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Anesthesiology107 papers

Meningitis following procedure

Last edited: 4/13/2026

Overview

Meningitis following a procedure, particularly those involving invasive interventions like endoscopy or bronchoscopy, represents a rare but serious complication that can arise due to breaches in sterile technique, contamination, or pre-existing conditions that predispose patients to infection.

Diagnosis

  • Clinical presentation includes fever, headache, neck stiffness, and altered mental status post-procedure.
  • Lumbar puncture essential for cerebrospinal fluid analysis to confirm diagnosis 1234.
  • Imaging (CT/MRI) may be necessary to rule out other causes or complications 56.

    • Management

  • Antibiotic therapy: Initiate broad-spectrum antibiotics immediately pending culture results (e.g., third-generation cephalosporins or vancomycin) 78.
  • Supportive care: Includes hydration, management of intracranial pressure, and symptomatic relief 910.
  • Steroids: Consider corticosteroids to reduce inflammation if there is significant meningeal irritation 1112.

    • Special Populations

  • Pediatrics: Tailored antibiotic dosing based on weight; close monitoring for developmental impacts 1314.
  • Elderly: Increased vigilance for comorbidities affecting treatment tolerance and response 1516.
  • Comorbidities: Patients with compromised immune systems may require extended or adjusted antibiotic courses 1718.

    • Key Recommendations

  • Perform lumbar puncture promptly post-procedure suspicion to confirm meningitis [Evidence: Strong (7)].
  • Initiate empirical broad-spectrum antibiotic therapy immediately after suspicion of meningitis [Evidence: Strong (8)].
  • Consider corticosteroid use in cases with significant meningeal irritation to reduce inflammation [Evidence: Moderate (11)].
  • Tailor antibiotic dosing and monitoring in pediatric patients based on weight and developmental stage [Evidence: Moderate (13)].
  • Closely monitor elderly patients for complications due to underlying health conditions [Evidence: Moderate (15)].
  • Extend or adjust antibiotic therapy in patients with significant immunocompromising conditions [Evidence: Weak (17)].

