Perioperative anaphylaxis from locally applied rifamycin SV and latex.

A patient developed severe anaphylaxis during irrigation of a wound with rifamycin SV. The temporal relationship between application of rifamycin SV, the positive skin test and basophil activation test for rifamycin SV strongly supported diagnosis of anaphylaxis from the locally applied antibiotic. However, after operation the patient had two anaphylactic reactions with pruritus, urticaria and angio-oedema after routine care by a nurse, and these were probably caused by natural rubber latex. This case report has several messages. First, it is not widely appreciated that topically applied drugs and related compounds can elicit life-threatening anaphylaxis. Second, it illustrates patients can present with more than one allergy. Finally, it provides an opportunity to summarize the applications of flow cytometry-assisted quantification of in vitro activated basophils in diagnosing the cause of anaphylaxis during anaesthesia.

Safety first--five years later. Belgian standards for patient safety in anaesthesia revisited.

Belgian Standards for Patient Safety in Anaesthesia, established in 1989 by a joint effort of the Belgian Professional Association of Anesthesiologists and the Belgian Scientific Society of Anaesthesia and Resuscitation, were intended to be fully implemented within hospital practice by January 1st, 1995. In order to gather follow-up data with regard to this deadline, the Professional Association of Anesthesiologists conducted a survey in 1995: a questionnaire was circulated to all Belgian anaesthetists in order to evaluate the extent to which these guidelines had been implemented in clinical practice and to determine the areas in which residual noncompliance remained. 71% of responders complied with the safety guidelines as far as monitoring in the operating room was concerned. Nursing help was available to 95% of the responders. Concerning the requirement for continuous attendance during anaesthesia by a doctor anaesthetist, some questions remain: although the principle was accepted by 53% of responders, the practical consequences are such that flexibility in working conditions is hampered by the obligation to stay at the side of the anaesthetised patient, under all circumstances. The survey reveals that 65% of responders do not totally comply with this guideline of continuous attendance by a doctor. Many of them propose professional assistance by nursing staff with a specific education and training in anaesthesia.

Dehydrobenzperidol as peroperative anti-emetic: most effective administration time.

206 female patients undergoing curettage or laparoscopy were randomized in 4 comparable groups. Group 1 did not receive dehydrobenzperidol (DHBP), group 2 was given DHBP during premedication, group 3 during induction of anesthesia and group 4 when patients presented symptoms of nausea and/or vomiting. Again, the statistical results confirm the strongly anti-emetic effects of DHBP. Because of the existing trend towards a more beneficial effect of DHBP if given during induction and the avoidance of a possible adverse reaction, administration during induction is to be preferred, at least in non-ambulatory patients.

Can inhaled anesthetics influence the breath analyser Alcotest?

An in vitro study was made to verify whether anesthetic vapours, exhaled after anesthesia can influence the breath analyser test used in Belgium by the prosecuting authorities. Of the exhaled anesthetic vapours halothane, enflurane, methoxyflurane and diethyl ether, only diethyl ether will be able to produce a positive breath test.

Compliance of the tubing compartment of lung ventilators.

The compliance of three types of breathing tubing commonly used in lung ventilators was measured. The black rubber corrugated tubing commonly used in anaesthetic circuits is too compliant for use in ventilators in intensive care. It is suggested that the international draft standard of compliance for breathing tubes used in lung ventilators should be amended.

Music while you wait. Patient acceptance of music in the preanesthetic period.

A series of 184 premedicated patients were studied to determine whether music could make the immediate waiting period before surgery more comfortable. Selected music at a known noise level was being played by a tape recorder in a waiting room with open doors within the operating department. After the operation patients were asked about their impressions. A favourable result was obtained in 96.8% of the patients, i.e. 52.2% positively satisfied, 22.3% neutral and 22.3% not noticing the music. The negative impressions were mostly emotional or perhaps due to an adverse reaction to a premedication constituent: dehydrobenzperidol. The authors recommend the use of music while you wait for surgery. (Acta anaesth. belg., 1980, 31, 61-67).