Rachianesthésie et anesthésie péridurale chez le patient fébrile ou infecté

After an epidural or a spinal puncture performed in a febrile patient, the incidence of meningitis and/or epidural abscess is extremely low (1/100,000) but it may occur. Meningeal barrier might be altered in such circumstances by release of cytokines and dysfunctions such as depressed molecular adhesion, or transmembranous transport or enzymes dysregulation may occur. Sepsis might be favored by the lack of antibiotic treatment, massive bacteremia, compromised asepsia, immunosuppression, combined spinal epidural technique, multiple punctures… When no obvious benefit is expected from regional anesthesia and when the patient suffers from an active infectious process (fever, shivering, positive blood cultures) and when no effective antibiotic treatment has been instituted, it is preferable not to use perimedullar block. On the contrary, a spinal puncture is acceptable in a patient treated with the adequate antibiotic. Secondary herpes infection is not a contraindication to perimedullar blocks. In any circumstance, patients must be carefully and repeatedly monitored for any neurological symptoms. Any delay in the treatment of a meningitis or an epidural abscess may lead to serious complications. Suspected meningitis urges the administration of antibiotics after lumbar puncture.