Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Systematic Review

SBA 2020: Regional anesthesia safety recommendations update

SBA 2020: Atualização das recomendações para segurança em anestesia regional

Liana Maria Tôrres de Araújo Azi, Neuber Martins Fonseca, Livia Gurgel Linard

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The purpose of the Brazilian Society of Anesthesiology’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.


Regional anesthesia;  Infection;  Patient safety


O propósito desta atualização das Recomendações da Sociedade Brasileira de Anestesiologia para Segurança em Anestesia Regional foi apresentar novas diretrizes com base na relevância e atualidade clínica nos aspectos de segurança relacionados a analgesia e anestesia regional. Este artigo visa prover uma visão ampla sobre o conhecimento atual no tocante a assepsia e antissepsia pré-procedimento, fatores de risco, diagnóstico e tratamento das complicações infecciosas decorrentes das técnicas anestésicas. Também visa esclarecer sobre o uso de materiais reprocessados na prática da anestesia regional, estabelecer as implicações no manejo asséptico de frascos e ampolas e elucidar sobre a relação custo-efetividade no preparo de soluções a serem administradas continuamente em bloqueios regionais. As bases de dados eletrônicas foram pesquisadas entre Janeiro de 2011 (final da pesquisa de literatura das diretrizes anteriores da SBA sobre segurança em anestesia regional) e Setembro de 2019. Um total de 712 artigos foram encontrados, dos quais 201 foram incluídos para análise posterior e 82 novos estudos foram acrescentados nesta revisão. O sistema de Avaliação, Desenvolvimento e Avaliação da Classificação das Recomendações (GRADE) foi utilizado para avaliar a qualidade do estudo individual e classificar a força da evidência. Esta revisão foi elaborada por membros da Comissão de Normas Técnicas da SBA.


Anestesia regional;  Infecção;  Segurança do paciente


1 C.R. Fernandes, N.M. Fonseca, D.M. Rosa, et al. Recomendações da Sociedade Brasileira de Anestesiologia para Segurança em Anestesia Regional Rev Bras Anestesiol., 61 (2011), pp. 668-694

2 J.R. Hebl, A.D. Niesen Infectious complications of regional anesthesia Curr Opin Anaesthesiol., 24 (2011), pp. 573-580

3 T.M. Cook, D. Counsell, J.A.W. Wildsmith Major complications of central neuraxial block: Report on the Third National Audit Project of the Royal College of Anaesthetists Br J Anaesth., 102 (2009), pp. 179-190

4 M. Neuburger, J. Büttner, S. Blumenthal, et al. Inflammation and infection complications of 2285 perineural catheters: a prospective study Acta Anaesthesiol Scand., 51 (2007), pp. 108-114

5 J.R. Hebl, J.M. Neal Infectious complications: a new practice advisory Reg Anesth Pain Med., 31 (2006), pp. 289-290

6 A. Trampuz, Fa. Widmer Hand hygiene: a frequently missed lifesaving opportunity during patient care Mayo Clinic Proc, 79 (2004), pp. 109-116

7 WHO Guidelines for Hand Hygiene in Health Care (Advanced Draft), World Health Organization, Geneva (2006)

8 M.H. Samore, L. Venkataraman, P.C. DeGirolami, et al. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea Am J Med., 100 (1996), pp. 32-40

9 A.S. Levin, S.F. Costa, N.S. Mussi, et al. Candida parapsilosis fungemia associated with implantable and semiimplantable central venous catheters and the hands of healthcare workers Diagn Microbiol Infect Dis., 30 (1998), pp. 243-249

10 V.C. Cassettari, I.R. Silveira, A.C. Balsamo, et al. Surto em berçário por Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido atribuído à colonização de profissional de saúde portador de onicomicose J Pediatr., 82 (2006), pp. 313-316

11 R.W. Loftus, M.K. Muffly, J.R. Brown, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission Anesth Analg., 112 (2011), pp. 98-105

12 C.R. Raymond, J.B. Sorin, H.E. John Surgical site infections and the anesthesia professionals’ microbiome: we’ve all been slimed! Now what are we going to do about it? Anesth Analg., 112 (2011), pp. 4-7

13 Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings MMWR Morb Mortal Wkly Rep., 51 (2002), pp. 1-48

14 M.D. Koff, R.W. Loftus, C.C. Burchman, et al. Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through use of a novel device Anesthesiology., 110 (2009), pp. 978-985

15 K.L. Cummings, D.J. Deverick, K.S. Kaye Hand hygiene noncompliance and the cost of hospital- acquired methicillin-resistant Staphylococcus aureus infection Infect Control Hosp Epidemiol., 31 (2010), pp. 357-364

