INTRAOPERATIVE ANAPHYLAXIS DUE TO EXPOSURE TO LATEX (NATURAL-RUBBER) IN CHILDREN

Intraoperative anaphylaxis secondary to exposure to latex is a serious and potentially life-threatening phenomenon that has been recognized more frequently in recent years. Between 1989 and 1992, twenty-one pat ients had a Type-I (anaphylactic) reaction to latex intraoperatively a t The Children's Hospital of Philadelphia. Twelve (57 per cent) of the se patients had spina bifida. Six patients (29 per cent) had cerebral palsy, and five of them had a ventriculoperitoneal shunt. Of the remai ning three patients, one (5 per cent) had exstrophy of the bladder, on e had VATER syndrome, and one had Duchenne muscular dystrophy. All of the patients had had at least two previous operative procedures. Overa ll, sixteen patients (76 per cent) had a ventriculoperitoneal shunt. T he manifestations of the allergic reaction included a rash in fifteen patients (71 per cent), hypotension in fifteen, tachycardia in eleven (52 per cent), bronchospasm in ten (48 per cent), bradycardia in two ( 10 per ent), and cardiac arrest in two. The symptoms occurred within m inutes after the induction of the anesthesia in all but one patient, i n whom hypotension and cardiovascular arrest developed approximately o ne hour after the beginning of the operation. Two patients had a full cardiopulmonary arrest while under the anesthesia. All twenty-one pati ents responded to management; there were no deaths. Of the six patient s who had cerebral palsy, five had been managed with a ventriculoperit oneal shunt because of hydrocephalus following a previous intraventric ular hemorrhage that was related to prematurity. We believe that patie nts who have cerebral palsy (especially those who have a ventriculoper itoneal shunt and who have had several previous operations) represent a new group at risk for latex-induced anaphylaxis. Orthopaedic surgeon s must be aware of the risk, diagnosis, prevention, and treatment of a naphylaxis secondary to exposure to latex. A latex-free environment sh ould be provided for patients who are sensitive to the substance.