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LETTERS

The Mask Avenger?

Department of Anesthesiology Perioperative and Pain Management Brigham & Women’s Hospital Harvard Medical School Boston, MA

To the Editor:

I read with interest the suggestions of Dolinski and Gerancher (1) to facilitate patient positioning for neuraxial anesthetic techniques. In our practice, we frequently utilize methods that facilitate a pronounced curvature of the spine with limitation of patient movement; anecdotally we find that the lateral recumbent, fetal position offers less side-to-side motion, as well as the front-to-back motion common in the seated position.

Nonetheless, the potentially advantageous patient positions were obscured by the potentially detrimental mask position (i.e., covering neither nose nor mouth) of the anesthetist performing the block in Figure 1. Although bacterial meningitis is a rare sequelae of regional anesthesia, observational and case control studies have implicated health care providers, including anesthesiologists, as the source of infections (2,3). Moreover, laboratory evidence appears to corroborate the clinical value of surgical masks in preventing the transmission of infectious agents from the upper airway and limiting bacterial contamination of a surface (4).

The use of surgical masks during the placement of neuraxial techniques is far from uniform (5,6). However, given the available evidence on the relationship between oral commensal bacteria and iatrogenic meningitis, the use of surgical masks should be recommended and practiced.

References

1. Dolinski S, Gerancher JC. Two suggestions to facilitate patient positioning in the performance of regional anesthesia. Anesth Analg 2000; 91: 500.[Free Full Text]
2. Moen V. Meningitis is a rare complication of spinal anesthesia: good hygiene and face masks are simple preventive measures [in Swedish]. Lakartidningen 1998;95:628, 631–5.
3. Schneeberger PM, Janssen M, Voss A. Alpha-hemolytic streptococci: a major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature. Infection 1996; 24: 29–33.[Web of Science][Medline]
4. Philips BJ, Fergusson S, Armstrong P, et al. Surgical face masks are effective in reducing bacterial contamination caused by dispersal from the upper airway. Br J Anaesth 1992; 69: 407–8.[Abstract/Free Full Text]
5. Panikkar KK, Yentis SM. Wearing of masks for obstetric regional anesthesia: a postal survey. Anaesthesia 1996; 51: 398–400.[Web of Science][Medline]
6. Sleth JC. Evaluation of aseptic measures in the performance of epidural catheterization and perception of its risk of infection: results of a survey in Languedoc-Roussillon [in French]. Ann Fr Anesth Reanim 1998; 17: 408–14.[Web of Science][Medline]

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