16 C.J. Fahy, D.A. Costi, A.M. Cyna A survey of aseptic precautions and needle type for paediatric caudal block in Australia and New Zealand Anaesth Intensive Care., 41 (2013), pp. 102-107

17 E.T. William, O.V. Michael, A.H. Robert, et al. Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital Clin Infect Dis., 36 (2003), pp. 1383-1390

18 A.R. Jeans, J. Moore, C. Nicol, et al. Wristwatch use and hospital-acquired infection J Hosp Infect., 74 (2010), pp. 16-21

19 A. Gupta, P. Della-Latta, B. Todd Outbreak of extended-spectrum beta-lactamase producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails Infect Control Hosp Epidemiol., 25 (2004), pp. 210-215

20 R.J. Olsen, P. Lynch, M.B. Coyle, et al. Examination gloves are barriers to hand contamination in clinical practice JAMA., 270 (1993), pp. 350-353

21 T.T. Horlocker, D.J. Wedel Infectious complications of regional anesthesia Best Pract Res Clin Anaesthesiol., 22 (2008), pp. 451-475

22 S. Pelke, D. Ching, D. Easa, et al. Gowning does not affect colonization or infection rates in a neonatal intensive care unit Arch Pediatr Adolesc Med., 148 (1994), pp. 1016-1020

23 N.T. Siddiqui, S. Davies, A. McGeer, et al. The effect of gowning on labor epidural catheter colonization rate - a randomized controlled trial Reg Anesth Pain Med., 39 (2014), pp. 520-524

24 J.R. Hebl The importance and implications of aseptic techniques during regional anesthesia Reg Anesth Pain Med., 31 (2006), pp. 311-323

25 I.I. Raad, D.C. Hohn, B. Gilbreath, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion Infect Control Hosp Epidemiol., 15 (1994), pp. 227-230

26 Practice advisory for the prevention, diagnosis, and management of infectious complications associated with neuraxial techniques – report by the American Society of Anesthesiologists Task Force on infectious complications associated with neuraxial techniques Anesthesiology., 112 (2010), pp. 530-545

27 D.H. Lambert Gloved and masked: will gowns be next? Let the data (not logic) decide this issue Anesthesiology., 106 (2007), pp. 877-888

28 C. Couzigou, T.K. Vuong, A.H. Botherel, et al. Iatrogenic Streptococcus salivarius meningitis after spinal anaesthesia: need for strict application of standard precautions J Hosp Infect., 53 (2003), pp. 313-314

29 P.M. Schneeberger, M. Janssen, A. Voss Alpha-hemolytic streptococci: a major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature Infection., 24 (1996), pp. 29-35

30 M. Trautmann, P.M. Lepper, F.J. Schmitz Three cases of bacterial meningitis after spinal and epidural anesthesia Eur J Clin Microbiol Infect Dis., 21 (2002), pp. 43-45

31 R.R. Wickett, M.O. Visscher Structure and function of the epidermal barrier Am J Infect Control., 34 (2006), pp. S98-110

32 E.N. Kaiser, J.L. Newman Formulation technology as a key component in improving hand hygiene practices Am J Infect Control., 34 (2006), pp. S82-97

33 G. Kampf, A. Kramer Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs Clin Microbiol Rev., 17 (2004), pp. 863-893

34 M.E. Balmer, T. Poiger, C. Droz, et al. Occurrence of methyl triclosan, a transformation product of the bactericide triclosan, in fish from various lakes in Switzerland Environ Sci Technol., 38 (2004), pp. 390-395

35 B. Kinirons, O. Mimoz, L. Lafendi, et al. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial Anesthesiology., 94 (2001), pp. 239-244

36 J.C. Dumville, E. McFarlane, P. Edwards, et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery Cochrane Database of Systematic Reviews (2015), Article CD003949

37 G.P. Privitera, A.L. Costa, S. Brusaferro, et al. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis Am J Infect Control., 45 (2017), pp. 180-189

38 Angelique Sutcliffe vs Aintree Hospitals NHS Trust. EWCA Civ 179. UK Court of Appeal (2008)

39 D. Bogod The sting in the tail: antiseptics and the neuraxis revisited Anaesthesia., 67 (2014), pp. 1305-1320

40 T. Killeen, A. Kamat, D. Walsh, et al. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review Anaesthesia., 67 (2012), pp. 1386-1394

