affiliation(s)
- Afaf Shaabi
- Neurological Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Rana H Moshref
- Neurological Surgery, King Fahad General Hospital, Jeddah, SAU
| |
Collapse
|
15
|
Ananda RA, Attwood LO, Lancaster R, Jacka D, Jhoomun T, Danks A, Woolley I. The Clinical and Financial Burden of Spinal Infections in People who Inject Drugs. Intern Med J 2021; 52:1741-1748. [PMID: 34028966 DOI: 10.1111/imj.15397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/08/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are known to be at increased risk of infectious diseases including bacterial and blood-borne viral infections. However, there is limited literature surrounding the burden of spinal infections as a complication of injecting drug use (IDU). AIMS To quantify the clinical and financial burden of IDU-related spinal infections. METHODS Retrospective chart review of adult PWID with spinal infections requiring hospital admission to a tertiary health service in Melbourne, Australia between 2011 and 2019. RESULTS Fifty-seven PWID with 63 episodes of spinal infections were identified with a median hospital stay of 47 days (IQR 16, range 4-243). One-third of episodes required neurosurgical intervention and 11 episodes (17%) required intensive care unit (ICU) admission (range 2-17 days). Staphylococcus aureus was the most common causative pathogen, present in three-quarters of all episodes (n = 47). The median duration of antibiotic regime was 59 days (IQR 42) and longer courses were associated with known bacteraemia (p = 0.048), polymicrobial infections (p = 0.001) and active IDU (p = 0.066). Predictors of surgery include neurological symptoms at presentation (RR 2.6; p = 0.010), inactive IDU status (RR 3.0; p = 0.002), a diagnosis of epidural abscess (RR 4.1; p = 0.001) and spinal abscess (RR ∞; p < 0.001). Completion of planned antimicrobial therapy was reported in 51 episodes (82%). Average expenditure per episode was AUD $61 577. CONCLUSIONS Spinal infections in PWID are an underreported serious medical complication of IDU. Though mortality is low, there is significant morbidity with prolonged admissions, large antimicrobial requirements and surgical interventions generating a substantial cost to the health system. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Roshan A Ananda
- Monash Infectious Disease, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash Health, Monash University, Victoria, Australia
| | - Lucy O Attwood
- Monash Infectious Disease, Monash Health, Victoria, Australia
| | - Reece Lancaster
- Monash Addiction Medicine, Monash Health, Victoria, Australia
| | - David Jacka
- Monash Addiction Medicine, Monash Health, Victoria, Australia
| | - Tanya Jhoomun
- Monash Neurosurgery, Monash Health, Victoria, Australia
| | - Andrew Danks
- Monash Neurosurgery, Monash Health, Victoria, Australia
| | - Ian Woolley
- Monash Infectious Disease, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash Health, Monash University, Victoria, Australia
| |
Collapse
|
16
|
Pus in Spinal Needle: Diagnosis and Management of a Long-Segment Spinal Epidural Abscess. Case Rep Infect Dis 2021; 2021:9989847. [PMID: 34007497 PMCID: PMC8100421 DOI: 10.1155/2021/9989847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 11/21/2022] Open
Abstract
Spinal-epidural abscess (SEA) is believed to be primarily of haematogenous origin and very rarely as a consequence of central neuraxial blockade. Early diagnosis and pertinent management invariably improve neurological outcomes. We report a case of long-segment SEA, which was suspected during subarachnoid anaesthesia, subsequently diagnosed and managed appropriately, averting irreversible neurological deficits.
Collapse
|
17
|
Campos MG, Peixoto AR, Fonseca S, Santos F, Pinho C, Leite D. Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort. Braz J Anesthesiol 2021; 72:605-613. [PMID: 33887339 PMCID: PMC9515676 DOI: 10.1016/j.bjane.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
Collapse
Affiliation(s)
- Marta G Campos
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal.
| | - Ana R Peixoto
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Sara Fonseca
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Francisca Santos
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Cristiana Pinho
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Diana Leite
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| |
Collapse
|
18
|
Shehata IM, Barsoumv S, Elhass A, Varrassi G, Paladini A, Myrcik D, Urits I, Kaye AD, Viswanath O. Anesthetic Considerations for Cesarean Delivery After Uterine Transplant. Cureus 2021; 13:e13920. [PMID: 33880271 PMCID: PMC8051428 DOI: 10.7759/cureus.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infertility has many etiologies and can have devastating consequences for young couples attempting to bring children into the world. Uterine factor for infertility is related to either uterine agenesis (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome), unexpected hysterectomy, or presence of a nonfunctioning uterus. In this review, a patient with MRKH syndrome underwent donor uterus transplantation at the Cleveland Clinic, conceived, and delivered the first healthy baby in the United States and the second worldwide. Additionally, we review the pertinent literature on anesthesia problems. Donor-related uterine transplant is a recent medical innovation requiring multidisciplinary expertise. In patients who deliver successfully, according to the current literature, the transplanted uterus can be used for one more pregnancy only if the mother so desires, otherwise cesarean hysterectomy (C-Hyst) should be performed. In the observed case, C-Hyst was performed because the patient developed placenta accreta and the couple desired no further pregnancy. In summary, with our limited data, careful management of these patients is required to ensure the best outcome for the mother and the newborn fetus.
