Dear ripd,
I spoke on the phone with Dr. David Birnbach of the University of
Miami
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
e-mailed
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
benefits
of regional anesthesia are the same. No better, no worse. Dr. Birnbach
says there is no evidence that the past, cured infection leaves any
lingering
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
infection,
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.
Cath,
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 info@meningitis-trust.org 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
reply!
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:
http://www.esraeurope.org/abstracts/abstracts2000/rosenberg2.htm
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
situation,
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
delivered
twin girls, because I have a lumbar spinal fusion. The OB didn’t
consult
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
ask
me to clarify before you rate it. Thanks for your business, and good
luck!
Sincerely, Cath-ga
Search strategy: on Google:
“medical sites”
meningitis
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
support@musa.org
http://www.musa.org
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
http://search.nlm.nih.gov/medlineplus/query?DISAMBIGUATION=true&FUNCTION=search&PARAMETER=Meningitis
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
e-mail: mail@asahq.org
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:
http://www.meningitis.org/
e-mailed their media contact address.
Meningitis Trust at:
http://www.meningitis-trust.org.uk/frame.htm
e-mailed their contact person, and searched the entire site- no
mention of epidural anesthetic. |
