Free
Correspondence  |   April 2007
Think about Room Air
Author Notes
  • Eastern Maine Medical Center, Bangor, Maine.
Article Information
Correspondence
Correspondence   |   April 2007
Think about Room Air
Anesthesiology 4 2007, Vol.106, 877. doi:10.1097/01.anes.0000264757.18426.db
Anesthesiology 4 2007, Vol.106, 877. doi:10.1097/01.anes.0000264757.18426.db
To the Editor:—
I read the articles “Post–Dural Puncture Bacterial Meningitis”1 and “Incidence of Epidural Hematoma, Infection, Neurologic Injury in Obstetric Patients with Epidural Analgesia/Anesthesia”2 and the editorial “Gloved and Masked—Will Gowns Be Next? The Role of Asepsis during Neuraxial Instrumentation”3 in the August 2006 issue of Anesthesiology. They are very informative with many excellent areas of discussion. However, it seems to me that there is one glaringly large area that was missed in all three articles. The issue is the source of contamination of the epidural space. It makes me shudder to see anesthesiologists inject room air, which may have a droplet from any of a dozen people's noses who have been in the room in the past hour! Many residents, not sure of the feel, will then inject several more milliliters. Then they wonder why they have a spotty block! But that is another issue. In my opinion, injecting air should have been clearly condemned, but it was not even mentioned. Three of the four deaths presented had multiple epidural attempts, at least some with inexperienced personnel. How many cubic centimeters of air were injected? Maybe the source of infection results from the combination of air plus a dural puncture. Was there an epidural attempt before the obstetric spinal case? The only thing that should be injected into the epidural space is sterile liquid that is filtered for glass. Preferring the feel of the air is not enough reason to use air for the loss-of-resistance technique. Are there any other reasons that are backed up with data for using air? Rather than go through the inconvenience of learning the feel of the saline method, those practitioners continue to subject the patient to the risk of infection. This ban should include the hanging drop method. Although less air is entrailed, why allow any? It seems clear that the data show that room air has contaminated droplets and that injecting them into the epidural space is unnecessary and of greater risk than using saline. Of even more concern is how many other issues are out there, easily discovered, if we only followed up with our patients and accurately measured outcomes as we are morally obligated to, but rarely, do.
Eastern Maine Medical Center, Bangor, Maine.
References
Baer ET: Post–dural puncture bacterial meningitis. Anesthesiology 2006; 105:381–93Baer, ET
Ruppen W, Derry S, McQuay H, Moore A: Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology 2006; 105:394–9Ruppen, W Derry, S McQuay, H Moore, A
Hepner D: Gloved and masked—will gowns be next? The role of asepsis during neuraxial instrumentation (editorial). Anesthesiology 2006; 105:241–3Hepner, D