Central Nervous System Infections

In routine anesthesia practice, the reported incidence of infection after regional anesthesia is extremely low. It is interesting to note that an epidural abscess may form spontaneously in up to 1 in 10,000 patients admitted to the hospital in the United States.^[228] Typical signs and symptoms include fever, back pain, and localized infection at the level of the epidural site 2 to 3 days after the procedure.

Serious infectious complications after spinal/epidural analgesia and anesthesia are rare, but they can have devastating sequelae. Infection may be exogenous in origin and be caused by the contamination of equipment or pharmacologic agents or by colonization of the catheter. Endogenous spread may occur from a site of infection elsewhere in the body. There have also been reports of meningitis after spinal anesthesia in which the same phage type of organism (Streptococcus viridans) was isolated from the patient and the anesthesiologist who performed the procedure.^[229] Despite the lack of national guidelines on infection control precautions for neuraxial techniques, most anesthesiologists believe that sterile precautions should be observed at all times.