Collapse
Affiliation(s)
| | - Sabri Barsoumv
- Department of Anesthesiology, Cleveland Clinic, Cleveland, USA
| | - Amir Elhass
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | | | - Antonella Paladini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, ITA
| | | | - Ivan Urits
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, USA
| | | |
Collapse
|
19
|
Cervical, Thoracic, and Lumbar Spine Epidural Abscess: Case Report and Literature Review. Case Rep Infect Dis 2020; 2020:8834589. [PMID: 33101744 PMCID: PMC7568137 DOI: 10.1155/2020/8834589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
We report a case of a spinal epidural abscess (SEA) in a patient without significant risk factors. The patient was treated in an outpatient setting for one week for worsening back pain and subsequently admitted to the hospital for the treatment of sepsis and suspected SEA. An MRI obtained on admission showed an epidural abscess extending from the lower cervical to the upper lumbar region and accompanying paraspinal cervical and psoas abscesses. The patient was successfully treated with antibiotics based on the sensitivity of the surgical cultures received from a needle aspiration of the abscess. SEA has a low incidence; however, the number of cases is consistently rising over the last two decades. The outcome of SEA treatment is related to the duration of the process prior to intuition of the treatment. Patients with no neurological symptoms, or with symptoms lasting less than 36 h, have the best recovery rate. As the typical symptoms of SEA are seen in only 13% of cases, physicians should have a low threshold to order MRI in patients with back pain that is new or changed from the baseline. With the help of CT-guided aspiration for culture analysis, patients can be successfully treated conservatively using antibiotics in cases where neurological signs are absent.
Collapse
|
20
|
Kesici S, Demırci M, Kesici U. [Antimicrobial effects of fentanyl and bupivacaine]. Rev Bras Anestesiol 2020; 70:357-363. [PMID: 32819727 DOI: 10.1016/j.bjan.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
STUDY OBJECTIVE In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. DESIGN In vitro prospective study. SETTING University Clinical Microbiology Laboratory. MEASUREMENTS In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37°C. MAIN RESULTS In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24hours of incubation were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). CONCLUSIONS Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate, which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.
Collapse
Affiliation(s)
- Sevgi Kesici
- University of Health Sciences, Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Mehmet Demırci
- University of Beykent, Faculty of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Ugur Kesici
- University of Beykent, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| |
Collapse
|
21
|
Sharfman ZT, Gelfand Y, Shah P, Holtzman AJ, Mendelis JR, Kinon MD, Krystal JD, Brook A, Yassari R, Kramer DC. Spinal Epidural Abscess: A Review of Presentation, Management, and Medicolegal Implications. Asian Spine J 2020; 14:742-759. [PMID: 32718133 PMCID: PMC7595828 DOI: 10.31616/asj.2019.0369] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Spinal epidural abscess (SEA) is a rare condition associated with significant morbidity and mortality. Despite advances in diagnostic medicine, early recognition of SEAs remains elusive. The vague presentation of the disease, coupled with its numerous risk factors, the diagnostic requirement for obtaining advanced imaging, and the necessity of specialized care constitute extraordinary challenges to both diagnosis and treatment of SEA. Once diagnosed, SEAs require urgent or emergent medical and/or surgical management. As SEAs are a relatively rare pathology, high-quality data are limited and there is no consensus on their optimal management. This paper focuses on presenting the treatment modalities that have been successful in the management of SEAs and providing a critical assessment of how specific SEA characteristics may render one infection more amenable to primary surgical or medical interventions. This paper reviews the relevant history, epidemiology, clinical presentation, radiology, microbiology, and treatment of SEAs and concludes by addressing the medicolegal implications of delayed treatment of the disease.
Collapse
Affiliation(s)
- Zachary Tuvya Sharfman
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pryiam Shah
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ari Jacob Holtzman
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joseph Roy Mendelis
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merritt Drew Kinon
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan David Krystal
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Allan Brook
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Claude Kramer
- Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
22
|
Kesici S, Demırci M, Kesici U. [Antimicrobial effects of fentanyl and bupivacaine]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2020; 70:357-363. [PMID: 32819727 PMCID: PMC9373070 DOI: 10.1016/j.bjane.2020.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 08/29/2024]
Abstract
STUDY OBJECTIVE In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. DESIGN In vitro prospective study. SETTING University Clinical Microbiology Laboratory. MEASUREMENTS In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18−24 hours at 37 °C. MAIN RESULTS In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24 hours of incubation were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). CONCLUSIONS Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.
