The incidence of latex sensitivity in ambulatory surgical patients: a correlation of historical factors with positive serum immunoglobin E levels.

Increasing reports of latex-induced anaphylaxis make preoperative identification of latex-sensitive individuals an important concern. The incidence of latex sensitivity and the efficacy of questionnaires in identifying this in ambulatory surgical populations have not been determined. To clarify these issues, 996 ambulatory surgical patients were studied preoperatively. A questionnaire addressing demographic information, previous surgeries, history of atopy, previous exposure or reactions to latex, congenital abnormalities, and food allergies was administered. These data were then compared with serum anti-latex immunoglobin E (IgE) levels (AlaSTAT test), and risk factors, sensitivity, and specificity were determined. Of this population, 6.7% had IgE antibodies against latex (i.e., latex sensitivity). Male gender, non-Caucasian race, age, asthma, spinal cord abnormalities, food allergies, stated latex allergy, and symptoms when exposed to latex increased the risk of latex sensitivity. The specificity and positive predictive value of history were low. No systemic allergic reactions occurred, a finding that could be attributed to chance alone. The incidence of latex sensitivity in this population suggests that latex allergy is a significant potential problem in ambulatory surgical patients. History, however, does not appear to be a reliable predictor of the presence of anti-latex antibodies.

Efficacy and safety of single injection peribulbar block performed by anesthesiologists prior to cataract surgery.

STUDY OBJECTIVE: To evaluate the safety and efficacy of single inferior injection peribulbar block administered by anesthesiologists prior to cataract surgery. DESIGN: Retrospective chart review. SETTING: Freestanding surgery center (teaching). PATIENTS: 1,074 consecutive patients who were treated over a two-year period. INTERVENTIONS: Single inferior injection peribulbar block and one inferior peribulbar supplement when indicated. MEASUREMENTS AND MAIN RESULTS: The efficacy of a single inferior injection peribulbar block was 74%; 96% with one inferior peribulbar injection supplement. There were no ocular or systemic complications. CONCLUSION: Single inferior injection peribulbar block is safe and effective when administered by anesthesiologists.

Desflurane versus propofol anesthesia: a comparative analysis in outpatients.

This study compares the induction, hemodynamic, and recovery characteristics of a general anesthetic with desflurane to one with propofol. Sixty outpatients presenting for orthopedic surgery received either a propofol induction of anesthesia followed by desflurane and nitrous oxide (Group 1), a propofol induction followed by propofol infusion and nitrous oxide (Group 2), a desflurane and nitrous oxide induction and maintenance (Group 3), or a desflurane induction and maintenance (Group 4). The quality of induction was inferior in Groups 3 and 4 with more breath-holding and excitation than in Groups 1 and 2. However, there was a more rapid emergence in Group 4 patients than any of the other groups. Group 4 patients were able to say their names (5.6 +/- 2.0 min vs 10.3 +/- 3.3 min, 8.6 +/- 3.1 min, and 9.3 +/- 1.5 min for Groups 1, 2, and 3, respectively) sooner after the discontinuation of anesthesia. Nonetheless, intermediate recovery was similar in Groups 2 and 4 being numerically but not statistically more rapid than in Groups 1 and 3. This pattern of intermediate recovery was also demonstrated by psychomotor function test results. Although there was no difference between the groups in postoperative narcotic requirement, more patients in Group 3 vomited (50%) than in either Group 2 (0%) or Group 4 (12.5%). Hemodynamically, the anesthetics were very similar. Although desflurane was a difficult drug to use for induction of anesthesia, this study demonstrates that desflurane is a suitable maintenance anesthetic for ambulatory surgery because it provides a rapid awakening and an intermediate recovery similar to propofol.