41 K. Girgirah, W.R. MacNab Arachnoiditis: is chlorhexidine spray a safe option? Anaesthesia, 68 (2013), p. 425

42 S. Malhotra, A. Dharmadasa, S.M. Yentis One vs two applications of chlorhexidine⁄ ethanol for disinfecting the skin: implications for regional anaesthesia Anaesthesia., 66 (2011), pp. 574-578

43 A.F. Widmer, M. Rotter, A. Voss, et al. Surgical hand preparation: state-of-the-art Journal of Hospital Infection., 74 (2010), pp. 112-122

44 M.B. Loeb, L. Wilcox, F. Smaill, et al. A randomized trial of surgical scrubbing with a brush compared to antiseptic soap alone Am J Infect Control., 25 (1997), pp. 11-15

45 L.Q. Liu, S. Mehigan The effects of surgical hand scrubbing protocols on skin integrity and surgical site infection rates: a systematic review AORN J., 103 (2016), pp. 468-482

46 World Health Organization (WHO) WHO guidelines on hand hygiene in health care. First global patient safety challenge. Clean care is safe care (2009) TSPD_101_R0=af301d35619af62b8dbbe612ccbd7e27p6K0000000000000002134e63b1ffff000000 00000000000000000000005bafeea900275b3a1f.

47 G. Kampf, C. Ostermeyer Efficacy of alcohol-based gels compared with simple hand wash and hygienic hand disinfection J Hosp Infect., 56 (2004), pp. 13-15

48 J.J. Parienti, P. Thibon, R. Heller, et al. Hand-rubbing with an aqueous alcoholic solution vs. traditional surgical hand- scrubbing and 30-day surgical site infection rates J Am Med Assoc., 288 (2002), pp. 722-727

49 H.F. Hsieh, H.H. Chiu, F.P. Lee Surgical hand scrubs in relation to microbial counts: systematic literature review J Adv Nurs., 55 (2006), pp. 68-78

50 M.L. Rotter, G. Kampf, M. Suchomel, et al. Population kinetics of the skin flora on gloved hands following surgical hand disinfection with 3 propanol-based hand rubs: a prospective, randomized, double-blind trial Infect Control Hosp Epidemiol., 28 (2007), pp. 346-350

51 K. Jehle, N. Jarrett, S. Matthews Clean and green: saving water in the operating theatre Annals of the Royal College of Surgeons of England., 90 (2008), pp. 22-24

52 R.B. Greer 3rd The ritual at the scrub sink Orthop Ver., 23 (97) (1994)

53 Protocolo para a prática de higiene das mãos em serviços de saúde. Ministério da Saúde/Anvisa/Fiocruz. 07/09/2013. maos. [Acessado em 29 de setembro de 2018].

54 Como fazer a fricção antisséptica das mãos com preparação alcoólica. Ministério da Saúde/Anvisa/Fiocruz. 06/04/2018. acao-das-maos/. [Acessado em 11 de outubro de 2018].

55 J.M. Boyce, D. Pittet Healthcare Infection Control Practices Advisory Committee. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/ SHEA/APIC/IDSA Hand Hygiene Task Force MMWR Recomm Rep., 51 (2002), pp. 1-45

56 European Standards CSN EN 12791. Chemical disinfectants and antiseptics – Surgical hand disinfection – Test method and requirements (phase2/step2) Brussels (2005)

57 T. Hennig, S. Werner, K. Naujox, et al. Chlorhexidine is not an essential component in alcohol- based surgical hand preparation: a comparative study of two handrubs based on a modified EN 12791 test protocol Antimicrobial Resistance and Infection Control., 6 (2017), pp. 96-101

58 G. Kampf, C. Ostermeyer Efficacy of two distinct ethanol-based hand rubs for surgical hand disinfection – a controlled trial according to prEN 12791 BMC Infect Dis., 5 (2005), pp. 17-20

59 Técnica para antissepsia cirúrgica das mãos com produto à base de álcool. Ministério da Saúde/Anvisa/ Fiocruz. Data de publicação: 20/03/2017. antissepsia-cirurgica-das-maos-com-produto-a-base-de-alcool. [Acessado em 30 de dezembro de 2018].

