Anaphylactic shock during hyperbaric oxygen therapy.

A case of a 38-year-old woman is reported who was treated with hyperbaric oxygen therapy to cure a dehiscent wound. She suffered from "oral-allergy syndrome" (OAS) while eating certain fruits, and from itching when wearing latex gloves to handle hair dyes. Fifteen minutes after the start of compression, malaise, anxiety, dyspnoea, tachycardia, cold sweating and laryngeal stridor occurred. Despite intensive care treatment, face angioedema persisted for several days. On the basis of history, radioallergosorbent test (RAST) and prick tests, latex was assumed to be responsible for the anaphylactic reaction. To our knowledge, this is the first extensive report of an anaphylactic reaction to latex in a hyperbaric chamber. The lesson drawn from this case record can be summarized as follows: 1) never fail to collect a thorough history; 2) set up a latex-safe hyperbaric chamber when needed; 3) have an emergency kit always near at hand.

Prediction of neurological outcome after birth asphyxia from early continuous two-channel electroencephalography.

OBJECTIVE: To determine whether two-channel continuous electroencephalography (EEG) applied within 12 h of birth can predict the severity of neurological complications and neurodevelopmental outcome following birth asphyxia. METHODS: A continuous two-channel EEG was performed within 12 h of birth in 22 infants suspected of having suffered birth asphyxia and 11 healthy control infants (22 infants at a general and 11 at a specialist paediatric unit). Criteria to categorise normal and abnormal EEG records were defined and compared with the severity of hypoxic/ischaemic encephalopathy (HIE) and with neurodevelopmental outcome, assessed at or after 12 months of age. RESULTS: EEG recordings were commenced at a median (range) of 2 h 50 min (1 h 45 min to 12 h) after birth. Technically satisfactory recordings were obtained in all but one infant. All control infants remained asymptomatic and had a normal EEG with discernible sleep/awake periods. 12 h after birth the EEG was normal in all 12 infants suspected of asphyxia who remained well or developed grade 1 HIE and was abnormal in six of nine infants with grade II or III HIE. Fifteen of 16 infants suspected of asphyxia with a normal neurodevelopmental outcome had a normal EEG at 12 h; transient abnormalities lasting not more than 8 h had been detected in three of these infants. All five infants who died or developed neurodevelopmental abnormalities had an abnormal EEG. At 12 h of age the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio for predicting severe (grade II or III) HIE were: 67, 100, 100, 80% and infinity and for subsequent death or neurodevelopmental impairments: 100, 94, 83, 100 and 16%, respectively. Assessment of the EEG before 12 h of age altered prognostic accuracy: 4 h after birth the sensitivity, specificity, positive and negative predictive values and the likelihood ratio for poor neurodevelopmental outcome were 100, 71, 33%, 100 and 3.7%, respectively (16 infants). CONCLUSION: Continuous two-channel EEG is an accurate tool for assessing the severity of neurological insult soon after birth asphyxia.