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Q: spinal or epidural following meningitis. ( Answered 4 out of 5 stars,   1 Comment )
Subject: spinal or epidural following meningitis.
Category: Health > Conditions and Diseases
Asked by: ripd-ga
List Price: $100.00
Posted: 19 Mar 2003 05:48 PST
Expires: 18 Apr 2003 06:48 PDT
Question ID: 178161
Efficacy and risks of either epidural or spinal anesthesia in a person
who has had recent meningitis.

Request for Question Clarification by cath-ga on 19 Mar 2003 12:40 PST
Hello, ripd,

I have been researching your question, and have a general answer to
it. However, if you can provide the following information, I can
make it more specific to you:

What kind of meningitis did you have? How recently? Are you completely
Why do you need an epidural or spinal?

Thanks!! cath-ga

Clarification of Question by ripd-ga on 20 Mar 2003 09:35 PST
it's actually a general question to which i have not been able to find
a scientific answer(ie percentage risk, chance of local anaesthetic
spreading normally,length of time needed between meningitis and
epidural). Getting opinions has been easy (none of them agree). every
time i search medline and google i get papers on the risk of menigitis
following spinal or epidural.
specifically, listeria meningitis. last antibiotics 5 weeks ago.
pregnancy contemplated.

Request for Question Clarification by cath-ga on 20 Mar 2003 12:43 PST
Thanks for your clarification. I have several calls and e-mails out,
and will get you an answer ASAP! cath-ga
Subject: Re: spinal or epidural following meningitis.
Answered By: cath-ga on 25 Mar 2003 12:39 PST
Rated:4 out of 5 stars
Dear ripd,

I spoke on the phone with Dr. David Birnbach of  the University of
School of Medicine. He is a spokesman for the American Society of
Anesthesiologists. He is also past president of the Society of
Obstetric Anesthesiologists and Perinatologists, and has been doing
epidurals for
20 years. He asked me to get the personal details from you, then
me this response:

Assuming that she returns to normal following the treatment (and has
no chronic neurologic problems), there should be no contraindication
to her receiving epidural or spinal anesthesia for delivery in more
than 9 months! There is nothing in the literature to suggest that the
remote history of meningitis is a contraindication to neuraxial
(epidural, spinal) techniques.
But the bottom line is that this is something that she will need to
discuss with the people who treated her meningitis,and with her
obstetrician and with the anesthesiologist at the hospital in which
she is planning on delivering.
Hope this helps.
David J. Birnbach, MD
Professor and Executive Vice Chair
Department of Anesthesiology
University of Miami School of Medicine

Birnbach also told me on the phone: 

1)If you are totally cured of meningitis and have no neurological
symptoms, then you are just like anybody else and the risks and
of regional anesthesia are the same. No better, no worse. Dr. Birnbach
says there is no evidence that the past, cured infection leaves any
sensitivity to the anesthetic.

2)If you still have meningitis, of course, you probably should NOT be
having regional anesthesia because of the danger of spreading the
worsening the neurological symptoms and doing some major damage.

I also e-mailed the Meningitis Trust in the UK with your question.
They preferred not to answer me, but to speak or correspond with you
directly. Here is the e-mail from them.

I have spoken to our helpline team and they have said that they would
rather speak to the individual direct, as each case is different. It
would be great if you could pass on our helpline number (24 hours)
0845 6000800, or email and write HELPLINE in
the subjectbox.
I'm sorry if this doesn't help answering the question, but we feel it
would be dealt with better in this way - just in this instance, as it
isn't a simple question. We could usually just send you a simple

As you mentioned, ripd, searches of Medline and on Google do not turn
up articles which would answer your question. I searched several
meningitis and anesthesiology sites (cited below) and there was no
mention. I believe this is because, as Dr. Birnbach stated, there is
no problem there. Once you are cured, there is no contraindication
worth mentioning. The closest relevant thing I found in my search was
an article on “Contraindications for Regional Anesthetic” at:

Contraindications for regional anaesthesia - central blocks 
Per H. Rosenberg, MD, PhD Department of Anaesthesiology and Intensive
Care, Helsinki Universit Hospital,  Helsinki, Finland

It does list “PRE-EXISTING neurological disease” as a  “relative
contraindication,” but doesn’t mention “PAST neurological disease.”