60 M.E. Graf, A. Machado, L.L. Mensor, et al. Antissepsia cirúrgica das mãos com preparações alcóolicas: custo-efetividade, adesão de profissionais e benefícios ecológicos no cenário de saúde J Bras Econ Saúde., 6 (2014), pp. 71-80

61 M.P. Tavolacci, I. Pitrou, V. Merle, et al. Surgical hand rubbing compared with surgical hand scrubbing: comparison of efficacy and costs J Hosp Infect., 6 (2006), pp. 55-59

62 K.J. Gonçalves, K.U. Graziano, J.Y. Kawagoe Revisão sistemática sobre antissepsia cirúrgica das mãos com preparação alcoólica em comparação aos produtos tradicionais Rev Esc Enferm USP., 46 (2012), pp. 1484-1493

63 J. Tanner, J.C. Dumville, G. Norman, et al. Surgical hand antisepsis to reduce surgical site infection Cochrane Database Syst Rev. (2016), Article CD004288

64 J.Y. Kawagoe Tendências e desafios do preparo cirúrgico das mãos Rev SOBECC., 21 (2016), pp. 217-222

65 D. Jochum, G. Iohom, H. Bouaziz Asepsis in regional anesthesia Int Anesthesiol Clin., 48 (2010), pp. 35-44

66 N. Siddiqui, Z. Friedman, A. McGeer, et al. Optimal had washing technique to minimize bacterial contamination before neuraxial anesthesia: a randomized control trial Int J Obstet Anesth., 29 (2017), pp. 39-44

67 C. Von Peltz, A. Bennet, V. Patil Central neurological complications following obstetric neuraxial blockade Curr Opin Anaesthesiol, 32 (2019), pp. 315-324

68 L.P. Wang, J. Hauerberg, J.F. Schmidt Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey Anesthesiology., 91 (1999), pp. 1928-1936

69 D. Scholle, F. Kipp, A. Reich, et al. Influence of protective measures after epidural catheter disconnection on catheter lumen colonization: an in vitro study J Hosp Infect., 86 (2014), pp. 133-137

70 E.T. Baer Post-dural puncture bacterial meningitis Anesthesiology., 105 (2006), pp. 381-393

71 R.L. Videira, P.P. Ruiz-Neto, M. Brandão Neto Post spinal meningitis and asepsis Acta Anaesthesiol Scand., 46 (2002), pp. 639-646

72 L. Rubin, H. Sprecher, A. Kabaha, et al. Meningitis following spinal anesthesia: 6 cases in 5 years Infect Control Hosp Epidemiol., 28 (2007), pp. 1187-1190

73 E.M. Ganem, Y.M.M. Castiglia, P.T.G. Vianna Complicações neurológicas determinadas pela anestesia subaracnóidea Rev Bras Anestesiol., 52 (2002), pp. 471-480

74 F. Suy, P.O. Verhoeven, F. Lucht, et al. Nosocomial meningitis due to Streptoccus salivarius linked to the oral flora of an anesthesiologist Infect Control Hosp Epidemiol., 34 (2013), pp. 331-332

75 Z. Zhang, X. Xu, H. Ni Disseminated Staphylococcus aureus infection following spinal anesthesia: a case report J Clin Anesth., 33 (2016), pp. 438-441

76 S.M. Hayek, R. Goomber A review of epidural catheter-related infections Hosp Pract (1995) (40) (2012), pp. 176-185

77 G. Ersoz, M. Uguz, G. Aslan, et al. Outbreak of meningitis due to Serratia marcescens after spinal anaesthesia J Hosp Infect., 87 (2014), pp. 122-125

78 A. Hadzic, N. Koluder-Cimic, M. Hadzovic-Cengic, et al. Serratia marcescens meningitis following spinal anaesthesia and arthroscopy Med Arch., 66 (2012), pp. 54-55

79 O.A. De Leon-Casasola, B. Parker, M. Lema, et al. Postoperative epidural bupivacaine-morphine therapy: experience with 4,227 surgical cancer patients Anesthesiology., 81 (1994), pp. 368-375

80 J.M. Feldman, K. Chapin-Robertson, J. Turner Do agents used for epidural analgesia have antimicrobial properties? Reg Anesth., 19 (1994), pp. 43-47

81 A.G. McKenzie, K. Darragh A national survey of prevention of infection in obstetric central neuraxial blockade in the UK Anaesthesia., 66 (2011), pp. 497-502

82 P.S. Smitt, A. Tsafka, Z.F. Teng-van, et al. Outcome and complications of epidural analgesia in patients with chronic cancer pain Cancer., 83 (1998), pp. 2015-2022

83 Jong De, P.J. Kansen A comparison of epidural catheters with or without subcutaneous injections ports for treatment of cancer pain Anesth Analg., 78 (1994), pp. 94-100

84 H.M. Holt, S.S. Andersen, O. Andersen, et al. Infections following epidural catheterization J Hosp Infect., 30 (1995), pp. 253-260

85 D.P. Davis, R.M. Wold, R.J. Patel, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess J Emerg Med., 26 (2004), pp. 285-291

