Latex allergy: an unfamiliar cause of intra‐operative cardiovascular collapse

Abstract

SummaryWe describe severe latex allergy in an 8-year-old girl undergoing elective orthopaedic surgery and anaesthesia. Sudden, profound cardiorespiratory collapse occurred 40 min after induction. During the I h period of resuscitation the child required a total of 14.5 rnl adrenaline I in 10 000. A subsequent latex radioallergosorbent test was very strongly positive. Two weeks later the child presented again for surgery. Neoprene surgical gloves were used and all latex products eliminated from the anaesthetic equipment. Latex contact was strictly avoided during drug preparation and administration. This time the intra-operative course was unevenrful. Key wordsComplications; anaphylaxis, latex.Latex allergy has been increasingly reported in the American literature as a cause of severe intra-operative anaphylaxis [1][2][3][4], but has received less attention in the British press [S]. Many British anaesthetists are unfamiliar with the condition, and may be taken by surprise on encountering it for the first time. Case historyAn 8-year-old girl with cerebral palsy, weighing 25 kg, presented for adductor tendon release and femoral osteotomy. She was quadriplegic, blind, and received fluids via a gastrostomy tube following many episodes of inhalational pneumonitis. She had undergone two uneventful orthopaedic procedures at other centres. A pre-operative history of allergy to grass pollen was obtained and her family volunteered that she had developed mild peri-orbital oedema after the taping of her eyes during a previous operation. There was no history of allergy to rubber products or of repeated urinary catheterisation.Anaesthesia was induced by inhalation of oxygen, nitrous oxide and halothane from a clear plastic mask. Cricoid pressure was applied, and, after putting in a venous cannula, suxamethonium 40 mg and atropine 0.2 mg were given. After intubation of the trachea, paralysis was maintained with atracurium lOmg, and morphine 2mg and cefazolin 500 mg were given.Forty minutes later the Spo, decreased abruptly from 98% to < 70% over approximately 10 s. Simultaneously, the end-tidal CO, decreased to 15mmHg, the systolic blood pressure decreased to SOmmHg, the heart rate increased to 140, and the chest would not move on attempting to hand ventilate with 100% oxygen. Surgery was stopped. Total obstruction of the tracheal tube was considered and the child's trachea was rapidly reintubated, although the original tube had proved patent. Severe anaphylaxis was then suspected, despite the length of time since induction and the absence of any recent boluses of drugs. Adrenaline 2.5 ml 1 in 10000 given intravenously resulted in temporary relief of the intense bronchospasm. Albumin 5% (500ml) was given by rapid intravenous infusion. Over the next hour the child developed widespread cutaneous flushing and peri-orbital oedema. Repeated boluses of adrenaline, to a total of 12 ml of 1 in 10 000, were required in order to maintain an Spo, > go%, a peak inspiratory pressure c 50 cmH,O, and a systolic blood pressure > 60 mmHg. The pa...

Risk factors for latex allergy in patients with spina bifida

“…While delayed type hyperreactivity reactions are well known. 934 there have been an increasing number of reports on immediate type reactions in recent years: symptoms are often severe, including full anaphylaxis [1][2][3][4][5]. Sensitization rates to latex differ in various populations and seem to be high in extentionally exposed persons.…”

Anaphylactic shock: mechanisms and treatment

“…This includes protein drugs such as insulin and ACTH; non‐protein drugs acting as haptens such as antibiotics, vitamins and steroids; vaccines; foods including milk, fish and nuts; venoms particularly of Hymenoptera; and many other substances as diverse as ethylene oxide, hydatid cysts and latex 8 . Latex allergy was first reported in 1979, and has caused intra‐operative anaphylactic reaction 12 . In addition, allergy to the latex catheter‐tip used in barium enemas has also been recorded, most commonly in children with spina bifida or congenital urological abnormalities 13 .…”

Latex Allergy during Anaesthesia: Cautionary Tales

“…Allergy to latex is increasing, and becoming a serious problem in many countries 1 particularly in healthworkers 1 and patients with spina bifida 2,3 . Anaphylaxis to latex has been described during anaesthesia, and characteristically produces a delayed reaction not temporally related to drug administration [3][4][5][6][7] .…”