Anaesthesia for the Patient with Allergy to Latex

Contact dermatitis to rubber products such as gloves, a delayed hypersensitivity reaction, has been described for many yearsl.Contact urticaria was first reported in 1979 2 , and is mediated by IgEl.The first systemic reactions to latex rubber were reported in 1987 4 and since then severe Type I hypersensitivity reactions have been increasingly described during surgery and anaesthesia s -12 .Most reports have come from North America while many anaesthetists in other countries are unaware of the probleml2.Recently in our institution, two patients have presented for surgery with a history of a severe intraoperative anaphylactic reaction to latex rubber.The following is an account of their anaesthetic management. CASE HISTORIES Patient 1A 5-year-old, 19k9 boy was scheduled to have dental restorative work as a day case under general anaesthesia.Past medical history included VATER syndrome, and treatment for associated neurogenic bladder had involved intermittent catheterizations.There was no history of atopy.Three months previously he underwent an inguinal hernia repair under general anaesthesisa, for which he was anaesthetized with halothane and nitrous oxide in oxygen, and his trachea was intubated with a clear plastic uncuffed tube.Thirty minutes after the start of surgery his oxygen saturation suddenly fell from 98070 to 85%, associated with tachycardia, bronchospasm and hypotension.The leak around the endotracheal tube disappeared.A diagnosis of anaphylaxis was made and he was successfully treated with crystalloid fluids, adrenaline and hydrocortisone.Following surgery a skin rash was noted around the operation site.Latex allergy was confirmed by a strongly positive RAST test."ER.