Collapse
Affiliation(s)
- Sevgi Kesici
- University of Health Sciences, Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Mehmet Demırci
- University of Beykent, Faculty of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Ugur Kesici
- University of Beykent, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| |
Collapse
|
23
|
Azi LMTDA, Fonseca NM, Linard LG. SBA 2020: Regional anesthesia safety recommendations update. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32636024 PMCID: PMC9373527 DOI: 10.1016/j.bjane.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the Brazilian Society of Anesthesiology (SBA)’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
Collapse
Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
| |
Collapse
|
24
|
Azi LMTDA, Fonseca NM, Linard LG. [SBA 2020: Regional anesthesia safety recommendations update]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2020; 70:398-418. [PMID: 32636024 PMCID: PMC9373527 DOI: 10.1016/j.bjan.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/26/2020] [Accepted: 02/08/2020] [Indexed: 12/24/2022]
Abstract
The purpose of the Brazilian Society of Anesthesiology's (SBA) Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
Collapse
Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
| |
Collapse
|
25
|
Mallik J, Motiani V, Pai MG. Spinal Epidural Abscess Post Spinal Anesthesia: An Uncommon Complication of a Common Procedure. Asian J Neurosurg 2020; 15:730-732. [PMID: 33145241 PMCID: PMC7591180 DOI: 10.4103/ajns.ajns_154_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/19/2020] [Accepted: 07/03/2020] [Indexed: 11/11/2022] Open
Abstract
Spinal epidural abscess (SEA) is a severe pyogenic infection of the epidural space. Bacteria gain access to the epidural space either by hematogenous spread, contiguous spread from a neighboring infected structure, or through iatrogenic inoculation. The diagnosis of SEA is a challenge, largely because of its rarity. We present here a case of SEA of iatrogenic origin (post spinal anesthesia), which we treated at Tata Main Hospital, Jamshedpur.
Collapse
Affiliation(s)
- Jeevesh Mallik
- Department of Neurosurgery, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Vanita Motiani
- Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Manish Ganesh Pai
- Department of Neurosurgery, Denver Children's Hospital, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
26
|
van Samkar G, Balraadjsing PPS, Hermanns H, Hoogendijk IV, Hollmann MW, Zaat SAJ, Stevens MF. Microbiological and scanning electron microscopic evaluation of epidural catheters. Reg Anesth Pain Med 2020; 45:381-385. [PMID: 32179623 PMCID: PMC8408583 DOI: 10.1136/rapm-2019-101180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/04/2022]
Abstract
BackgroundEpidural catheters are frequently colonized by gram-positive bacteria. Although the incidence of associated epidural infections is low, their consequences can be devastating. We investigated bacterial growth on epidural catheters by quantitative bacterial culture and scanning electron microscopy (SEM) in order to explore the patterns of epidural catheter colonization.Methods28 patients undergoing major abdominal surgery with thoracic epidurals (treatment ≥72 hours) were studied. Before the removal of the catheter, the skin surrounding the insertion site was swabbed. The entire catheter was divided into extracorporeal, subcutaneous, and tip segments. Skin swabs and catheter segments were quantitatively cultured, bacterial species were identified, and SEM was performed on four selected catheters.Results27 of 28 catheters were included. The percentages of positive cultures were: skin swab 29.6%, extracorporeal segments 11.1%, subcutaneous segments 14.8%, and tip segments 33.3%. One patient was diagnosed with a catheter-associated infection.Staphylococcus epidermidiswas cultured from the skin and the catheter extracorporeal, subcutaneous, and tip segments. SEM of this catheter showed bacteria-like and intraluminal host cell-like structures. SEM of two other catheters showed intraluminal fibrin networks in their tip segments.ConclusionsWe present the first SEM pictures of an epidural catheter with a bacterial infection. Bacterial growth developed from the skin to the tip of this catheter, indicating the skin as a primary source of infection. By SEM, catheters with low levels of bacterial growth demonstrated an intraluminal fibrous network which possibly plays a role in catheter obstruction.
Collapse
|
27
|
Longo M, Pennington Z, Gelfand Y, De la Garza Ramos R, Echt M, Ahmed AK, Yanamadala V, Sciubba DM, Yassari R. Readmission after spinal epidural abscess management in urban populations: a bi-institutional study. J Neurosurg Spine 2020; 32:465-472. [PMID: 31756697 DOI: 10.3171/2019.8.spine19790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The incidence of spinal epidural abscess (SEA) is rising, yet there are few reports discussing readmission rates or predisposing factors for readmission after treatment. The aims of the present study were to determine the rate of 90-day readmission following medical or surgical treatment of SEA in an urban population, identify patients at increased risk for readmission, and delineate the principal causes of readmission. METHODS Neurosurgery records from two large urban institutions were reviewed to identify patients who were treated for SEA. Patients who died during admission or were discharged to hospice were excluded. Univariate analysis was performed using chi-square and Student t-tests to identify potential predictors of readmission. A multivariate logistic regression model, controlled for age, body mass index, sex, and institution, was used to determine significant predictors of readmission. RESULTS Of 103 patients with identified SEA, 97 met the inclusion criteria. Their mean age was 57.1 years, and 56 patients (57.7%) were male. The all-cause 90-day readmission rate was 37.1%. Infection (sepsis, osteomyelitis, persistent abscess, bacteremia) was the most common cause of readmission, accounting for 36.1% of all readmissions. Neither pretreatment neurological deficit (p = 0.16) nor use of surgical versus medical management (p = 0.33) was significantly associated with readmission. Multivariate analysis identified immunocompromised status (p = 0.036; OR 3.5, 95% CI 1.1-11.5) and hepatic disease (chronic hepatitis or alcohol abuse) (p = 0.033; OR 2.9, 95% CI 1.1-7.7) as positive predictors of 90-day readmission. CONCLUSIONS The most common indication for readmission was persistent infection. Readmission was unrelated to baseline neurological status or management strategy. However, both hepatic disease and baseline immunosuppression significantly increased the odds of 90-day readmission after SEA treatment. Patients with these conditions may require closer follow-up upon discharge to reduce overall morbidity and hospital costs associated with SEA.
