Intraoperative latex anaphylaxis compounded by atracurium sensitivity: a case report

This report describes a life-threatening anaphylactic reaction in an 8-year-old male patient that occurred shortly after intra-abdominal contact with latex surgical gloves. Follow-up skin testing as an outpatient revealed a positive reaction to both latex and atracurium while the other anesthetic agents tested proved negative. For a subsequent operation in which this patient received a kidney transplant, an uneventful anesthetic course was achieved by avoiding the use of latex products and atracurium. Careful planning for that successful procedure included use of vinyl gloves by the surgical team and use of vecuronium as the neuromuscular blocking agent. Anesthetists should enhance identification of latex-sensitive patients by obtaining a thorough history with specific questions about latex exposure and sensitivity and by allergy testing when indicated. During any anesthetic administration, the anesthetist must be prepared to treat life-threatening anaphylactic reactions.