"Pre-existing neurological disease which  involves the spinal cord
.......	  The nervous tissue may be more sensitive to toxic actions of
a local anaesthetic. However, conclusive evidence is lacking,  and, 
e.g.,multiple sclerosis does not seem to be aggravated after central
block .

I hesitate even to mention the above because it doesn’t fit your
you don't have "EXISTING neurological disease,"but I think if you’ll
click to the article, you’ll be reassured because “past meningitis” is
NOT mentioned among the several other contraindications.

Also, for what it’s worth, I was unable to have an epidural when I
twin girls, because I have a lumbar spinal fusion. The OB didn’t
with the anesthesiolgist in advance, and the anesthesiologist wasn’t
prepared to deal with me when I came in for an emergency C-section.
Make sure your doctors do all consult with each other in advance.
However, also be reassured that I delivered two healthy baby girls
just fine under general anesthetic. 

If you feel this answer is unclear or incomplete in any way, please do
me to clarify before you rate it. Thanks for your business, and good

Sincerely, Cath-ga 

Search strategy: on Google:
“medical sites”

Searched the site below and found nothing relevant under “epidural,”or
 “spinal anesthetic.” Also e-mailed and phoned them.

Meningitis Foundation of America, Inc.
7155 Shadeland Station 
Suite 190 
Indianapolis, IN 46256-3922
Tel: 800-668-1129 317-595-6383 
Fax: 317-595-6370

National Institutes of Health (NIH), referred me to the National
Institute of Allergies and Infectious Diseases.

Medline Plus

e-mailed , then phoned the
American Society of Anesthesiologists
Headquarters Office
520 N. Northwest Highway
Park Ridge, IL 60068-2573
telephone: (847) 825-5586
fax: (847) 825-1692
They referred me to Dr. David Birnbach, who I e-mailed and phoned.

National Institute of Allergies and Infectious Diseases:
301-496-5717 called with questions. They were not helpful.

Meningitis Foundation (UK)  website:

e-mailed their media contact address.

Meningitis Trust at:

e-mailed their contact person, and  searched the entire site- no
mention of epidural anesthetic.

Clarification of Answer by cath-ga on 26 Mar 2003 09:04 PST

Here is a late response, promising another answer next week. I'll send it
to you when it arrives. cath

Subj: Meningitis Query  
Date: 03/26/2003 8:42:49 AM Pacific Standard Time 
Dear Cath,
Our Head of Medical Information is currently on annual leave and I would
like her response to your query.  therefore we will respond with information
to you early next week
Kind regards

Shirley Gieron
Assistant helpline Co-ordinator
Tel ~ 01454 280 409
Fax ~ 01454 281 094
E-mail ~

Offices: Belfast  Bristol  Dublin  Edinburgh
A charity registered in England and Wales No 1091105
A company limited by guarantee.  Registered in England No 4367866
Registered Office: Midland Way  Thornbury  Bristol  BS35 2BS
ripd-ga rated this answer:4 out of 5 stars
I am actually a doctor, I asked the question because I was very
surprised when I could find no medical literature on the subject and
wondered whether my search technique was to blame. Dr Birnbach's
(experienced) opinion falls in with the majority of the opinions
expressed by those I questioned myself (also very experienced), but
there were a few pessimists. Their worry was whether the anaesthetic
agen would spread normally. Many are willing to give it a try a year
down the line, fewer at 5 weeks. There was no real consensus as to the
safe time interval between meningitis and epidural. In the end, I
guess the answer is there is no proven answer, but no-one has noted a
major problem.

Subject: Re: spinal or epidural following meningitis.
From: drbrains-ga on 06 May 2003 21:23 PDT
I took a look also, through a proprietary Medline front-end my
hospital pays for - no luck.

If the lady in question gets her epidural, and it works (or not), you
should write it up as a case report, so the next poor doc who needs to
know the answer can discover it!

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