11/31. Intraoperative anaphylaxis to bacitracin during pacemaker change and laser lead extraction.BACKGROUND: bacitracin is widely used in operating rooms to soak implants, irrigate compound fractures, and apply to surgical incisions. However, bacitracin is a known sensitizer and causes not only allergic contact dermatitis but also anaphylaxis. OBJECTIVE: To describe a 72-year-old woman with anaphylaxis after irrigation and packing of an infected pacemaker pocket with a bacitracin solution. methods: Skin prick testing to bacitracin and latex; serum tryptase, serum histamine, serum IgE to latex, and serial cardiac enzyme measurements; blood cultures, transthoracic echocardiograms, and venograms were performed to characterize the reaction. RESULTS: Six hours after the anaphylactic event, the patient had an elevated serum tryptase level of 49 ng/mL (reference range, 2-10 ng/mL), which normalized the next morning. She had immediate-type skin prick test reactions to full-strength bacitracin ointment (500 U/g) and bacitracin solution (150 U/mL). serum IgE level to latex was undetectable, and results of skin testing to latex were negative. CONCLUSIONS: To our knowledge, this is the first case report of anaphylaxis to bacitracin during pacemaker surgery. This case illustrates that intraoperative anaphylaxis to bacitracin can be life-threatening.- - - - - - - - - - ranking = 1keywords = latex (Clic here for more details about this article) |
12/31. Anaesthesia and the patient with latex allergy.Reports of severe life-threatening anaphylaxis to latex are increasing. A case of latex anaphylaxis occurring during surgery is reported. Sudden cardiorespiratory collapse 25 min after the start of surgery was treated with oxygen, fluid, epinephrine, hydrocortisone, and benadryl. Two months later, skin testing to latex was positive but intradermal testing to the drugs used during anaesthesia was negative. Anaesthetists should be aware of this clinical entity. Latex allergy should be considered in the differential diagnosis of intraoperative anaphylaxis. Fortunately, it is usually preventable by obtaining a positive history, recognising that it occurs in particular subsets of patients and by avoiding latex products. Skin testing to latex is available and may assist in the recognition of latex sensitivity.- - - - - - - - - - ranking = 3.4965756087879keywords = latex, latex allergy, allergy (Clic here for more details about this article) |
13/31. Intraoperative anaphylaxis: verba volant, scripta manent!We describe a case of intraoperative gelatine-induced anaphylaxis whose diagnosis was delayed as the use of gelatine during surgical procedures was omitted for two times in patient's medical records. The subject is a 66-year old woman, with a negative medical history of atopy, food and drug allergy, with arterial hypertension on a course of beta-blockers and with bladder carcinoma requiring surgery. The patient had tolerated both general and local anaesthesia on several previous occasions. On the first occasion she experienced arterial fibrillation secondary to a severe episode of hypotension following local anaesthesia, while on a course of beta-blockers. On the second occasion she developed a very severe episode of hypotension followed by the outbreak of a generalised rash during general anaesthesia. The tryptase sera level was 109 mg/L one hour after the reaction had subsided, while the basal values were normal. On the third occasion the patient redeveloped severe hypotension and a generalised rash during general anaesthesia. The allergological work-up was negative, except for intradermal test with gelatine. A study of the intra-cellular cytokines in blood lymphocytes showed a production of IL4 from CD4 lymphocytes after stimulation by gelatine. The patient underwent a successive surgical procedure without any adverse event.- - - - - - - - - - ranking = 0.0083483289583795keywords = allergy (Clic here for more details about this article) |
14/31. Perioperative anaphylaxis from locally applied rifamycin SV and latex.A patient developed severe anaphylaxis during irrigation of a wound with rifamycin SV. The temporal relationship between application of rifamycin SV, the positive skin test and basophil activation test for rifamycin SV strongly supported diagnosis of anaphylaxis from the locally applied antibiotic. However, after operation the patient had two anaphylactic reactions with pruritus, urticaria and angio-oedema after routine care by a nurse, and these were probably caused by natural rubber latex. This case report has several messages. First, it is not widely appreciated that topically applied drugs and related compounds can elicit life-threatening anaphylaxis. Second, it illustrates patients can present with more than one allergy. Finally, it provides an opportunity to summarize the applications of flow cytometry-assisted quantification of in vitro activated basophils in diagnosing the cause of anaphylaxis during anaesthesia.- - - - - - - - - - ranking = 1.2586408263863keywords = latex, allergy, rubber (Clic here for more details about this article) |
