Volume 7, Issue 11 S A M B A T A L K S - PAGE 2 April, 2008

JOIN THE DISCUSSION - TOP

Need advice about a problem case in ambulatory anesthesia? Suggestions about a difficult situation in your ambulatory surgery center? A reply to questions others have raised about ambulatory anesthesia issues?

If you answered "yes" to any of these questions, or would like to share with other professionals a comment or opinion on a topic related to ambulatory anesthesia then please "Join the Discussion".

Your question, reply or comment will be published in the next available issue of SAMBA TALKS. Include your name (or initials), email address, city, and state, if you would like these published. Please note that because of the high volume of questions we receive, there is often a delay of 1 to 2 months before publication.

SAMBA Talks will include all discussion questions we receive considered of interest to the membership at large. We will endeavor to publish a response to at least one of these questions. The response will be from experts in the field, and from those willing to express a view on a particular topic, backed by experience and/or published evidence. Where email addresses are published, those individuals have indicated their interest in discussing the published questions.

Questions and responses from previous months are now available at the eNewsletter Discussion Archive. If you have any comments regarding the previous questions, please submit them to SAMBA Discussion, and they will be published here next month.

Please note: The information presented in the replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

?? - LAST MONTH'S QUESTION WITH REPLIES - ?? - TOP

I am looking for the general consensus on whether patients that have a history of true latex allergy, not just sensitivity, are acceptable outpatient surgical candidates or should they be only done as inpatients? Thank you in advance.

-- From: Michael Koumas, Columbus, OH (mkoumas@hotmail.com)

REPLY 1

The precautions needed to avoid exposure to natural rubber latex are well documented in a variety of sources, including a booklet produced by the ASA. If your institution can follow those guidelines the risk of a serious allergic reaction has to be extremely low. Following such guidelines is much easier than it was 10 years ago because manufacturers now substitute for latex in many items, and are also required to label any medical items that contain latex.

The only exception I can think of relates to the rare individual whose extreme latex sensitivity engenders reactions to small amounts of inhaled antigen. If your center is still using high antigen powdered latex gloves this may be a problem for such patients and you would want either to bar such patients, or, more appropriately, to switch to readily available low antigen powder-free latex gloves, or to synthetic (neoprene) gloves that do not disperse latex antigen into the environment of the surgical suite.

As always, a thorough history should be taken to document the nature of previous allergic responses, the type of exposure that provoked the reactions, the veracity of the diagnosis, and how reactions have been treated. 

Anaphylaxis is always a possibility in any patient undergoing anesthesia and surgery and your center should have standard airway and resuscitative equipment and trained staff who can deal with such a reaction. In my view if your outpatient center cannot perform this role it probably shouldn't be doing outpatient surgery at all.

-- From: Gary Kantor, M.D., Cleveland, OH

REPLY 2

We would not take care of a patient with a history of latex anaphylaxis in our offices. While we are prepared to take care of unanticipated anaphylaxis to latex and other triggers; we would not electively treat that patient. A lot of the reason is due to postoperative concerns and what might develop after the patient is out of our care.

-- From: Melinda Mingus, M.D., NY

REPLY 3

I feel quite strongly that these cases are exactly the same as MH cases: Don't expose them to the allergen and it’ll be safe to proceed. These cases should be treated as any other allergy.

I have never read or heard of anyone in an ASC having a latex allergy that they could not deal with. The catastrophes have occurred in a specific group of patients with certain surgeries.

-- From: F. Barry Florence, Stony Brook, NY

REPLY 4

In the several ASCs that I've set up and run on both coasts for the past 15 years, we've always had a 'latex free' cart to cover all the necessary anesthetic and surgical needs for such patients. I've personally done dozens of these cases myself without incident (proper supplies, open vials with wrench, pre-tx with prophylactic decadron, H1 and H2 blockers, etc.)! I feel that these are acceptable cases to be performed in an outpatient setting.

-- From: Adam F. Dorin, M.D., MBA, San Diego, CA

?? -- THIS MONTH'S QUESTION -- ?? - TOP

What rationale, if any, exists for routine use of vancomycin for prophylactic antibiosis in patients receiving implanted sacral nerve stimulators? You could characterise this as a low risk, but "high consequence" (of infection) procedure. Does vancomycin actually have greater prophylactic efficacy compared with cefazolin against MRSA? Or any other organism for that matter?

-- From: Anonymous

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