Intraoperative latex anaphylaxis in children: classification and prophylaxis of patients at risk.

Over a 3-year period, in 36,075 general anesthetic anesthesia procedures done at our institution, 21 patients had type I (anaphylactic) intraoperative reactions to latex (phase 1). We subsequently established a system for classification of at-risk patients with a corresponding regimen for prophylaxis used prospectively between January 1992 and July 1994 (phase II). Three groups of patients at risk for type I hypersensitivity reaction were identified, and a regimen for prophylaxis developed (based in part on protocols used in preparing patients who are allergic to radiocontrast media). Since using this protocol, the incidence of intraoperative anaphylaxis has decreased. During phase 2, 34,513 patients received a general anesthetic in the operating room, and there have been three cases of suspected intraoperative latex anaphylaxis; two of these three patients did not meet any of the risk criteria and therefore did not receive preoperative prophylaxis or avoidance of latex. Of these 34,513 patients, 86 at-risk patients received prophylaxis. A prospective study is needed to determine whether the pharmacologic prophylaxis is needed in addition to a latex-free environment.