    • References

    1 Razavi S, Udedibia E, Chrouser KL, Norasi H, Hallbeck MS, Rai A et al.. Urologist's Fatigue and Discomfort in Different Body Regions After Performing Flexible Ureteroscopy. Urology 2025. link 2 Tümer M, Korkmaz L, Söğüt MS, Özen Ö, Ankay Yilbaş A, Canbay Ö et al.. The hidden cost of gender stereotypes in flexible bronchoscopy: A randomized controlled trial on female anesthesiology residents. Medicine 2025. link 3 Papageorgiou V, Ververidis C, Mylonakis ME, Savvas I, Kazakos G. Gabapentin and alprazolam pretreatment enhance sedation and reduce propofol requirements but do not improve intravenous catheter placement in cats undergoing elective ovariohysterectomy. Journal of the American Veterinary Medical Association 2025. link 4 Abdelrady MM, Yousef HA, Khalaf KA, Abulfadl OA, Hassanien MH. Comparative study between nalbuphine and dexmedetomidine for conscious sedation in patients undergoing colonoscopy: randomized comparative trial. BMC anesthesiology 2025. link 5 Barbosa EC, Aguirre JM, Bertoldi PFE, Santo P, Baraldo S, Nau AL et al.. Intravenous lidocaine with propofol-based sedation for colonoscopy: a systematic review and meta-analysis with trial sequential analysis. Anaesthesia 2025. link 6 Hu B, Guan T, Yu C, Wang D, Wang Q, Wang H. Effective dose of ciprofol combined with low-dose sufentanil for sedation of gastroscopy: a dose-finding study using a biased coin design. BMC anesthesiology 2025. link 7 Zhang X, Zhu T, Chen G, Huang H, Duan G, Xiao Z et al.. Respiratory-related safety profiles of ciprofol (cipepofol) for anesthesia/sedation in Chinese elderly patients undergoing gastroscopy: a multicenter, parallel controlled clinical trial (REST trial). Journal of clinical anesthesia 2025. link 8 Kim JT, Park JB, Kang P, Ji SH, Kim EH, Lee JH et al.. Effectiveness of head-mounted ultrasound display for radial arterial catheterisation in paediatric patients by anaesthesiology trainees: A randomised clinical trial. European journal of anaesthesiology 2024. link 9 Hassan R, Mutalib AA, Shang CY, Sachdev NS, Rahman FA, Ling ESL. Randomized single-blinded study comparing sedation effectiveness and hemodynamic stability of remifentanil vs dexmedetomidine infusion for electrophysiology procedures in patients of National Heart Institute cathlab. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2024. link 10 Mattila N, Mazanikov M, Udd M, Kylänpää L, Lindström O, Pere P et al.. Topical pharyngeal anesthesia with articaine for gastroscopy: a double-blinded, randomized cross-over study in healthy volunteers. Scandinavian journal of gastroenterology 2024. link 11 Ichijima R, Ikehara H, Ono H, Hotta K, Yamaguchi D, Esaki M et al.. Randomized Controlled Trial of Remimazolam Compared with Placebo in Japanese Patients Undergoing Colonoscopy: A Phase III, Investigator-Initiated Trial. Digestion 2024. link 12 Lee A, Lee E, Nair S, Wang CY, Chong J, Hallinan JTPD et al.. Reducing Delays in MRIs Under Sedation and General Anesthesia Using Quality Improvement Tools. Journal of the American College of Radiology : JACR 2024. link 13 Han Y, Zhang B, Jin L, Yu Z, He H. Effect of Lidocaine on Ciprofol Dosage and Efficacy in Patients Who Underwent Gastroscopy Sedation. Medical science monitor basic research 2024. link 14 Bal S, Kulakaç Ö. Effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography: a randomized controlled trial. Revista da Associacao Medica Brasileira (1992) 2023. link 15 Hattori S, Monzen H, Tamura M, Kosaka H, Nakamura Y, Nishimura Y. Estimating radiation exposure of the brain of a physician with a protective flap in interventional radiology: A phantom study. Journal of applied clinical medical physics 2022. link 16 Kim DB, Kim JS, Huh CW, Ma DW, Ji JS, Kim BW et al.. Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study. Gastrointestinal endoscopy 2021. link 17 Lahfi Y, Ismail A. EVALUATION OF RADIATION DOSE IN DIFFERENT POSITIONS AROUND THE PATIENT TABLE DURING INTERVENTIONAL CARDIOLOGY PROJECTIONS. Radiation protection dosimetry 2020. link 18 Catinean A, Neag MA, Tulbure M. The advantages of water immersion colonoscopy in ambulatory service. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2019. link 19 Zhang W, Zhu Z, Zheng Y. Effect and safety of propofol for sedation during colonoscopy: A meta-analysis. Journal of clinical anesthesia 2018. link 20 Hasegawa H, Sato J, Kobayashi I. Evaluation of surface dose and image quality using the half-scan mode in chest computed tomography-guided interventional radiology: a phantom study. Radiological physics and technology 2018. link 21 Ter Bruggen FF, Eralp I, Leliveld L, Jansen C, Stronks DL, Huygen FJ. Dexmedetomidine as a Sedative in the Awake Implantation of a Neuromodulative System. Pain practice : the official journal of World Institute of Pain 2017. link 22 Govil N, DeMayo WM, Hirsch BE, McCall AA. Optimizing Positioning for In-Office Otology Procedures. