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Perioperative management of latex allergic patients

Created: 27/6/2005
Updated: 14/10/2008
 

The most important precaution is the use of non-latex gloves by the anaesthetist and surgical team.


If an allergy to latex proteins exists, latex-free gloves must be used. The gloves may be used by anaesthetists managing latex-allergic patients, in all types of surgery by staff who have a known or suspected allergy to natural rubber latex (NRL) proteins, when performing surgery on patients who have a known or suspected allergy to NRL proteins and for those concerned about such allergies.

Communication

When a patient presents with latex allergy they must be identified (annotate the patient notes, provide a wrist band, place a sign above the patient's bed) and ensure that all members of staff are made aware of the allergy.

Premedication

Types 1 and 2 antihistamines and steroids have been suggested, but they do not prevent reactions and may not be necessary if proper precautions have been carried out.

Minimise exposure

  • All staff must wear latex-free gloves.
  • All latex-containing equipment must be removed from the theatre.
  • Patients should be placed first on the operating list (reduce risk of exposure to aerosolised latex protein).
  • Use laminar airflow in theatre, where possible.
  • Alert staff outside theatre of patient with latex allergy.

Anaesthesia

All theatres should have a latex-free equipment box. Ensure that a new HME filter is used (as should be used with every new patient anyway). The anaesthetic otherwise need not be altered for these patients.

Latex-free equipment


 Equipment type
 Supplier
Sterile gloves Regent
Non-sterile gloves Regent
Face masks Rusch
Breathing circuits Intersurgical
HME filter Intersurgical
Guedel airway Universal Hospital Supplies
Laryngeal mask Portex
Endotracheal tube Portex
Syringes Becton and Dickinson
Cannulae Ohmeda
CVP lines Arrow
Epidural catheter Portex minipack
PCA Baxter (disposable)
Fluid giving sets Braun

The anaesthetic technique need not be influenced by latex allergy. Problems may arise from the use of drug ampoules containing latex stoppers. If unavoidable, the stopper should be removed prior to drawing up the contents.

Drugs with latex-free stoppers


 Drug type
 Supplier
Thiopentone May and Baker
Ketamine Parke Davis
Rocuronium Organon
Vecuronium Organon
Cefuroxime GSK
Dantrolene Procter and Gamble


Surgical equipment

Latex-free surgical equipment should be available for such cases.

Postoperative

Anaphylactic reactions to latex occur 20-60 minutes after exposure. Therefore, patients should remain in the recovery area for a minimum of 1 hour.

Ensure that latex-free syringes are available for the postoperative care of the patient.


ArticleDate:20050627
SiteSection: Article
 
   
    
                                            
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