Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000300012
Brazilian Journal of Anesthesiology
Clinical Information

Reação anafilática induzida por látex em paciente submetido à apendicectomia aberta: relato de caso

Latex-induced anaphylactic reaction in a patient undergoing open appendectomy: case report

Jean Abreu Machado; Romilton Crozetta da Cunha; Benhur Heleno de Oliveira; Jane da Silva

http://dx.doi.org/10.1590/S0034-70942011000300012 Braz J Anesthesiol, vol.61, n3, p.363-366, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: Embora crescente a incidência de alergia ao látex na população em geral, eventos graves de anafilaxia durante alguns procedimentos cirúrgicos felizmente ainda são raros, porém com morbidade e mortalidade elevados. Não apenas a prevenção, mas o diagnóstico, o pronto tratamento e o acompanhamento dos pacientes acometidos por esse evento representam um desafio para o anestesiologista. O presente relato teve por objetivo descrever um caso de anafilaxia grave ao látex e discutir seu diagnóstico e tratamento. RELATO DO CASO: Paciente do sexo feminino, 39 anos, branca com suspeita diagnóstica de apendicite, é levada para procedimento de urgência sob raquianestesia. Aproximadamente 30 minutos após o início da cirurgia, apresentou quadro de anafilaxia com parada cardiorrespiratória, revertida após tratamento. Um dos cuidados foi o isolamento de eventuais agentes causais, sendo que, posteriormente, a paciente foi encaminhada para unidade de terapia intensiva e evoluiu sem sequelas. A dosagem de IgE-RAST (Radioallergosorbent Test) específico para o látex mostrou-se positiva. A paciente foi encaminhada para acompanhamento com o alergologista. CONCLUSÕES: O anestesiologista deve concentrar esforços na anamnese, mesmo em procedimentos de urgência, estando consciente das limitações que se apresentam nessas ocasiões. O prognóstico de anafilaxia depende do pronto início do tratamento adequado e o diagnóstico não se limita ao momento do evento, mas sim à determinação do fator causal. Criar um meio de acompanhar esses pacientes, a exemplo de outros centros internacionais, parece ser o caminho a ser seguido.

Palavras-chave

CIRURGIA, COMPLICAÇÕES, DOENÇAS, Imunológica

Abstract

BACKGROUND AND OBJECTIVE: Despite the increase of latex allergy in general population, severe anaphylactic events during some surgical procedures are still rare; however, they are associated with increased morbidity and mortality. Prevention, diagnosis, treatment, and follow-up of patients affected by this event represent a challenge for anesthesiologists. The objective of this report was to describe a case of severe latex-induced anaphylactic reaction and discuss its diagnosis and treatment. CASE REPORT: This is a 39-year-old Caucasian female patient, with a diagnostic suspicion of appendicitis, who underwent an emergency surgery under spinal anesthesia. Approximately 30 minutes after beginning the surgery, the patient developed an anaphylactic reaction with cardiorespiratory arrest, which was reversed after treatment. Possible causative agents were isolated and, posteriorly, the patient was transferred to the intensive care unit, evolving without sequelae. Latex-specific IgE-RAST (Radioallergosorbent Test) was positive. The patient was referred to an allergist for follow-up. CONCLUSIONS: Anesthesiologists should focus on patient's history, even in urgent procedures, being aware of the limitations arising on these situations. The prognosis of anaphylaxis depends on prompt initiation of adequate treatment; diagnosis is not limited to the event occasion, but to the determination of the causative factor. Creating the means of following-up these patients, similar to other international centers, seems to be the example to be followed.

Keywords

Latex Hypersensitivity, Radioallergosorbent Test, Anesthesia, Spinal, Appendectomy, Heart Arrest

Referencias

Valls A, Pascual CY, Caballero MT. Alergia al latex. Allergol Immunopathol (Madr). 2004;32:295-305.

Uribe Llopis P, Barbero Del Palacio P, Alonso Cobo MT. Hacia un hospital sin látex. Med Segur Trab (Madr). 2008;54:99-108.

Allarcon JB, Malito M, Linde H. Alergia ao látex. Rev Bras Anestesiol. 2003;53:89-96.

Parisi CA, Biló B, Bonifazzi F. Alergia al látex. Arch Argent Pediatr. 2006;104:520-529.

Hamilton RG. Latex allergy: Epidemiology, clinical manifestations, and diagnosis. Base de dados Up ToDate. 2010. .

Potério GMB, Braga AFA, Santos RMSF. Reação anafilática durante transplante renal intervivos em criança alérgica ao látex: Relato de caso. Rev Bras Anestesiol. 2009;59:210-218.

Ledford DK. Perioperative anaphylaxis: Clinical manifestations, etiology, and diagnosis. . Base de dados Up ToDate. 2010. 21 s.

Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;1:466- 469.

Simons FER. Anaphylaxis. J Allergy Clin Immunol. 2010;125:S161-S181.

Kroigaard M, Garvey LH, Gillberg L. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand. 2007;51:655-670.

Dewachter P, Mouton-Faivre C, Emala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology. 2009;111:1141-1150.

Soar J, Deakin C, Nolan J. European Resuscitation Council guidelines for resuscitation 2005: Section 7. Cardiac arrest in special circumstances. Resuscitation. 2005;67:S135-S170.

Brown SGA, Blackman KE, Stenlake V. Insect sting anaphylaxis: prospective evaluation of treatment with intravenous adrenaline and volume resuscitation. Emerg Med J. 2004;21:149-154.

Holt NF, Haspel KL. Vasopressin: a review of therapeutic applications. J Cardiothorac Vasc Anesth. 2010;24:330-347.

Soar J, Perkins GD, Abbas G. European Resuscitation Council Guidelines for Resuscitation 2010. Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81:1400-1433.

Harper NJ, Dixon T, Dugue P. Suspected anaphylactic reactions associated with anaesthesia. Anaesthesia. 2009;64:199-211.

Mertes PM, Lambert M, Guéant-Rodriguez RM. Perioperative anaphylaxis. Immunol Allergy Clin North Am. 2009;29:429-451.

Filon FL, Radman G. Latex allergy: a follow up study of 1040 healthcare workers. Occup Environ Med. 2006;63:121-125.

Katz JD, Holzman RS, Brown RH. Natural rubber latex allergy: Considerations for anesthesiologists. 2005.

Hallgren J, Pejler G. Biology of mast cell tryptase: An inflammatory mediators. FEBS J. 2006;273:1871-1895.

Fisher MM, Baldo BA. Mast cell tryptase in anaesthetic anaphylactoid reactions. Br J Anaesth. 1998;80:26-29.

Shaffer HC, Parsons DJ, Peden DB. Recurrent syncope and anaphylaxis as presentation of systemic mastocytosis in a pediatric patient: case report and literature review. J Am Acad Dermatol. 2006;54:S210-S213.

Guttormsen AB, Johansson SGO, Öman H. No consumption of IgE antibody in serum during allergic drug anaphylaxis. Allergy. 2007;62:1326-1330.

Garvey LH, Kroigaard M, Polsen LK. IgE-mediated allergy to chlorhexidine. J Allergy Clin Immunol. 2007;120:409-415.

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