Collapse
Affiliation(s)
- Michael Longo
- 1Spine Research Group and
- 2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Zach Pennington
- 3Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yaroslav Gelfand
- 1Spine Research Group and
- 2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Rafael De la Garza Ramos
- 1Spine Research Group and
- 2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Murray Echt
- 1Spine Research Group and
- 2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - A Karim Ahmed
- 3Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vijay Yanamadala
- 1Spine Research Group and
- 2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Daniel M Sciubba
- 3Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reza Yassari
- 1Spine Research Group and
- 2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| |
Collapse
|
28
|
Fujii M, Shirakawa T, Shime N, Kawabata Y. Successful treatment of extensive spinal epidural abscess with fluoroscopy-guided percutaneous drainage: a case report. JA Clin Rep 2020; 6:4. [PMID: 32026104 PMCID: PMC6967264 DOI: 10.1186/s40981-020-0309-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Surgical drainage and antimicrobial therapy are the most accepted empirical treatments for spinal epidural abscess. However, surgery may not be indicated when patient’s general health condition is poor. Percutaneous drainage has been reported as a non-surgical treatment for children or patients with no or minor neurological deficits. Here we describe the successful treatment of an extensive spinal epidural abscess with fluoroscopy-guided percutaneous drainage in an elderly man with progressive muscle weakness who could not be operated because of a poor general health condition. Case presentation An 81-year-old man presented with fever, back pain, and progressive muscle weakness in bilateral legs. Magnetic resonance imaging (MRI) showed extensive fluid retention in the spinal epidural space (Th6 to L3). Paraplegia due to an epidural abscess was suspected. We considered an emergency operation; however, the patient’s general condition was poor. Therefore, fluoroscopy-guided percutaneous epidural drainage was performed. After drainage, his back pain and muscle weakness gradually resolved. After 3 weeks, MRI showed that the abscesses had completely disappeared. Discussion Compared with surgical drainage, fluoroscopy-guided percutaneous epidural drainage is a less invasive treatment option for patients with a poor general condition.
Collapse
Affiliation(s)
- Masashi Fujii
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae-cho, Nagahama, Shiga, 526-8585, Japan.
| | - Tsutomu Shirakawa
- Department of Orthopedic Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuyo Kawabata
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae-cho, Nagahama, Shiga, 526-8585, Japan
| |
Collapse
|
29
|
Tetsuka S, Suzuki T, Ogawa T, Hashimoto R, Kato H. Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management. JMA J 2019; 3:29-40. [PMID: 33324773 PMCID: PMC7733760 DOI: 10.31662/jmaj.2019-0038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/26/2019] [Indexed: 01/08/2023] Open
Abstract
Spinal epidural abscess (SEA) is still an uncommon but devastating infection of the spine. In recent years, a number of reported cases have risen. The most important prognostic factor for a favorable outcome is early diagnosis and appropriate treatment. However, a diagnosis of SEA is often delayed, particularly in the early stages of the disease before patients present with neurological symptoms. With enough knowledge of risk factors, clinical features, and appropriate diagnostic procedures, it may be possible to reduce diagnostic delay in the early stages of the disease. This review focuses on early diagnosis of SEA based on risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI), and also discusses the timing of surgical interventions. Traditionally, the symptoms of SEA are characterized by fever, back pain, and neurological symptoms, which are described as a classical triad of symptoms for this type of infection; but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis of SEA. Patients diagnosed prior to neurological deficits with a known causative microbial organism can be safely treated with antimicrobial therapy alone. However, about 30%–40% of the patients fail in conservative management without surgery. The best management and timing for surgical decompression in patients with or without mild neurological deficits should be established in the near future. Early diagnosis and management, before the occurrence of serious neurological symptoms, are the most important prognostic factors for good outcomes in patients with SEA. We proposed a simple algorithm for early diagnosis of SEA by selecting patients with severe back pain, leading to emergent MRI.
Collapse
Affiliation(s)
- Syuichi Tetsuka
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Tomohiro Suzuki
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Tomoko Ogawa
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Ritsuo Hashimoto
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Hiroyuki Kato
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| |
Collapse
|
30
|
Simlett-Moss AB, Freeman A, McConnell FJ, Coe R, Sanchez-Masian D. Successful surgical management of an Escherichia coli epidural-subdural abscess secondary to sino-rhinotomy. J Vet Emerg Crit Care (San Antonio) 2019; 29:696-701. [PMID: 31642173 DOI: 10.1111/vec.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe a case of successful management of epidural-subdural abscess and severe meningitis with secondary brain herniation in a dog. CASE SUMMARY A rhino-sinusotomy was performed in a 3-year-old mixed-breed dog for management of refractory sinonasal aspergillosis. Initial recovery was good, but the dog became acutely stuporous 36 hours after surgery. Evidence of increased intracranial pressure with brain herniation and midline shift secondary to an epidural abscess was observed on magnetic resonance imaging. Decompressive craniectomy and drainage of the abscess was performed. Intensive nursing care and physiologic support was performed with consciousness returning 7 days after initial stupor. The dog was discharged 14 days after craniectomy and was ambulatory with support. NEW/UNIQUE INFORMATION PROVIDED Intracranial abscesses are rarely described in dogs and few had a successful outcome reported. All previous reports have been of brain abscesses or empyema, rather than a combination of epidural and subdural abscessation. Additionally, the process of sino-rhinotomy for management of aspergillosis has not been previously linked to intracranial abscess formation. To the authors' knowledge, this is the first report of successful management of an epidural-subdural abscess and suggests that even with cases with low modified Glasgow Coma Scale scores outcome may be positive.
