Portal de Periódicos da CAPES

Unmasked Mischief

2001; Lippincott Williams & Wilkins; Volume: 92; Issue: 1 Linguagem: Inglês

10.1097/00000539-200101000-00060

1526-7598

I. Browne, David J. Birnbach,

Anesthesia and Sedative Agents

To the Editor: We read with interest Dolinski and Gerancher’s description of positioning of patients undergoing regional anesthesia (1). Although we applaud any new approach that potentially increases the success of neuraxial blocks, we were shocked by the photograph that accompanied their letter. That photograph was a particularly egregious example of the lamentable decline in aseptic technique that has unfortunately become acceptable practice. The anesthesiologist performing the block (resident?) is without mask, and the second anesthesiologist holding the patient’s back (attending?) is without gloves. Although the risk of infection following neuraxial techniques is slight, lack of scrupulous asepsis “invites serious danger from meningitis or epidural abscess”(2). Common sense and universal precautions should be adequate to convince anesthesiologists to wear a mask during the administration of neuraxial anesthesia. However, if more evidence is necessary, we suggest a review of the report of an epidural abscess that was proven to be caused by a phage of Staphylococcus that was cultured from the nose of the anesthesiologist who had inserted the catheter (3). Anesthesiologists share with all physicians the responsibility to provide safe and compassionate care for their patients. Although the absence of gloves and mask during initiation of neuraxial anesthesia may not necessarily cause the patient to develop an infection, their use surely makes the procedure a safer one. The ethical principle of primum non nocere (“first do no harm”) is well established and implores physicians to avoid harming or exposing the risk of harm to their patients. Surely, this must apply to minimizing the risks associated with neuraxial techniques. Anesthesiologists must consider the potential harm caused by our techniques and do everything to reduce potential morbidity. Is there any reasonable justification to forego appropriate sterile precautions when performing neuraxial blocks? We think not! Ingrid M. Browne MD, FFARCSI David J. Birnbach MD