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Latex allergy and cesarean section under spinal anesthesia: an evidence-based approach
Abstract Number: 249
Abstract Type: Case Report/Case Series
The prevalence of latex allergy (LA) is increasing in obstetric patient populations. (1). The incidence of intraoperative anaphylactic reaction due to latex during cesarean section (C/S) is 1:310 per year (2). We herein report on 3 parturients with LA undergoing C/S under spinal anesthesia and address key anesthetic considerations.
A 30 y/o healthy parturient with LA unknown to healthcare providers received spinal anesthesia with bupivacaine, 12 mg, fentanyl, 10 µg and morphine, 100 µg for elective C/S. Intravenous (IV) pre-hydration with Ringer’s lactate (RL) and aspiration prophylaxis with ranitidine and metoclopramide were administered prior to anesthesia. After delivery of a healthy newborn, standard IV oxytocin infusion was initiated. Twenty two minutes after skin incision, the parturient suddenly developed severe pruritis, swelling on her eyes, marked flushing on her face, dyspnea, hypotension and severe bronchospasm. Oxytocin infusion was discontinued and IV injection of ephedrine, 5 mg in oxytocin free RL solution was given. Upon patient’s admission of LA, IV injections of antihistaminic agents, adrenaline, prednisolone and theophylline were given. Rapid induction of general anesthesia and endotracheal intubation followed. The trachea was extubated at the surgery completion. Postoperatively the diagnosis of LA was confirmed (high levels of specific anti-latex IgE). (Table).
A 26 y/o parturient with known LA received spinal anesthesia for C/S following failed induction of labor. Latex free equipment was used for the surgery. Anesthesia was uneventful except for skin rush on puncture site of the IV catheter. Postoperatively specific anti-latex IgE level was determined. (Table).
A 31 y/o parturient with a history of LA and previous uneventful C/S received spinal anesthesia for another C/S. Latex free equipment was used preoperatively. Anesthesia was uneventful. Postoperatively specific anti-latex IgE level was very high. (Table).
Severe later-related anaphylactic reaction in our 1st patient was diagnosed promptly and treated successfully. Latex free perioperative environment was provided for the 2nd and 3rd patients and no complications were reported despite high levels of specific antilatex IgE. In conclusion we believe that avoidance of exposure to the allergen is essential to minimizing perioperative complications in parturients suspected to be at risk.
1. Br J Anaesth