Collapse
Affiliation(s)
| | - Alistair Freeman
- Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | | | - Richard Coe
- Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | | |
Collapse
|
31
|
Lipton G, Tikka T, Soulsby H, Keh S. Prevertebral neck abscess with Salmonella sandiego: a case presentation and literature review. BMJ Case Rep 2019; 12:12/7/e230881. [PMID: 31345833 DOI: 10.1136/bcr-2019-230881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe an unusual case of a 58-year-old man with type 2 diabetes mellitus (T2DM) developing sepsis secondary to a prevertebral neck abscess. Following cross-sectional imaging, the patient underwent surgical drainage. Salmonella sandiego was isolated from urine, blood and pus cultures. Salmonella species neck infections represent a rare cause of focal salmonellosis, though have been reported in the literature. This is the first reported case of S. sandiego causing neck abscess. The case highlights an atypical presentation of salmonellosis, with the surprising finding of a neck abscess on cross-sectional imaging without evidence of co-existing significant discitis or osteomyelitis.
Collapse
Affiliation(s)
- Gareth Lipton
- ENT Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Theofano Tikka
- ENT Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Hannah Soulsby
- Microbiology Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Siew Keh
- ENT Department, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
32
|
Kim HT, Lim SW, Yim KH, Park SH, Choi JH, Bae YM, Shin ID, Shin YD. Antibacterial effect of lidocaine in various clinical conditions. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Hyeon Tae Kim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Woon Lim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyoung Hoon Yim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Hi Park
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jung Hee Choi
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yoo-Mee Bae
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Il Dong Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| |
Collapse
|
33
|
Kim MH, Lee KY, Bae SJ, Jo M, Cho JS. Intraoperative dexmedetomidine attenuates stress responses in patients undergoing major spine surgery. Minerva Anestesiol 2019; 85:468-477. [DOI: 10.23736/s0375-9393.18.12992-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Gabriel RA, Swisher MW, Sztain JF, Furnish TJ, Ilfeld BM, Said ET. State of the art opioid-sparing strategies for post-operative pain in adult surgical patients. Expert Opin Pharmacother 2019; 20:949-961. [DOI: 10.1080/14656566.2019.1583743] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rodney A. Gabriel
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Matthew W. Swisher
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Jacklynn F. Sztain
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
| | - Timothy J. Furnish
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
| | - Brian M. Ilfeld
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Engy T. Said
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
35
|
Noori SA, Gungor S. Spinal epidural abscess associated with an epidural catheter in a woman with complex regional pain syndrome and selective IgG3 deficiency: A case report. Medicine (Baltimore) 2018; 97:e13272. [PMID: 30557971 PMCID: PMC6319999 DOI: 10.1097/md.0000000000013272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Continuous epidural infusion of local anesthetic may be an alternative to sympathetic blocks in refractory cases of complex regional pain syndrome (CRPS). Spinal epidural abscess (SEA) is a well-known complication associated with this technique, especially in patients with immune deficiencies. We herewith report a cervical SEA associated with an epidural catheter in a woman with CRPS and selective IgG3 subclass deficiency. PATIENT CONCERNS Severe pain interfering with activities of daily living. DIAGNOSIS Complex regional pain syndrome type-1 with involvement of upper extremity. INTERVENTIONS The patient underwent inpatient epidural infusion for management of left upper extremity CRPS. Her history was notable for previous left shoulder injury requiring numerous surgical revisions complicated by recurrent shoulder infections, and selective IgG3 deficiency. She received antibiotic prophylaxis and underwent placement of a C6-C7 epidural catheter. On day 5, she became febrile. Neurological examination remained unchanged and an MRI demonstrated acute fluid collection from C3-T1. The following day she developed left arm weakness and was taken for emergent cervical decompression. Intraoperative abscess cultures were positive for Pseudomonas aeruginosa. OUTCOMES Postoperatively, the patient's neurological symptoms and signs improved. LESSONS Patients with selective IgG3 deficiency who are being considered for epidural catheterization may benefit from expert consultation with infectious diseases specialist. A history of recurrent device- or tissue-related infections should alert the clinician to the possible presence of a biofilm or dormant bacterial colonization. Close monitoring in an ICU setting during therapy is recommended. In case of early signs of infection, clinicians should have a high suspicion to rule out a SEA in immunocompromised patients.
Collapse
Affiliation(s)
- Selaiman Ahmad Noori
- Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Semih Gungor
- Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| |
Collapse
|
36
|
Abstract
Infection of the neck is a relatively common emergency department complaint. If not diagnosed and managed promptly, it may quickly progress to a life-threatening infection. These infections can result in true airway emergencies that may require fiberoptic or surgical airways. This article covers common, as well as rare but emergent, presentations and uses an evidence-based approach to discuss diagnostic and treatment modalities.