15/31. Intraoperative anaphylactic reaction due to latex hypersensitivity.Severe anaphylactic reaction secondary to latex allergy has lately been recognized and reported especially in individuals with spina bifida. We report a case of severe intraoperative anaphylactic reaction due to latex allergy. Preoperative testing for latex allergy may be helpful in determining latex allergy. We suggest a preoperative management protocol for patients who are thought to have latex allergy. An increased awareness to latex allergy will help avoid this potentially catastrophic event.- - - - - - - - - - ranking = 3.9823409197443keywords = latex, latex allergy, allergy (Clic here for more details about this article) |
16/31. Intraoperative cardiovascular collapse secondary to latex allergy.An apparent allergic reaction has been noted in children undergoing open urological surgery. This condition is characterized by precipitous hypotension, tachycardia and upper body flushing, and it often causes termination of the procedure. Latex allergy has been identified as the possible inciting event. Contact of latex rubber gloves with intra-abdominal structures (handling bowel) appears to be the most dramatic trigger mechanism for this reaction. We report on 10 patients with latex allergy, 6 of whom have myelomeningocele, who have undergone reconstructive surgery. Severe anaphylactic shock developed intraoperatively in 5 patients and during a barium enema performed with a latex catheter in 1 patient. These 6 patients had previous allergic reactions to latex material, which was not detected preoperatively. In the remaining 4 patients latex allergy was diagnosed preoperatively. A total of 6 patients agreed to a skin prick test to liquid latex. Three patients reacted with a wheal size greater than or equal to a histamine control at a dilution of 1:1,000 and 3 patients at 1:100. In contrast, none of the 5 normal controls reacted to any of the concentrations including full strength latex. A history of exposure to latex products (balloons, surgical gloves, catheters, condoms and so forth) with allergic reactions should heighten surgeon awareness of a potentially severe intraoperative reaction. Furthermore, a skin prick test may be used to screen high risk patients such as those with myelomeningocele. A protocol involving preoperative corticosteroid and antihistamine therapy is recommended.- - - - - - - - - - ranking = 4.4909817461306keywords = latex, latex allergy, allergy, rubber (Clic here for more details about this article) |
17/31. anaphylaxis to latex during surgery.Five young women, all of whom had anaphylactic responses in operating units, are described. Three of them worked in a hospital three showed immediate hypersensitivity to fruit and all had known urticaria to latex. anaphylaxis appeared progressively 15 to 30 minutes after injection of anaesthetic drugs. skin tests with these drugs were negative. Skin prick tests through gloves and with four different allergen preparations (saline which had been incubated with gloves and three kinds of latex) were positive. Human basophil degranulation tests with all four allergens were positive and radio allergo sorbent tests to latex were also positive. IgE-dependent allergy to latex may be investigated by questionnaire and if necessary by prick tests before each operation to prevent anaphylaxis due to surgical gloves.- - - - - - - - - - ranking = 2.0083483289584keywords = latex, allergy (Clic here for more details about this article) |
18/31. shock in the operating room.Many factors may contribute to producing a shock state within the surgical environment. The classic causes of shock--hypovolemia, cardiac failure, and sepsis--occur commonly in the operating room. Additionally, concurrent surgery and anesthesia may contribute to produce clinical shock. Surgery may produce hypovolemia from "third space" loss and/or from blood loss. Some anesthetic drugs, by inhibiting the autonomic nervous system, impair the body's ability to compensate for hypovolemia, cardiac failure, or sepsis. Other entities such as tension pneumothorax, drug allergy, or mechanical factors produced by surgical exposure may contribute to hemodynamic compromise of the patient. shock that occurs outside the surgical