86 C. Gronwald, T. Vowinkel, K. Hahnenkamp Regional anesthetic procedures in immunosuppressed patients: risk of infection Curr Opin Anaesthesiol., 24 (2011), pp. 698-704

87 T.T. Lai, L. Jaeger, B.L. Jones, et al. Continuous peripheral nerve block catheter infections in combat- related injuries: a case report of five soldiers from Operation Enduring Freedom/Operation Iraqi Freedom Pain Med., 12 (2011), pp. 1676-1681

88 J.K. McNeely, N.C. Trentadue, L.M. Rusy, et al. Culture of bacteria from lumbar and caudal epidural catheters used for postoperative analgesia in children Reg Anesth., 22 (1997), pp. 428-431

89 S. Kost-Byerly, J.R. Tobin, R.S. Greenberg, et al. Bacterial colonization and infection rate of continuous epidural catheters in children Anesth Analg., 86 (1998), pp. 712-716

90 H.B. Yuan, Z. Zuo, K.W. Yu, et al. Bacterial colonization of epidural catheters used for short-term postoperative analgesia: microbiological examination and risk factor analysis Anesthesiology., 108 (2008), pp. 130-137

91 N. Dahlgren, K. Tornebrandt Neurological complications after anaesthesia. A follow-up of 18,000 spinal and epidural anaesthetics performed over three years Acta Anaesth Scand, 39 (1995), pp. 872-880

92 R.E. Kane Neurologic deficits following epidural or spinal anesthesia Anesth Analg., 60 (1981), pp. 150-161

93 B. Darchy, X. Forceville, E. Bavoux, et al. Clinical and bacteriologic survey of epidural analgesia in patients in the intensive care unit Anesthesiology., 85 (1996), pp. 988-998

94 M. Jabaudon, R. Chabanne, A. Sossou, et al. Epidural analgesia in the intensive care unit: An observational series of 121 patients Anaesth Crit Care Pain Med., 34 (2015), pp. 217-223

95 S.L. Du Pen, D.G. Peterson, A. Williams, et al. Infection during chronic epidural catheterization: diagnosis and treatment Anesthesiology., 73 (1990), pp. 905-909

96 X. Capdevila, P. Pirat, S. Bringuier, et al. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery Anesthesiology., 103 (2005), pp. 1035-1045

97 P. Cuvillon, J. Ripart, L. Lalourcey, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects Anesth Analg., 93 (2001), pp. 1045-1049

98 H. Bomberg, D. Krotten, C. Kubulus, et al. Single-dose antibiotic prophylaxis in regional anesthesia: A retrospective registry analysis Anesthesiology., 125 (2016), pp. 505-515

99 M. De Cicco, M. Matovic, G.T. Castellani, et al. Time-dependent efficacy of bacterial filters and infection risk in long-term epidural catheterization Anesthesiology., 82 (1995), pp. 765-771

100 M.R. Rasouli, P.K. Cavanaugh, C. Restrepo, et al. Is neuraxial anesthesia safe in patients undergoing surgery for treatment of periprosthetic joint infection? Clin Orthop Relat Res., 473 (2015), pp. 1472-1477

101 T.T. Horlocker, D.J. Wedel Regional anesthesia in the immunocompromised patient Reg Anesth Pain Med., 31 (2006), pp. 334-345

102 D.J. Wedel, T.T. Horlocker Regional anesthesia in the febrile or infected patient Reg Anesth Pain Med., 31 (2006), pp. 324-333

103 K. Gritsenko, D. Marcello, G.A. Liguori, et al. Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses Br J Anaesth., 108 (2012), pp. 485-490

104 Do corticosteroids improve outcome in meningitis? Drug Ther Bull, 48 (2010), pp. 116-120

105 E.T. Baer Post-dural puncture bacterial meningitis Anesthesiology., 105 (2006), pp. 381-393

106 E.P. Laguna del, P.A. Castañeda, G.M. López-Cano Bacterial meningitis secondary to spinal analgesia and anaesthesia Neurologia., 25 (2010), pp. 552-556

107 N. Shioya, Y. Ishibe, S. Kan, et al. Sternoclavicular joint septic arthritis following paraspinal muscle abscess and septic lumbar spondylodiscitis with epidural abscess in a patient with diabetes: a case report BMC Emerg Med, 12 (2012), pp. 7-8

108 H. Bomberg, N. Albert, K. Schmitt, et al. Obesity in regional anesthesia a risk factor for peripheral catheter-related infections Acta Anaesthesiol Scand., 59 (2015), pp. 1038-1048