Collapse
Affiliation(s)
- Renjie Michael Li
- Department of Emergency Medicine, Loma Linda University Medical Center, 11234 Anderson Street MC A-108, Loma Linda, CA 92354, USA
| | - Michael Kiemeney
- Department of Emergency Medicine, Loma Linda University School of Medicine, 11234 Anderson Street MC A-108, Loma Linda, CA 92354, USA.
| |
Collapse
|
37
|
New PW, Eriks-Hoogland I, Scivoletto G, Reeves RK, Townson A, Marshall R, Rathore FA. Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil 2018; 23:299-312. [PMID: 29339906 DOI: 10.1310/sci2304-299] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Non-traumatic spinal cord dysfunction (SCDys) is caused by a large range of heterogeneous etiologies. Although most aspects of rehabilitation for traumatic spinal cord injury and SCDys are the same, people with SCDys have some unique rehabilitation issues. Purpose: This article presents an overview of important clinical rehabilitation principles unique to SCDys. Methods: Electronic literature search conducted (January 2017) using MEDLINE and Embase (1990-2016) databases for publications regarding SCDys. The focus of the literature search was on identifying publications that present suggestions regarding the clinical rehabilitation of SCDys. Results: The electronic search of MEDLINE and Embase identified no relevant publications, and the publications included were from the authors' libraries. A number of important clinical rehabilitation principles unique to people with SCDys were identified, including classification issues, general rehabilitation issues, etiology-specific issues, and a role for the rehabilitation physician as a diagnostic clinician. The classification issues were regarding the etiology of SCDys and the International Standards for Neurological Classification of Spinal Cord Injury. The general rehabilitation issues were predicting survival, improvement, and rehabilitation outcomes; admission to spinal rehabilitation units, including selection decision issues; participation in rehabilitation; and secondary health conditions. The etiology-specific issues were for SCDys due to spinal cord degeneration, tumors, and infections. Conclusions: Although there are special considerations regarding the rehabilitation of people with SCDys, such as the potential for progression of the underlying condition, functional improvement is typically significant with adequate planning of rehabilitation programs and special attention regarding the clinical condition of patients with SCDys.
Collapse
Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | | | - Giorgio Scivoletto
- Spinal Unit, IRCCS Fondazione S. Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Ronald K Reeves
- Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Andrea Townson
- GF Strong Rehab Centre, British Columbia, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, Northfield, South Australia, Australia.,Discipline of Orthopaedics and Trauma, School of Medicine, Faculty of Health Science, University of Adelaide, South Australia, Australia
| | - Farooq A Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan.,Department of Rehabilitation Medicine, Bahria University Medical and Dental College, Bahria University, Karachi, Pakistan
| |
Collapse
|
38
|
Abstract
Chronic low back pain (LBP) places a tremendous economic burden on society due to both direct and indirect costs. Health care costs for adults with chronic LBP have steadily increased over the past 20 years, coinciding with a large increase in the utilization of spinal injections, surgical interventions, opioid medications, and physical therapy. The treatment of LBP is best approached by a multimodal and even multidisciplinary approach with a combination of physical rehabilitation, pharmacologic management, psychological intervention, spinal injections, and surgical intervention with a goal of improving the functional status of the patient. In this review, we discuss the interventional management of LBP secondary to herniated nucleus pulposus, spinal stenosis, facet mediated pain, sacroiliitis, and discogenic pain.
Collapse
|
39
|
Thomson C. Spinal cord compression secondary to epidural abscess: the importance of prompt diagnosis and management. BMJ Case Rep 2018; 2018:bcr-2017-220694. [PMID: 29437718 DOI: 10.1136/bcr-2017-220694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 66-year-old woman presented with a 4-day history of fever, lethargy, neck and lower back pain. Neurological examination revealed mild quadraparesis. In view of this, MRI whole spine with contrast was performed and showed extensive spinal epidural abscess extending from the cervical to lumbar region causing compression of the thecal sac, spinal cord and nerves. The patient received multiple laminectomies to decompress the spinal cord and required a prolonged course of intravenous flucloxacillin as Staphylococcus aureus was cultured from three sets of blood cultures. Although spinal epidural abscess is rare, it is important for clinicians to have a high index of suspicion; so appropriate imaging is performed to determine the diagnosis. Patient age, degree of thecal sac compression and duration of symptoms are all independently associated with poor outcome. 1.
Collapse
Affiliation(s)
- Chloe Thomson
- Acute Medicine, William Harvey Hospital, Ashford, UK
| |
Collapse
|
40
|
Can early oral prolonged-release oxycodone with or without naloxone reduce the duration of epidural analgesia after cystectomy? A 3-arm, randomized, double-blind, placebo-controlled trial. Pain 2017; 159:560-567. [DOI: 10.1097/j.pain.0000000000001112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
41
|
Gungor S, Aiyer R, Erkan D. Cervical Epidural Injection in the Management of Refractory Pain and Stiffness in Spondyloarthropathy: A Case Report Series. Pain Pract 2017; 18:532-538. [PMID: 28742241 DOI: 10.1111/papr.12616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/20/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The primary objective of this case series was to report the use of cervical epidural steroid injection in the management of neck pain and stiffness secondary to spondyloarthropathy in cases refractory to conservative therapy. METHODS This was a case report series on three patients with diagnosis of spondyloarthropathy who presented with severe stiffness and non-radicular axial neck pain refractory to conservative therapy. All patients received cervical epidural steroid injections with significant improvement of their axial neck pain and stiffness. RESULTS Cervical epidural steroid injections may be effective to improve the axial neck pain and stiffness in patients with diagnosis of spondyloarthropathy refractory to conservative management. Thus, we believe that epidural steroid injections should be considered in the management of patients with spondyloarthopathies.
