| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Correspondence |
Cleveland, Ohio
To the Editor:
We present an unusual case of latex allergy in a patient who experienced three major episodes of bronchospasm and hypotension under three different surgical settings before the actual diagnosis of latex allergy was established.
A 64-yr-old, 80 kg, 163 cm female with cervical spondylitic myelopathy presented for cervical spine surgery. She had had left knee arthroplasty under spinal anesthesia three years prior to the present surgery. In the recovery room, 500 mL of salvaged blood were transfused and she developed wheezing followed by severe hypotension and tachycardia. Supportive measures included supplemental oxygen, iv fluids, boluses of ephedrine and phenylephrine and dopamine infusion. This episode was attributed to a transfusion reaction from the wound drain.1
She came for revision knee arthroplasty two years later, again under regional anesthesia. Approximately ten minutes after tourniquet deflation, she developed respiratory distress and hypotension requiring boluses of ephedrine and phenylephrine. She was intubated and mechanical ventilation was instituted. Oropharyngeal edema and poor lung compliance were noted, both improving with epinephrine. The episode was attributed to venous embolism.2,3
The most recent surgery was cervical spine decompression and fusion. About two hours into the procedure, the patient developed bronchospasm, hypoxemia and severe hypotension. At this stage we suspected an anaphylactic reaction to latex. After the administration of epinephrine, hydrocortisone and diphenhydramine, the hemodynamic status improved. The following day she had a skin prick test that showed a positive result for latex. She also had a radioallergosorbant test that showed a high positive titer of 7.47 KU•L-1 (normal range: < 0.35 KU•L-1).
Several features delayed the identification of latex allergy in this patient. In the first episode the patient seemed to have anaphylaxis following wound blood transfusion. In retrospect, application of the tourniquet might have prevented the systemic absorption of latex proteins. Transfusion of blood from the surgical drain probably resulted in the administration of latex proteins. During the second episode signs and symptoms appeared immediately after tourniquet release. Again, in retrospect, release of the tourniquet might have resulted in a systemic bolus of latex proteins. During the third episode the bronchospasm and hypotension began approximately 30 min after incision. The sequence of events was now clearer, pointing towards anaphylaxis4 which was later proven to be due to latex.
We conclude that clinical events can delay the diagnosis of latex allergy. Considering the increasing incidence of latex allergy it might be worth considering preoperative skin testing in any patient who suffered a major episode of perioperative hypotension and hypoxemia in the past.
References
1 Woda R, Tetzlaff JE. Upper airway oedema following autologous blood transfusion from a wound drainage system. Can J Anaesth 1992; 39: 290–2.
2 Tsuchiya M, Ueda W, Tomoda M, Mokudai Y, Takeda A, Hirakawa M. The hemodynamic and metabolic changes following tourniquet release during halothane anesthesia (Japanese). Masui 1991; 40: 540–3.[Medline]
3 McGrath BJ, Hsia J, Boyd A, et al. Venous embolization after deflation of lower extremity tourniquets. Anesth Analg 1994; 78: 349–53.[Abstract]
4 Weiss ME, Hirshman CA. Latex allergy. Can J Anaesth 1992; 39: 528–32.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