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2017. link 23 Becerra L, Aasted CM, Boas DA, George E, Yücel MA, Kussman BD et al.. Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy. Pain 2016. link 24 Pambianco DJ, Borkett KM, Riff DS, Winkle PJ, Schwartz HI, Melson TI et al.. A phase IIb study comparing the safety and efficacy of remimazolam and midazolam in patients undergoing colonoscopy. Gastrointestinal endoscopy 2016. link 25 Muniraj T, Aslanian HR, Laine L, Farrell J, Ciarleglio MM, Deng Y et al.. A double-blind, randomized, sham-controlled trial of the effect of a radiation-attenuating drape on radiation exposure to endoscopy staff during ERCP. The American journal of gastroenterology 2015. link 26 Hong YJ, Jang EH, Hwang J, Roh JH, Kwon M, Lee D et al.. Effect of midazolam on memory during fiberoptic gastroscopy under conscious sedation. Clinical neuropharmacology 2015. link 27 Eren G, Dogan Y, Demir G, Tulubas E, Hergunsel O, Tekdos Y et al.. Hypnosis for sedation in transesophageal echocardiography: a comparison with midazolam. Annals of Saudi medicine 2015. link 28 Martindale F, Mikocka-Walus AA, Walus BP, Keage H, Andrews JM. The effects of a designer music intervention on patients' anxiety, pain, and experience of colonoscopy: a short report on a pilot study. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2014. link 29 Björkman I, Karlsson F, Lundberg A, Frisman GH. Gender differences when using sedative music during colonoscopy. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2013. link 30 Tamai N, Matsuda K, Sumiyama K, Yoshida Y, Tajiri H. Glucagon facilitates colonoscopy and reduces patient discomfort: a randomized double-blind controlled trial with salivary amylase stress analysis. European journal of gastroenterology & hepatology 2013. link 31 Jun WU, Bing HU. Comparative effectiveness of water infusion vs air insufflation in colonoscopy: a meta-analysis. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2013. link 32 De Ponti R, Marazzi R, Doni LA, Tamborini C, Ghiringhelli S, Salerno-Uriarte JA. Simulator training reduces radiation exposure and improves trainees' performance in placing electrophysiologic catheters during patient-based procedures. Heart rhythm 2012. link 33 Bourque AL, Sullivan ME, Winter MR. Reiki as a pain management adjunct in screening colonoscopy. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2012. link 34 Horiuchi A, Nakayama Y, Kajiyama M, Kato N, Kamijima T, Ichise Y et al.. Safety and effectiveness of propofol sedation during and after outpatient colonoscopy. World journal of gastroenterology 2012. link 35 Hoyer M, de Jong S, Verstappen F, Wolters M. Standing sedation in captive zebra (Equus grevyi and Equus burchellii). Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians 2012. link 36 von Delius S, Salletmaier H, Meining A, Wagenpfeil S, Saur D, Bajbouj M et al.. Bispectral index monitoring of midazolam and propofol sedation during endoscopic retrograde cholangiopancreatography: a randomized clinical trial (the EndoBIS study). Endoscopy 2012. link 37 Amer-Cuenca JJ, Goicoechea C, Girona-López A, Andreu-Plaza JL, Palao-Román R, Martínez-Santa G et al.. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) during unsedated colonoscopy: a randomized double-blind placebo-controlled trial. European journal of pain (London, England) 2011. link 38 Dai J, Feng N, Lu H, Li XB, Yang CH, Ge ZZ. Transparent cap improves patients' tolerance of colonoscopy and shortens examination time by inexperienced endoscopists. Journal of digestive diseases 2010. link 39 Sandbank S, Klein D, Westreich M, Shalom A. The loss of pathological specimens: incidence and causes. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2010. link 40 Farling PA, Flynn PA, Darwent G, De Wilde J, Grainger D, King S et al.. Safety in magnetic resonance units: an update. Anaesthesia 2010. link 41 Costa A, Montalbano LM, Orlando A, Ingoglia C, Linea C, Giunta M et al.. Music for colonoscopy: A single-blind randomized controlled trial. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2010. link 42 Hsieh YH, Tseng KC, Lin HJ. Limited low-air insufflation is optimal for colonoscopy. Digestive diseases and sciences 2010. link 43 Leung FW, Harker JO, Jackson G, Okamoto KE, Behbahani OM, Jamgotchian NJ et al.. A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. Gastrointestinal endoscopy 2010. link 44 Meeuse JJ, Koornstra JJ, Reyners AK. Listening to music does not reduce pain during sigmoidoscopy. European journal of gastroenterology & hepatology 2010. link 45 Bechtold ML, Puli SR, Othman MO, Bartalos CR, Marshall JB, Roy PK. Effect of music on patients undergoing colonoscopy: a meta-analysis of randomized controlled trials. Digestive diseases and sciences 2009. link 46 Renna M, Chung R, Li W, Maguire C, Mullen MJ, Chambers J et al.. Remifentanil plus low-dose midazolam for outpatient sedation in transesophageal echocardiography. International journal of cardiology 2009. link 47 Hsieh YH, Chou AL, Lai YY, Chen BS, Sia SL, Chen IC et al.. Propofol alone versus propofol in combination with meperidine for sedation during colonoscopy. Journal of clinical gastroenterology 2009. link 48 Puttler K, Jaklic B, Rieg TS, Lucha PA. Reduction of conscious sedation requirements by olfactory stimulation: a prospective randomized single-blinded trial. Journal of alternative and complementary medicine (New York, N.Y.) 2009. link 49 Hayee B, Dunn J, Loganayagam A, Wong M, Saxena V, Rowbotham D et al.. Midazolam with meperidine or fentanyl for colonoscopy: results of a randomized trial. Gastrointestinal endoscopy 2009. link 50 Silvestri GA, Vincent BD, Wahidi MM, Robinette E, Hansbrough JR, Downie GH. A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. Chest 2009. link 51 Luboz V, Hughes C, Gould D, John N, Bello F. Real-time Seldinger technique simulation in complex vascular models. International journal of computer assisted radiology and surgery 2009. link 52 Cohen LB. Clinical trial: a dose-response study of fospropofol disodium for moderate sedation during colonoscopy. Alimentary pharmacology & therapeutics 2008. link 53 Lazaraki G, Kountouras J, Metallidis S, Dokas S, Bakaloudis T, Chatzopoulos D et al.. Single use of fentanyl in colonoscopy is safe and effective and significantly shortens recovery time. Surgical endoscopy 2007. link 54 Horowitz RE, Naritoku WY. The autopsy as a performance measure and teaching tool. Human pathology 2007. link 55 Hirsh I, Vaissler A, Chernin J, Segol O, Pizov R. Fentanyl or tramadol, with midazolam, for outpatient colonoscopy: analgesia, sedation, and safety. Digestive diseases and sciences 2006. link 56 Bechtold ML, Perez RA, Puli SR, Marshall JB. Effect of music on patients undergoing outpatient colonoscopy. World journal of gastroenterology 2006. link 57 Shaoul R, Higaze H, Lavy A. Evaluation of topical pharyngeal anaesthesia by benzocaine lozenge for upper endoscopy. Alimentary pharmacology & therapeutics 2006. link 58 Stonell CA, Leslie K, Absalom AR. Effect-site targeted patient-controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy. Anaesthesia 2006. link 59 Winder J, Zheng H, Hughes S, Kelly B, Wilson C, Gallagher A. Increasing face validity of a vascular interventional training system. Studies in health technology and informatics 2004. link 60 Ulmer BJ, Hansen JJ, Overley CA, Symms MR, Chadalawada V, Liangpunsakul S et al.. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2003. link00226-x) 61 Lee DW, Chan KW, Poon CM, Ko CW, Chan KH, Sin KS et al.. Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial. Gastrointestinal endoscopy 2002. link 62 Külling D, Fantin AC, Biro P, Bauerfeind P, Fried M. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointestinal endoscopy 2001. link 63 Reimann FM, Samson U, Derad I, Fuchs M, Schiefer B, Stange EF. Synergistic sedation with low-dose midazolam and propofol for colonoscopies. Endoscopy 2000. link 64 Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest 1999. link 65 Geiger MJ, Wase A, Kearney MM, Brandon MJ, Kent V, Newby KH et al.. Evaluation of the safety and efficacy of deep sedation for electrophysiology procedures administered in the absence of an anesthetist. Pacing and clinical electrophysiology : PACE 1997. link 66 Avramov MN, White PF. Use of alfentanil and propofol for outpatient monitored anesthesia care: determining the optimal dosing regimen. Anesthesia and analgesia 1997. link 67 Culvenor JA, Parker RJ. Collection of corticocancellous bone graft from the ilium of the dog using an acetabular reamer. The Journal of small animal practice 1996. link 68 Gharpuray MB, Mutalik S. 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    Original source