109 P. Sendi, T. Bregenzer, W. Zimmerli Spinal epidural abscess in clinical practice QJM., 101 (2008), pp. 1-12

110 K. Sakushima, Y. Hayashino, T. Kawaguchi Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis J Infect., 62 (2011), pp. 255-262

111 N.T. Huy, N.T. Thao, D.T. Diep, et al. Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis Crit Care., 14 (2010), p. R240

112 K. Prasad, J.K. Sahu Cerebrospinal fluid lactate: Is it a reliable and valid marker to distinguish between acute bacterial meningitis and aseptic meningitis? Crit Care., 15 (2011), p. 104

113 J.M.G. Phillips, J.C. Stedeford, E. Hartsilver, et al. Epidural abscess complicating insertion of epidural catheters Br J Anaesth., 89 (2002), pp. 778-782

114 C. Gosavi, D. Bland, R. Poddar, et al. Epidural abscess complicating insertion of epidural catheters Br J Anaesth., 89 (2004), pp. 294-298

115 J.M. Pondé, E. Valente, J. Lemos Abscesso após anestesia peridural: Relato de caso Rev Bras Anestesiol., 46 (1996), pp. 427-430

116 M.P. Abreu, R.G. Deda, L.H. Cangiani Abscesso peridural após analgesia controlada pelo paciente por via peridural: relato de caso Rev Bras Anestesiol., 54 (2004), p. 78

117 R.L. Danner, B.J. Hartman Update of spinal epidural abscess: 35 cases and review of the literature Rev Infect Dis., 9 (1987), pp. 265-274

118 F. Reynolds Neurological infections after neuraxial anesthesia Anesthesiol Clin., 26 (2008), pp. 23-52

119 E. Reihsaus, H. Waldbaur, W. Seeling Spinal epidural abscess: a meta-analysis of 915 patients Neurosurg Ver., 23 (2000), pp. 175-204

120 E.M. Bluman, M.A. Palumbo, P.R. Lucas Spinal epidural abscess in adults J Am Acad Orthop Surg., 12 (2004), pp. 155-163

121 J.R. Van Rappard, J.L. Tolenaar, A.B. Smits, et al. Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia BMJ Case Rep., 20 (2015), pp. 1-4

122 D. Van de Beek, Jj Farrar, J. de Gans, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data Lancet Neurol, 9 (2010), pp. 254-263

123 M.C. Brouwer, P. McIntyre, J. de Gans, et al. Corticosteroids for acute bacterial meningitis Cochrane Database Syst Rev., 8 (2010), Article CD004405

124 S. Grewal, G. Hocking, J.A.W. Wildsmith Epidural abscesses Br J Anaesth., 96 (2006), pp. 292-302

125 J.R. Gasparini, S.S. Mello, R.S. Marques, et al. Analgesia pós-operatória plexular contínua. Estudo dos efeitos colaterais e do risco de infecção dos cateteres Rev Bras Anestesiol., 58 (2008) 6:602-6.

126 A. Jeffreys, R. Horton, B. Evans Epidural abscesses Br J Anaesth., 97 (2006), pp. 115-120

127 D. Hailey, P.D. Jacobs, N.M. Ries, et al. Reuse of single use medical devices in Canada: clinical and economic outcomes, legal and ethical issues, and current hospital practice Int J Technol Assess Health Car., 24 (2008), pp. 430-436

128 P. Jacobs, J. Polisena, D. Hailey, et al. Economic analysis of reprocessing single-use medical devices: a systematic literature review Infect Control Hosp Epidemiol., 29 (2008), pp. 297-301

129 J. Polisena, D. Hailey, K. Moulton, et al. Reprocessing and reuse of single-use medical devices: a national survey of Canadian acute care hospitals Infect Control Hosp Epidemiol., 29 (2008), pp. 437-439

130 A. Kramer, O. Assadian Ethical and hygiene aspects of the reprocessing of medical devices in Germany GMS Krankenhhyg Interdiszip., 3 (2008), p. 25

131 M. Kraft Framework conditions and requirements to ensure the technical functional safety of reprocessed medical devices GMS Krankenhhyg Interdiszip., 3 (2008), p. 23

132 S.B. Adams, G.E. Moore, M. Elrashidy, et al. Effect of needle size and type, reuse of needles, insertion speed, and removal of hair on contamination of joints with tissue debris and hair after arthrocentesis Vet Surg., 39 (2010), pp. 667-673

133 W.J. Armitage, A.B. Tullo, J.W. Ironside Risk of Creutzfeldt-Jakob disease transmission by ocular surgery and tissue transplantation Eye., 23 (2009), pp. 1926-1930

134 K. Roth, P. Heeg, R. Reichl Specific hygiene issues relating to reprocessing and reuse of single- use devices for laparoscopic surgery Surg Endosc., 16 (2002), pp. 1091-1097

135 RDC nº 156, de 11 de agosto de 2006. Dispõe sobre o registro, rotulagem e reprocessamento de produtos médicos, e dá outras providências. [Acessado em agosto de 2019].

