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1/31. Current perspectives on the perioperative management of the latex-allergic patient.

    The increasing incidence of latex allergy necessitates thorough preanesthetic screening for risk factors, which will be delineated in this article, that are associated with latex allergy. The pathophysiology, epidemiology, and testing procedures for latex allergy will be reviewed. This case report will illustrate the management of a patient who was found to be latex-sensitive during surgery and the management of intraoperative anaphylaxis is provided. Safe perioperative care can be provided for latex-sensitive patients if latex avoidance techniques are used consistently.
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ranking = 1
keywords = latex, latex allergy, allergy
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2/31. latex allergy: an update for the otolaryngologist.

    OBJECTIVE: To describe the clinical manifestations of latex allergy in otolaryngology patients. DESIGN: Descriptive case series. SETTING: Tertiary academic otolaryngology practice. patients: otolaryngology patients with documented allergic reactions to latex during surgery and confirmatory laboratory test results for latex allergy. MAIN OUTCOME MEASURES: Clinical description of latex reactions; identification of risk factors for latex allergy. RESULTS: We describe 3 patients, 2 children and 1 young adult, with severe latex allergy manifested by intraoperative cardiorespiratory changes and confirmed by positive latex-specific IgE test results. A 9-year-old boy with a tracheotomy and a history of multiple procedures for laryngeal stenosis developed a rash and unexplained bronchospasm during an open laryngeal procedure. Surgery was aborted, and subsequent surgery was performed uneventfully 4 weeks later using a latex-safe environment. A 13-year-old boy with recurrent respiratory papillomatosis and a ventriculoperitoneal shunt had sudden unexplained arterial oxygen desaturation and a rash during laser endoscopy. He was then treated successfully using latex-safe protocols. A 23-year-old man with a parotid malignancy developed unexplained hypotension and ventilatory difficulties in the operating room during preparation for surgery. He responded to medical treatment for anaphylaxis. CONCLUSION: The otolaryngologist should share in the increased awareness of latex allergy. Our patients who have had multiple surgical procedures or who are exposed to latex on a long-term basis may be at increased risk. latex allergy should be considered when unexplained cardiorespiratory compromise occurs during surgery.
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ranking = 1.2424603378428
keywords = latex, latex allergy, allergy
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3/31. Anaphylactic reactions in anaesthetised patients - four cases of chlorhexidine allergy.

    chlorhexidine is widely used all over the world in many different preparations. In denmark chlorhexidine is the standard skin disinfectant used before surgery or invasive procedures and it is widely used in the general population in mouthwash or for disinfection of minor scratches etc. The potential for developing allergy to chlorhexidine is thus great, especially in surgical patients. We have identified four patients with serious allergic reactions in connection with surgery and general anaesthesia, who on subsequent skin testing tested positive for chlorhexidine. Symptoms appeared 20-40 min into the operation and all four patients required treatment with adrenaline. All four patients had a history of minor symptoms like rashes or faints in connection with previous surgery/invasive procedures. Allergy to chlorhexidine may be more prevalent in surgical patients and cases may have been overlooked due to the nature of reactions and lack of suspicion towards this substance.
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ranking = 0.012878571278088
keywords = allergy
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4/31. Anaphylactoid reaction to etomidate: report of a case.

    We report an anaphylactoid reaction to etomidate twice in a 60-year-old male with coronary artery disease and peripheral vascular disease. Following the first anaphylactoid reaction, the patient developed myocardial infarction. In addition, the patient's blood was moderately positive for latex antibodies, which made the differential diagnosis difficult. We concluded that the patient had anaphylactoid reaction to etomidate due to the temporal relationship to induction with the drug. The patient did not manifest similar reaction to other induction drugs used for other surgeries. The patient recovered from both incidents of anaphylactoid reaction to etomidate following intravenous administration of epinephrine and fluids.
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ranking = 0.077132629429759
keywords = latex
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5/31. cataract surgery for natural rubber latex allergic patients.

    The prevalence of reactions against natural rubber latex (NRL) is thought to be increasing in both the general public and healthcare workers. These can vary from mild benign skin reactions to bronchospasm, anaphylactic shock, and death. Difficulties exist for ophthalmic departments wishing to establish protocols in providing 'latex-free environments' for patients undergoing cataract surgery. Currently no legislation exists regarding the labelling of NRL-containing products in the United Kingdom with information on a product's NRL content provided by the manufacturer on a voluntary basis only. It is hoped this review article will act as a basic guide in the management of NRL-sensitive patients undergoing cataract surgery in the United Kingdom.
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ranking = 0.46324699849292
keywords = latex, rubber
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6/31. Specific immunotherapy for severe latex allergy.