Collapse
Affiliation(s)
- Semih Gungor
- Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery-Weill Cornell Medicine, Cornell University, New York, New York, U.S.A
| | - Rohit Aiyer
- Department of Psychiatry, Hofstra Northwell Health, Staten Island University Hospital, Staten Island, New York, U.S.A
| | - Doruk Erkan
- Division of Rheumatology, Department of Internal Medicine, Hospital for Special Surgery-Weill Cornell Medicine, Cornell University, New York, New York, U.S.A
| |
Collapse
|
42
|
Schmitt J, Prunet B, Veyrieres JB, Gaillard T, Delarbre D, Meaudre E. [Staphylococcus aureus epidural abscess following epidural catheter placement in a patient suffering from psoriasis]. Presse Med 2017. [PMID: 28623076 DOI: 10.1016/j.lpm.2017.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- J Schmitt
- Hôpital d'instruction des armées Sainte-Anne, département d'anesthésie-réanimation, boulevard Sainte-Anne, 83000 Toulon, France.
| | - B Prunet
- Hôpital d'instruction des armées Sainte-Anne, département d'anesthésie-réanimation, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-B Veyrieres
- Hôpital d'instruction des armées Sainte-Anne, service d'imagerie médicale, boulevard Sainte-Anne, 83000 Toulon, France
| | - T Gaillard
- Hôpital d'instruction des armées Sainte-Anne, laboratoire de bactériologie, boulevard Sainte-Anne, 83000 Toulon, France
| | - D Delarbre
- Hôpital d'instruction des armées Sainte-Anne, service de médecine interne, boulevard Sainte-Anne, 83000 Toulon, France
| | - E Meaudre
- Hôpital d'instruction des armées Sainte-Anne, département d'anesthésie-réanimation, boulevard Sainte-Anne, 83000 Toulon, France
| |
Collapse
|
43
|
Maddali P, Moisi M, Page J, Chamiraju P, Fisahn C, Oskouian R, Tubbs RS. Anatomical complications of epidural anesthesia: A comprehensive review. Clin Anat 2017; 30:342-346. [DOI: 10.1002/ca.22831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | - Marc Moisi
- Department of Neurosurgery; Wayne State University; Detroit MI
| | - Jeni Page
- Swedish Neuroscience Institute; Seattle WA
| | | | | | | | | |
Collapse
|
44
|
The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg 2017; 153:e129-e146. [PMID: 28274565 DOI: 10.1016/j.jtcvs.2017.01.030] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/24/2016] [Accepted: 01/08/2017] [Indexed: 11/24/2022]
|
45
|
Aleman-Ortega H, Lee R, Shambo L, Czinn E. Neuraxial Anesthesia and the Use of Sterile Gowning. AORN J 2017; 105:184-192. [DOI: 10.1016/j.aorn.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/11/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022]
|
46
|
Kumar A, Kumar V, Dhatt SS, Lal H, Bahadur R. Spontaneous spinal epidural abscess in a normoglycemic diabetic patient - Keep it as a differential. J Clin Orthop Trauma 2017; 8:178-180. [PMID: 28720998 PMCID: PMC5498741 DOI: 10.1016/j.jcot.2016.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/07/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022] Open
Abstract
Spinal epidural abscess (SEA) is a rare and serious condition which can lead to permanent neurological deficit. Spontaneous SEA is even rarer condition with an incidence of less than 1 per 10,000 person-year. Being spontaneous, it has high chances of being misdiagnosed, more so when the risk factors are not clearly explainable for the condition. This is a case report of such a case in a middle aged normoglycemic recently diagnosed diabetic man with atypical presentation. The diagnosis was made after magnetic resonance imaging and confirmed after surgical intervention in form of spinal decompression and patient recovered after appropriate antibiotics. This article also sums up the risk factors of spontaneous SEA.
Collapse
Affiliation(s)
- Avinash Kumar
- Department of Orthopaedics, Room No. 15, Nehru Hospital, PGIMER, Chandigarh 160012, India
| | - Vishal Kumar
- Department of Orthopaedics, Room No. 15, Nehru Hospital, PGIMER, Chandigarh 160012, India,Corresponding author.
