Related Experiment Videos
Intraoperative latex anaphylaxis in children: classification and prophylaxis of patients at risk
J P Dormans1, J Templeton, M S Schreiner
1Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104-4399, USA.
Insights
Implementing a latex allergy risk classification and prophylaxis system significantly reduced intraoperative anaphylaxis. Further studies are needed to confirm the necessity of pharmacologic prophylaxis alongside latex-free environments for high-risk patients.
Area of Science:
- Anesthesiology
- Immunology
- Patient Safety
Background:
- Intraoperative anaphylaxis to latex is a significant concern during general anesthesia.
- Type I hypersensitivity reactions to latex pose a risk to patients undergoing surgical procedures.
Purpose of the Study:
- To develop and evaluate a system for classifying patients at risk for latex-induced anaphylaxis.
- To assess the effectiveness of a prophylactic regimen in reducing intraoperative anaphylactic reactions.
- To investigate the need for pharmacologic prophylaxis in addition to latex avoidance.
Main Methods:
- Retrospective analysis of 36,075 general anesthesia procedures to identify latex reactions (Phase 1).
- Prospective implementation of a risk classification and prophylaxis protocol for at-risk patients (January 1992 - July 1994, Phase 2).
- Identification of three patient groups at risk for type I hypersensitivity.
Main Results:
- Phase 1: 21 cases of intraoperative anaphylaxis to latex were identified.
- Phase 2: Incidence of suspected intraoperative latex anaphylaxis decreased to 3 cases in 34,513 patients.
- Two of the three suspected cases did not meet risk criteria and did not receive prophylaxis.
Conclusions:
- The established protocol for classifying and managing at-risk patients has led to a decrease in intraoperative anaphylaxis.
- The effectiveness of pharmacologic prophylaxis in conjunction with a latex-free environment requires further prospective investigation.
Abstract:
Over a 3-year period, in 36,075 general anesthetic anesthesia procedures done at our institution, 21 patients had type I (anaphylactic) intraoperative reactions to latex (phase 1). We subsequently established a system for classification of at-risk patients with a corresponding regimen for prophylaxis used prospectively between January 1992 and July 1994 (phase II). Three groups of patients at risk for type I hypersensitivity reaction were identified, and a regimen for prophylaxis developed (based in part on protocols used in preparing patients who are allergic to radiocontrast media). Since using this protocol, the incidence of intraoperative anaphylaxis has decreased. During phase 2, 34,513 patients received a general anesthetic in the operating room, and there have been three cases of suspected intraoperative latex anaphylaxis; two of these three patients did not meet any of the risk criteria and therefore did not receive preoperative prophylaxis or avoidance of latex. Of these 34,513 patients, 86 at-risk patients received prophylaxis. A prospective study is needed to determine whether the pharmacologic prophylaxis is needed in addition to a latex-free environment.