    We studied 4 patients (3 adult females 13y old boy) with latex allergy. All patients had anaphylaxis related with latex and oral-latex-fruit syndrome. All 3 females had severe symptoms in the workplace. The boy had spina bifida with 9 previous surgeries and needed further surgical interventions. Positive skin prick tests (SPT), the presence of serum latex specific IgE (CAP-RAST, Pharmacia-Upjohn, sweden- class 3 in the 3 females and class 4 in the boy) demonstrated the sensitisation. All 4 patients were treated with specific immunotherapy (SIT) with aqueous extract (ALK-ALK-ABELLO SA, spain) administered subcutaneously at the hospital, by a modified rush schedule. A maintenance dose (MD) of 0.35_g protein was established according to the magnitude of local reactions (LRs). In one patient a higher dose induced the appearance of a systemic reaction (SR) 40 min after administration, which promptly remitted with treatment. After reaching MD, all 3 females remained assymptomatic at workplace. A challenge test with latex gloves was performed. Two months after MD was reached 2 females had no symptoms and one other had mild symptoms of rhinoconjunctivitis. The boy was subjected to a surgical intervention with no allergic reaction. We also observed a reduction on skin reactivity to latex in all patients by prick tests. We consider SIT with latex to be highly effective, safe and well tolerated provided we use this dose of the allergenic extract.
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ranking = 1.2295817665647
keywords = latex, latex allergy, allergy
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7/31. An alternative technique for nasotracheal intubation.

    Surgical procedures on structures of the oral cavity or the mandible may require nasotracheal intubation to allow for surgical access. Even with appropriate technique, trauma to the nasopharynx may occur, resulting in bleeding. The authors describe an alternative technique involving the placement of the flanged end of a red rubber catheter over the distal tip of the endotracheal tube (ETT) to decrease the potential for trauma as the ETT passes through the nasopharynx.
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ranking = 9.0244382873571E-5
keywords = rubber
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8/31. anaphylaxis to latex in patients without identified risk factors for latex allergy.

    We describe a representative patient diagnosed with anaphylaxis to latex occurring during elective surgery in the absence of any previous risk factors for latex allergy. latex allergy was identified by skin prick testing and confirmed by serological diagnosis testing. We review our experience screening patients for latex allergy in connecticut over the period 1995-present. patients without known risk factors for latex allergy in a highly atopic population had a low rate (approximately 1%) of positive skin tests to latex when screened using an allergenic extract characterized for latex allergen by serological diagnosis at 200-500 AU/ml. Our experience suggests that skin prick test screening with serological diagnosis standardized latex extracts can be used to rapidly screen and identify individuals with latex allergy although the cost-effectiveness, sensitivity and safety of screening remains to be determined. Clinicians should consider the diagnosis of latex allergy in all cases of anaphylaxis without identified causes, even in patients without identified risk factors for latex allergy.
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ranking = 2.153208729666
keywords = latex, latex allergy, allergy
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9/31. Allergy to latex surgical gloves: an unfamiliar cause of intraoperative anaphylaxis.

    Natural rubber products, including surgical gloves, are known to be associated with contact dermatitis in allergic individuals. These cell-mediated immune reactions are usually not serious. However, an increasing number of reports have appeared recently in the medical literature concerning the association of latex with type I IgE-mediated anaphylactic reactions. We report on a patient with a history of cutaneous sensitivity to latex who experienced an intraoperative anaphylactic reaction felt to be secondary to latex surgical gloves. This report is intended to familiarize clinicians with this unexpected cause of intraoperative anaphylaxis.
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ranking = 0.54001865039119
keywords = latex, rubber
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10/31. Unilateral blindness as a complication of patient positioning for spinal surgery. A case report.

    Extreme care must be used in positioning patients for surgery in a prone position. A padded Mayfield headrest may not be appropriate for all patients undergoing spinal surgery, as exophthalmus or a flattened nasal bridge may allow transmission of pressure to the globe. Our current approach is to use supplementary foam rubber support, with repeated, meticulous attention to keeping the eyes free from all pressure. Finally, unexplained intraoperative occurrence of a bradyarrhythmia or conduction disturbance may signal increased intraorbital pressure during general anesthesia.
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ranking = 9.0244382873571E-5
keywords = rubber
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