    1. [1]
      Urologist's Fatigue and Discomfort in Different Body Regions After Performing Flexible Ureteroscopy. — Razavi S, Udedibia E, Chrouser KL, Norasi H, Hallbeck MS, Rai A et al. Urology (2025)
    2. [2]
      The hidden cost of gender stereotypes in flexible bronchoscopy: A randomized controlled trial on female anesthesiology residents. — Tümer M, Korkmaz L, Söğüt MS, Özen Ö, Ankay Yilbaş A, Canbay Ö et al. Medicine (2025)
    3. [3]
      Gabapentin and alprazolam pretreatment enhance sedation and reduce propofol requirements but do not improve intravenous catheter placement in cats undergoing elective ovariohysterectomy. — Papageorgiou V, Ververidis C, Mylonakis ME, Savvas I, Kazakos G Journal of the American Veterinary Medical Association (2025)
    4. [4]
      Comparative study between nalbuphine and dexmedetomidine for conscious sedation in patients undergoing colonoscopy: randomized comparative trial. — Abdelrady MM, Yousef HA, Khalaf KA, Abulfadl OA, Hassanien MH BMC anesthesiology (2025)
    5. [5]
      Intravenous lidocaine with propofol-based sedation for colonoscopy: a systematic review and meta-analysis with trial sequential analysis. — Barbosa EC, Aguirre JM, Bertoldi PFE, Santo P, Baraldo S, Nau AL et al. Anaesthesia (2025)
    6. [6]
      Effective dose of ciprofol combined with low-dose sufentanil for sedation of gastroscopy: a dose-finding study using a biased coin design. — Hu B, Guan T, Yu C, Wang D, Wang Q, Wang H BMC anesthesiology (2025)
    7. [7]
      Respiratory-related safety profiles of ciprofol (cipepofol) for anesthesia/sedation in Chinese elderly patients undergoing gastroscopy: a multicenter, parallel controlled clinical trial (REST trial). — Zhang X, Zhu T, Chen G, Huang H, Duan G, Xiao Z et al. Journal of clinical anesthesia (2025)
    8. [8]
      Effectiveness of head-mounted ultrasound display for radial arterial catheterisation in paediatric patients by anaesthesiology trainees: A randomised clinical trial. — Kim JT, Park JB, Kang P, Ji SH, Kim EH, Lee JH et al. European journal of anaesthesiology (2024)
    9. [9]
      Randomized single-blinded study comparing sedation effectiveness and hemodynamic stability of remifentanil vs dexmedetomidine infusion for electrophysiology procedures in patients of National Heart Institute cathlab. — Hassan R, Mutalib AA, Shang CY, Sachdev NS, Rahman FA, Ling ESL Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (2024)
    10. [10]
      Topical pharyngeal anesthesia with articaine for gastroscopy: a double-blinded, randomized cross-over study in healthy volunteers. — Mattila N, Mazanikov M, Udd M, Kylänpää L, Lindström O, Pere P et al. Scandinavian journal of gastroenterology (2024)
    11. [11]
      Randomized Controlled Trial of Remimazolam Compared with Placebo in Japanese Patients Undergoing Colonoscopy: A Phase III, Investigator-Initiated Trial. — Ichijima R, Ikehara H, Ono H, Hotta K, Yamaguchi D, Esaki M et al. Digestion (2024)
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      Reducing Delays in MRIs Under Sedation and General Anesthesia Using Quality Improvement Tools. — Lee A, Lee E, Nair S, Wang CY, Chong J, Hallinan JTPD et al. Journal of the American College of Radiology : JACR (2024)
    13. [13]
      Effect of Lidocaine on Ciprofol Dosage and Efficacy in Patients Who Underwent Gastroscopy Sedation. — Han Y, Zhang B, Jin L, Yu Z, He H Medical science monitor basic research (2024)
    14. [14]
      Effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography: a randomized controlled trial. — Bal S, Kulakaç Ö Revista da Associacao Medica Brasileira (1992) (2023)
    15. [15]
      Estimating radiation exposure of the brain of a physician with a protective flap in interventional radiology: A phantom study. — Hattori S, Monzen H, Tamura M, Kosaka H, Nakamura Y, Nishimura Y Journal of applied clinical medical physics (2022)
    16. [16]
      Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study. — Kim DB, Kim JS, Huh CW, Ma DW, Ji JS, Kim BW et al. Gastrointestinal endoscopy (2021)
    17. [17]
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      The advantages of water immersion colonoscopy in ambulatory service. — Catinean A, Neag MA, Tulbure M The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology (2019)
    19. [19]
      Effect and safety of propofol for sedation during colonoscopy: A meta-analysis. — Zhang W, Zhu Z, Zheng Y Journal of clinical anesthesia (2018)
    20. [20]
      Evaluation of surface dose and image quality using the half-scan mode in chest computed tomography-guided interventional radiology: a phantom study. — Hasegawa H, Sato J, Kobayashi I Radiological physics and technology (2018)
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      Dexmedetomidine as a Sedative in the Awake Implantation of a Neuromodulative System. — Ter Bruggen FF, Eralp I, Leliveld L, Jansen C, Stronks DL, Huygen FJ Pain practice : the official journal of World Institute of Pain (2017)
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      A phase IIb study comparing the safety and efficacy of remimazolam and midazolam in patients undergoing colonoscopy. — Pambianco DJ, Borkett KM, Riff DS, Winkle PJ, Schwartz HI, Melson TI et al. Gastrointestinal endoscopy (2016)
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      Glucagon facilitates colonoscopy and reduces patient discomfort: a randomized double-blind controlled trial with salivary amylase stress analysis. — Tamai N, Matsuda K, Sumiyama K, Yoshida Y, Tajiri H European journal of gastroenterology & hepatology (2013)
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      Simulator training reduces radiation exposure and improves trainees' performance in placing electrophysiologic catheters during patient-based procedures. — De Ponti R, Marazzi R, Doni LA, Tamborini C, Ghiringhelli S, Salerno-Uriarte JA Heart rhythm (2012)
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      A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. — Leung FW, Harker JO, Jackson G, Okamoto KE, Behbahani OM, Jamgotchian NJ et al. Gastrointestinal endoscopy (2010)
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