Neuraxial Anesthesia and Surgical Site Infection, Dr. Chang

Helen A. Chang, DO

Article:
Neuraxial Anesthesia and Surgical Site Infection

Sessler, Daniel I. M.D. Anesthesiology. Aug 2010 – Vol 113 – Issue 2, pp 265-267

Summary:

There is no 100% full proof method to avoid or prevent surgical site related infections. However, this article presents several methods from the anesthesia perspective that may wholly reduce surgical-specific infections. Three methods mentioned: induced hypothermia which reduces tissue oxygenation and thus impairs various immune functions; supplemental oxygen that increases FiO2 halves infection risk (although other studies show no difference) and enhances host defense against bacteria; and considering erythrocyte-based blood products stored less than 2 weeks.

The crux of the article mentioned utilizing neuraxial (i.e. spinal) versus general anesthesia, when clinically/surgically appropriate.  Three mechanisms supporting this theory included: reducing infection by vasodilation and improvement of tissue oxygenation; moderation of the inflammatory response and cascade markers to surgery; and hindering postoperative pain and thereby controlling the autonomic response. The remainder of the article proposes some details on how the study would be optimal to conduct with legitimate subjects and decreased bias.