| | - Sarvdeep S. Dhatt
- Department of Orthopaedics, Room No. 15, Nehru Hospital, PGIMER, Chandigarh 160012, India
| | - Hitesh Lal
- Central Institute of Orthopaedics, Safdarjung Hospital, Vardhman Mahavir Medical College, New Delhi, India
| | - Raj Bahadur
- Department of Orthopaedics, Room No. 15, Nehru Hospital, PGIMER, Chandigarh 160012, India
| |
Collapse
|
47
|
Dunphy L, Iyer S, Brown C. Rare cause of back pain: Staphylococcus aureus vertebral osteomyelitis complicated by recurrent epidural abscess and severe sepsis. BMJ Case Rep 2016; 2016:bcr-2016-217111. [PMID: 27965310 DOI: 10.1136/bcr-2016-217111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An epidural abscess represents a rare acute medical emergency, with a reported incidence of 2.5/10 000 hospital admissions annually. The clinical features include fever, spinal pain, radiating nerve root pain and leg weakness. When sepsis is present, prompt recognition is required to initiate appropriate antimicrobial therapy and surgical decompression. We present the case of a man aged 68 years presenting to the emergency department with a 3-day history of fever, low back, right hip and leg pain. He was hypoxic, tachycardic and hypotensive. He required intubation and ventilation. An MRI spine confirmed a posterior epidural abscess from T12 to L4. Blood cultures revealed Staphylococcus aureus He started treatment with linezolid and underwent incision and drainage. He remained septic and 8 days later, a repeat MRI spine showed a peripherally enhancing posterior epidural collection from L2/L3 to L4/L5, consistent with a recurrent epidural abscess. Further drainage was performed. He developed bilateral knee pain requiring washout. His right knee synovial biopsy cultured S. aureus He continued treatment with linezolid for 6 weeks until his C reactive protein was 0.8 ng/L. He started neurorehabilitation. 10 weeks later, he became feverish with lumbar spine tenderness. An MRI spine showed discitis of the L5/S1 endplate. A CT-guided biopsy confirmed discitis and osteomyelitis. Histology was positive for S. aureus and he started treatment with oral linezolid. After 19 days, he was discharged with 1 week of oral linezolid 600 mg 2 times per day, followed by 1 further week of oral clindamycin 600 mg 4 times daily. This case report reinforces the importance of maintaining a high clinical suspicion, with a prompt diagnosis and combined medical and surgical treatment to prevent adverse outcomes in this patient cohort. With spinal surgical services centralised, physicians may not encounter this clinical diagnosis more often in day-to-day hospital medical practice. The unique aspect of this case is the persistence and then the recurrence (despite 6 weeks of antimicrobial therapy and a second debridement) of S. aureus infection. Furthermore, the paucity of clinical recommendations and the controversy regarding the adequate duration of antimicrobial therapy are notable features of this case.
Collapse
Affiliation(s)
- Louise Dunphy
- Department of Trauma and Orthopaedic Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Shabnam Iyer
- Department of Microbiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Christopher Brown
- Department of Trauma and Orthopaedic Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK
| |
Collapse
|
48
|
Spinal Epidural Abscess: A Review with Special Emphasis on Earlier Diagnosis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1614328. [PMID: 28044125 PMCID: PMC5156786 DOI: 10.1155/2016/1614328] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022]
Abstract
Spinal epidural abscess (SEA) is an uncommon but serious condition with significant morbidity and mortality. The prognosis of SEA is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Unfortunately, often due to its nonspecific presentation, such as back pain, the diagnosis of SEA may be delayed in up to 75% of cases. Although many risk factors for SEA can be found in the published literature, their utility is limited by their frequent lack of objective evidence, numerousness, and absence in a significant proportion of cases. In this review, we call for a more discriminate evidence-based use of the term "risk factor" when discussing SEA and explore several approaches to its earlier diagnosis, including a simple algorithm based on its pathophysiology and serum C-reactive protein or erythrocyte sedimentation rate.
Collapse
|
49
|
Onofrei M, Wee MY, Parker B, Wee N, Hill S. Bacterial contamination of saline used for epidural procedures in an obstetric setting: a randomised comparison of two drawing-up techniques. Int J Obstet Anesth 2016; 29:45-49. [PMID: 27884664 DOI: 10.1016/j.ijoa.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/30/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is little evidence to inform practice regarding the optimum aseptic technique of drawing up saline for epidural insertion. Our regional practice is to draw up saline from a non-sterile packaged plastic ampoule, therefore introducing the risk of bacterial contamination. Usually, the anaesthetist draws up saline directly from the vial held by an assistant using a needle (needle technique). Alternatively, the saline vial is emptied onto a sterile tray by an assistant and then drawn up by the anaesthetist (tray technique). We hypothesised that the latter will lead to an increase in the number of contaminated saline samples as they are exposed to the environment. METHODS In labour rooms and before epidural catheter insertion, 110 samples of saline 20mL were randomly drawn up using our hospital's recommended epidural aseptic precautions, using either the needle or the tray technique. Equal amounts of saline were inoculated into aerobic and anaerobic blood culture bottles. RESULTS Eleven percent of samples in the needle arm and 24% of samples in the tray arm grew commensal micro-organisms including coagulase-negative Staphylococcus, Micrococcus luteus and Streptococcus viridans. A two-sided Fisher's exact test for categorical unpaired data showed no statistical difference between the two arms of the trial (P=0.13). CONCLUSION The difference in the saline contamination rate between the two techniques did not reach statistical significance. As bacterial contamination occurred with both techniques, we recommend using sterile saline pre-packaged in the epidural tray or individually wrapped sterile glass saline ampoules.
Collapse
Affiliation(s)
- M Onofrei
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK.
| | - M Y Wee
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - B Parker
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - N Wee
- Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - S Hill
- Department of Microbiology, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| |
Collapse
|
50
|
|