136 R. Magetsari, E.B. Van der Houwen, M.T. Bakker, et al. Biomechanical and surface physico- chemical analyses of used osteosynthesis plates and screws – Potential for reuse in developing countries? J Biomed Mater Res B, Appl Biomater., 79 (2006), pp. 236-244

137 P. Grantcharov, S. Ahmed, K. Wac, et al. Reprocessing and reuse of single-use medical devices: perceptions and concerns of relevant stakeholders toward current practices Int J Evid Based Healthc., 17 (2019), pp. 53-57

138 N.S. Bailard, J. Ortiz, R.A. Flores Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations Am J Health Syst Pharm., 71 (2014), pp. 373-385

139 D.P. Phillips, N. Christenfeld, L.M. Glynn Increase in US medication error deaths between 1983 and 1993 Lancet., 351 (1998), pp. 643-644

140 Formulário de Erro de Medicação. Ministério da Saúde. [Acessado em 22 de agosto de 2018].

141 A.F. Merry, C.S. Webster, J. Weller, et al. Evaluation in an anaesthetic simulator of a prototype of a new drug administration system designed to reduce error Anaesthesia., 57 (2002), pp. 256-263

142 I.J. Bergman, M.T. Kluger, T.G. Short Awareness during general anaesthesia: a review of 81 cases from the Anaesthetic Incident Monitoring Study Anaesthesia., 57 (2002), pp. 549-556

143 M. Sinclair, S. Simmons, A. Cyna Incidents in obstetric anaesthesia and analgesia – an analysis of 5000 AIMS reports Anaesth Intensive Care., 27 (1999), pp. 275-281

144 M. Currie, P. Mackay, C. Morgan, et al. The Australian Incident Monitoring Study. The ‘wrong drug’ problem in anaesthesia: an analysis of 2,000 incident reports Anaesth Intensive Care, 21 (1993), pp. 596-601

145 T.G. Short, A. O’Regan, J. Lew, et al. Critical incident reporting in an anaesthetic department quality assurance programme Anaesthesia., 48 (1993), pp. 3-7

146 S. Fasting, S.E. Gisvold Adverse drug errors in anesthesia, and the impact of coloured syringe labels Can J Anesth., 47 (2000), pp. 1060-1067

147 L.S. Jensen, A.F. Merry, C.S. Webster, et al. Evidence-based strategies for preventing drug administration errors during anaesthesia Anaesthesia., 59 (2004), pp. 493-504

148 R.J. Glavin Drug errors: consequences, mechanisms, and avoidance Br J Anaesth., 105 (2010), pp. 76-82

149 RDC nº 71, de 22 de dezembro de 2009. Estabelece regras para a rotulagem de medicamentos. [Acessado em agosto de 2018].

150 A.F. Merry, C.S. Webster, H. Connell A new infusion syringe label system designed to reduce task complexity during drug preparation Anaesthesia, 62 (2007), pp. 486-491

151 C.J. Hemingway, S. Malhotra, M. Almeida, et al. The effect of alcohol swabs and filter straws on reducing contamination of glass ampoules used for neuroaxial injections Anaesthesia., 62 (2007), pp. 286-288

152 S. Merriman, M.J. Paech, A.D. Keil Bacterial contamination in solution aspirated from non-sterile packaged fentanyl ampoules Anaesth Intensive Care., 37 (2009), pp. 608-612

153 R.R. Freitas, M.A. Tardelli Comparative analysis of ampoules and vials in sterile and conventional packaging as to microbial load and sterility test Einstein., 14 (2016), pp. 226-230

154 USP Chapter 797with proposed revisions. 2006. http://www.usp. org/pdf/EN/USPNF/PF797redline.pdf. [Acessado em 20 de setembro de 2018].

