Meningitis after regional spinal anesthesia.

Objective: Meningitis is a severe and an uncommon complication of both spin al and epidural anaesthesia. This review summarizes the knowledge on epidem iology, clinical and microbiological diagnosis and the ways to prevent them . Data sources: Articles published in English and French langage since 1989 h as been collected on Medline database, using "meningitis,", "spinal anaesth esia", and "epidural anaesthesia", as keywords. Data synthesis: Bacterial meningitis are usually in relation with Gram posi tive bacterias which is a clue for an exogenous contamination. Another unus ual ways of contamination are blood circulating bacterias and spreading of local infection. Aseptic meningitis has been described, in relation to intr oduction of irritant agents in subarachnoid space. Lumbar puncture must be done each time meningitis suspected so that it can assert the diagnosis and guid antibiotherapy. Easy hygienic guidelines has been widely published to prevent meningitis. Usually, antibjotherapy alone is sufficient to treat m eningitis but with an unjustified cost and sometimes severe persistent neur ologic sequelae. Conclusion: The unexpected appearance of meningitis during the wearing-off of a spinal anesthesia is exceptional; the possibility of death or serious sequela must be taken into account. The sources of contamination are quite frequently exogenous, the germs coming most often from the patient's cutane ous flora or the anesthetist's ENT flora. Prevention of this risk involves a rigorous respect for cutaneous disinfection and hygiene procedures. The a nesthetist's medico-legal responsibilities will be called upon in case of e xogenous contamination. (C) 2000 Editions scientifiques st medicales Elsevi er SAS.