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29 Postoperative delirium: a surgeon’s dilemma
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  1. R Khandelwal
  1. AHPGIC, Cuttack, India

Abstract

Background and Aims Iatrogenic meningitis following spinal anesthesia is rare but serious complication which can perplex the surgeon. The diagnosis of iatrogenic meningitis is difficult in the usual setting. As, all post – operative complications are directly targeted at the surgeon, this one too puts the surgeon in a challenging situation. It at times becomes difficult to explain to the relatives the cause of the patient’s condition.

Methods A 49 year female attended the OPD for complain of post menopausal bleeding since 3 months. Her ultrasound report showed an endometrial thickness of 11 mm with slightly enlarged uterus. An office endometrial biopsy (EB) was done. The EB report was suggestive of simple hyperplasia without any atypia. So, considering her symptoms she was planned for vaginal hysterectomy and, pre- anesthetic clearance was obtained. Eight hours following the surgery, the patient was found to be somnolent and confused.

Results Post-spinal meningitis should be considered in differential diagnosis of patients having post-spinal headache, convulsions and changes in mental status.Its etiology includes failure of aseptic techniques, presence of asymptomatic bacteremia, contamination during puncture through microscopic bleeding and possibility of aseptic chemical meningitis.

Conclusions The diagnosis of post-spinal aseptic meningitis caused probably by the hyperbaric bupivacaine injected in the subarachnoid space was made and this should alert surgeon and anesthesiologist about the possible but rare consequences of spinal anesthesia. We believe that the rarity of this complication necessitates health care providers all over the world to share such cases for early diagnosis and for instituting proper care to such patients.

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