155 S. Head, F.K. Enneking Infusate contamination in regional anesthesia: What every anesthesiologist should know Anesth Analg., 107 (2008), pp. 1412-1418

156 F.B. Sevarino, C.W. Pizarro, R. Sinatra Sterility of epidural solutions – recommendations for cost- effective use Reg Anesth Pain Med., 25 (2000), pp. 368-371

157 D. McIntosh, J. Spaven, N.A. Hagen How long do prepared epidural solutions remain sterile? J Pain Symptom Manage., 18 (1999), pp. 137-139

158 O.K. Svedberg, E. Chem, J. McKenzie, et al. Compatibility of ropivacaine with morphine, sufentanil, fentanyl, or clonidine J Clin Pharmacy Therap., 27 (2002), pp. 39-45

159 A. Jäppinen, M. Turpeinen, H. Kokki, et al. Stability of sufentanil and levobupivacaine solutions and a mixture in a 0.9% sodium chloride infusion stored in polypropylene syringes Eur J Pharm Sci., 19 (2003), pp. 31-36

160 L. Boitquin, J.D. Hecq, J.M. Evrard, et al. Long-term stability of sufentanil citrate with levobupivacaine hydrochloride in 0.9% sodium chloride infusion PVC bags at 4 degrees C J Pain Symptom Manage., 28 (2004), pp. 4-6

161 M.J. Priston, J.M. Hughes, M. Santillo, et al. Stability of an epidural analgesic admixture containing epinephrine, fentanyl and bupivacaine Anaesthesia., 59 (2004), pp. 979-983

162 Jm. Neal Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence- Based Analysis Reg Anesth Pain Med, 41 (2016), pp. 195-204

163 M.J. Barrington, Y. Uda Did ultrasound fulfill the promise of safety in regional anesthesia? Curr Opin Anaesthesiol., 31 (2018), pp. 649-655

164 H. Bouaziz, F. Aubrun, A. Belbachir, et al. Ultrasound-guided regional anesthesia Ann Fr Anesth Reanim., 32 (2013), pp. 119-120

165 C. Ecoffey Safety in pediatric regional anesthesia Paediatr Anaesth., 22 (2012), pp. 25-30

166 A. Lalueza, F. López-Medrano, A. del Palacio, et al. Cladosporium macrocarpum brain abscess after endoscopic ultrasound-guided celiac plexus block Endoscopy., 43 (2011), pp. 9-10

167 C.M. Nyhsen, H. Humphreys, R.J. Koerner, et al. Infection prevention and control in ultrasound - best practice recommendations from the European Society of Radiology Ultrasound Working Group Insights Imaging., 8 (2017), pp. 523-535

168 E.H. Spaulding Principles and application of chemical disinfection AORN Journal., 1 (1963), pp. 36-46

169 Healthcare Infection Control Practices Advisor Committee Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) Updated February 2017. Centers for Disease Control and Prevention. [Acessado em 12 de janeiro de 2019].

170 S. Bloc, T. Garnier, C. Bounhiol, et al. Ultrasound guided regional anaesthesia: an effective method for cleaning the probes [in French] Ann Fr Anesth Reanim., 27 (2008), pp. 994-998

171 D. Jochum Hygiène relative à l’utilisation des ultrassons Ann Fr Anesth Reanim., 31 (2012), pp. e219-21

172 Policy Statement of American College Emergency Physicians Guideline for Ultrasound Transducer Cleaning and Disinfection (2018) transducer-cleaning-and-disinfection.pdf. [Acessado em 20 de janeiro de 2019].

173 H. Alakkad, A. Naeeni, V.W. Chan, et al. Infection related to ultrasound-guided single-injection peripheral nerve blockade: a decade of experience at Toronto Western Hospital Reg Anesth Pain Med., 40 (2015), pp. 82-84

174 College of Physicians and Surgeons of British Columbia. Steps for Cleaning and Disinfection of Ultrasound Probes. Ultrasound-Probes.pdf. [Acessado em 28 de dezembro de 2018].

175 S. Bloc, L. Mercadal, T. Garnier, et al. Evaluation of a new disinfection method for ultrasound probes used for regional anesthesia: Ultraviolet C light J Ultrasound Med., 30 (2011), pp. 785-788

176 J.M. Basseal, S.C. Westerway, M. Juraja, et al. Guidelines for reprocessing ultrasound transducers Australas J Ultrasound Med., 20 (2017), pp. 30-40

177 G.S. Whiteley, T.O. Glasbey, S.C. Westerway, et al. A new sampling algorithm demonstrates that ultrasound equipment cleanliness can be improved Am J Infect Control., 46 (2018), pp. 887-892

178 H. Bouaziz, F. Aubrun, A.A. Belbachir, et al. Échographie en anesthésie locorégionale Locoregional anaesthesia and echography Ann Fr Anesth Reanim., 30 (2011), pp. 33-35

179 P. Marhofer, K. Schebesta, D. Marhofer Hygieneaspekte in der ultraschallgestützten Regionalanästhesie Anaesthesist., 65 (2016), pp. 492-498

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