Letters to the Editor: Letters & Announcements
Latex Allergy: Oh, What a Surprise! Another Reason Why All Anesthesia Equipment Should Be Latex-Free
To the Editor:
We report here an unusual presentation of a life-threatening latex allergy. The patient was an 18-year-old male with a history of spina bifida and developmental delay. He was admitted to our institution for treatment of a recurrent right ischial and peroneal pressure sore. He had undergone multiple previous general anesthetics for urological problems without incident, and he had no history of latex allergy. Despite that, our index of suspicion for latex sensitivity was high. Of interest and some concern was that he was seen chewing on an old latex-containing tourniquet for over 30 minutes prior to anesthesia. Routine general anesthesia was induced with patient placed in a prone position. Approximately 1 hour after induction of general anesthesia, the patient developed high peak inspiratory pressures (45 cm H2O), hypoxemia (85%), hypotension and a dramatic decrease in end tidal CO2. The FIO2 was increased to 1 and the patient placed in the supine position. Chest auscultation revealed no breath sounds over the left lung and very minimal sounds from the right. The ETT was withdrawn from 23 to 21 cm at the lips, with no change in the above respiratory findings. The ETT cuff was palpated in the trachea. Peak inspiratory pressures remained elevated (above 50 cm H2O). Epinephrine (50 μg) was administered IV for hypotension and presumed bronchospasm, after which chest auscultation revealed profound wheezing bilaterally. An additional 20 μg of IV epinephrine, 100 mg of IV hydrocortisone, and 10 puffs of Albuterol were administered through the ETT resulting in near resolution of the bronchospasm. The vital signs returned to normal. A decision to continue with the operation with full latex-free precautions was agreed upon. The operation concluded uneventfully. Tests revealed that the patient was highly sensitive to latex (1).
We learned three things from this case: 1) Patients with no history of latex allergy, but with a surgical history suspicious of a latex allergy can develop a life-threatening latex allergy at any time; 2) patients who have a high potential risk of developing latex allergy should be advised and prevented from chewing on and/or being exposed to latex products prior to general anesthesia; and 3) our hospital’s decision to have all latex-free anesthetic equipment, including latex-free tourniquets, is laudable.
Paul Eckinger, MD
Emily Ratner, MD
John Brock-Utne, MD, PhD
Department of Anesthesia, Stanford University Medical Center, Stanford, CA
© 2004 International Anesthesia Research Society
1. Hepner DL, Castelle MC. Latex allergy: an update. Anesth Analg 2003;96:1219–29.