Should you handle latex allergies as outpatients?
Should you handle latex allergies as outpatients?
The following information is excerpted with permission from the April 2008 issue of SAMBA Talks, published by the Society for Ambulatory Anesthesia:
Question: 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?
Answer: The precautions needed to avoid exposure to natural rubber latex are well documented in a variety of sources, including a booklet produced by the American Society of Anesthesiologists, says Gary Kantor, MD, of Cleveland. (See editor's note at end of story.) If your facility follows those guidelines, the risk of a serious allergic reaction has to be extremely low, he says.
"The only exception I can think of relates to the rare individual whose extreme latex sensitivity engenders reactions to small amounts of inhaled antigen," Kantor says.
Is your facility still using high-antigen powdered latex gloves? These gloves might be a problem for such patients, Kantor says. You would want to ban such patients or, more appropriately, switch to low-antigen powder-free latex gloves or to synthetic (neoprene) gloves that don't disperse latex antigen into the environment of the surgical suite, he says.
A thorough history should 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, Kantor says. "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," he says. "In my view, if your outpatient center cannot perform this role, it probably shouldn't be doing outpatient surgery at all."
Physician would not perform surgery in office
Melinda Mingus, MD, of New York, says she would not take care of a patient with a history of latex anaphylaxis in her offices.
"While we are prepared to take care of unanticipated anaphylaxis to latex and other triggers, we would not electively treat that patient," Mingus says. "A lot of the reason is due to postoperative concerns and what might develop after the patient is out of our care."
However, F. Barry Florence, MD, of Stony Brook, NY, feels strongly that latex allergy cases should be treated the same as malignant hyperthermia: "Don't expose them to the allergen, and it'll be safe to proceed," Florence says. "These cases should be treated as any other allergy."
Adam F. Dorin, MD, MBA, of San Diego has set up and managed several surgery centers for the past 15 years that always have a "latex-free" cart to cover the 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-treatment] with prophylactic decadron, H1 and H2 blockers, etc.," he says. "I feel that these are acceptable cases to be performed in an outpatient setting." (Editor's note: The American Society of Anesthesiologists has a booklet titled, "Natural Rubber Latex Allergy: Considerations for Anesthesiologists." Single copies are free and can be downloaded at www.asahq.org/publicationsAndServices/latexallergy.pdf. Additional copies are $5 each.)
The following information is excerpted with permission from the April 2008 issue of SAMBA Talks, published by the Society for Ambulatory Anesthesia:Subscribe Now for Access
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