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How high a WBC will you allow for a spinal for C/S?

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Aether2000

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Question came up at our hospital after a patient with a 23,500 WBC and febrile to 101.5 had a spinal for C/Section for premature rupture of membranes.

1. How high a WBC will you allow for a spinal in an afebrile patient without systemic symptoms?
2. How high a WBC will you allow for a spinal in a febrile patient temp 102?
 

CodeBlu

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Question came up at our hospital after a patient with a 23,500 WBC and febrile to 101.5 had a spinal for C/Section for premature rupture of membranes.

1. How high a WBC will you allow for a spinal in an afebrile patient without systemic symptoms?
2. How high a WBC will you allow for a spinal in a febrile patient temp 102?

1. Why are the WBCs elevated? Neutrophils? Something brewing? Steroids? If you're willing to accept the risk that you may end up with an abscess... sure go for it. There's no real # I can think of... but be able to justify your choice and risk vs benefit of doing a neuraxial technique.

2. No. Just no. I don't want to worry about abscess here. Unnecessary exposure to risk... just call it a day and do a GA.
 

anbuitachi

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Yea i would say most anesthesiologists wouldnt do it in a febrile patient. but if you think about it, people do LPs all the time on people with infections for meningitis. how many of those actually get abscess? probably still extremely rare! And elevated white count in cancer patients too

it's just that in our field we are very cautious.
 
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GravelRider

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You don’t do spinals for c-sections in cases of chorioamnionitis? Those patients are febrile and likely have elevated WBC.

Why is the patient febrile? Why are you checking WBC? Are you worried about bacteremia? Sepsis? If the patient is septic, I might avoid spinal for other reasons beyond infectious.

I see no absolute contraindication to spinal based on the information provided.
 
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ZzzPlz

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You don’t do spinals for c-sections in cases of chorioamnionitis? Those patients are febrile and likely have elevated WBC.

Why is the patient febrile? Why are you checking WBC? Are you worried about bacteremia? Sepsis? If the patient is septic, I might avoid spinal for other reasons beyond infectious.

I see no absolute contraindication to spinal based on the information provided.
Exactly. I’m thinking chori and being in labor contribute to both issues. Unless there is a damn good reason to suspect an unusual infection, poke her
 

BeddingfieldMD

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You don’t do spinals for c-sections in cases of chorioamnionitis? Those patients are febrile and likely have elevated WBC.

Good point! Yes, I would do a spinal for such an instance with a known source and no suspicion of bacteremia. For some reason I was thinking fever and high WBC of unknown origin.


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Mman

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I believe the only infection related contraindication to a spinal is a local infection that you will be passing the needle through. Epidural is a slightly different situation if you believe the patient is septic and will have an indwelling epidural catheter.
 
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facted

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I believe the only infection related contraindication to a spinal is a local infection that you will be passing the needle through. Epidural is a slightly different situation if you believe the patient is septic and will have an indwelling epidural catheter.
Agreed. Fever and infection are not contraindication to a spinal, unless the infection is at the site of placement.
 
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