suite may also be produced by a variety of insults. One or more factors may contribute to inadequate tissue perfusion, thus making diagnosis of the cause(s) of shock a clinical challenge. Presented in this review is an anesthesiologist's approach to shock on a macrocirculatory level. Two important concepts are vital to this approach. First, one must act immediately to restore adequate perfusion to the brain and heart when confronted with a patient in shock. This is possible without knowing the specific cause(s) of the poor perfusion. Second, a rapid, accurate diagnosis of the cause(s) must be made if the patient is slow to respond to the initial therapy. Through the use of pulmonary artery catheterization, the factors producing any given shock state may be identified, and appropriate therapy may be instituted and monitored.- - - - - - - - - - ranking = 0.0083483289583795keywords = allergy (Clic here for more details about this article) |
19/31. Coarctation resection in children with Turner's syndrome: a note of caution.Eight children were recognized to have Turner's syndrome, among 353 patients over 1 year of age who had undergone surgical treatment for coarctation of the aorta. Of these eight children, three developed a significant perioperative hemorrhage from aortic rupture, resulting in one death and one instance of paraparesis related to a period of prolonged hypotension. In two of the other five patients with Turner's syndrome, a decision was made to perform an angioplasty rather than a resection of the coarctation because of apparent friability of the aortic wall. In contrast, only one of the 345 patients without Turner's syndrome died as a result of surgical treatment, and none developed spontaneous perioperative aortic rupture or neurologic deficit. This experience suggests that the operative risk for coarctation of the aorta in this subgroup of patients is considerably greater than that in patients without Turner's syndrome (p < 0.001). Special precautions should include use of rubber-jaw vascular clamps, choice of technique to avoid tension at the anastomotic suture line, and careful control of systemic blood pressure intraoperatively and postoperatively. Indications for surgical treatment of coarctation as well as the type of operative procedure must be individualized cautiously in patients with Turner's syndrome.- - - - - - - - - - ranking = 0.00029249742793921keywords = rubber (Clic here for more details about this article) |
20/31. Anaphylactic reaction to local administration of rifamycin SV.BACKGROUND AND OBJECTIVE: Systemic reactions during anesthesia are commonly attributed to muscle relaxants, hypnotics, macromolecular solutions, latex, or parenteral antibiotics. After exclusion of these different components as causes, we were interested in the potential implication of rifamycin in the systemic reaction, which occurred during anesthesia, and in the immunologic mechanism by which it can trigger this reaction. methods: We report four cases of systemic reactions occurring after local administration of rifamycin. Three patients needed orthopedic surgery, and the fourth needed a urethrotomy. Severe systemic reactions occurred in all four patients when the surgeon washed the incision area with a rifamycin solution. All patients correctly responded to appropriate treatment and recovered. skin tests were performed 2 months after the incident with the drugs used during anesthesia, latex, and rifamycin. To assess the relationship with a possible IgE-mediated mechanism, two in vitro tests were concomitantly performed to evaluate the cell reactivity to rifamycin: (1) determination of histamine release from peripheral basophils and (2) platelet cytotoxicity test, which explored the presence on platelets of specific IgE antibodies bound to the low-affinity receptor for IgE. RESULTS: skin tests were performed with different drugs used during surgery, and results were only positive for rifamycin in the four cases, accompanied in two cases by a systemic reaction. histamine release from basophils was positive in three of four patients. The platelet cytotoxicity test results were positive in all four cases. CONCLUSION: It appears that rifamycin, used locally during surgery, is apt to trigger severe systemic anaphylactic reactions, which are linked to an IgE-related process. This situation is worth pointing out, especially in patients who undergo repeated orthopedic operations during which, at least in europe, rifamycin is commonly used for the prevention of local sepsis.- - - - - - - - - - ranking = 0.5keywords = latex (Clic here for more details about this article) |
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