腹腔鏡手術中のラテックスによるアナフィラキシーショックの1例

抄録

Latex can cause life-threatening allergic reactions in patients with a history of a rubber allergy. We describe a case of severe anaphylactic shock due to latex in a woman who was undergoing laparoscopic surgery.
A 33-year-old woman with a uterine leiomyoma was admitted for a total laparoscopic myomectomy. The operation was converted to a laparoscopic-assisted myomectomy (open-laparotomy) because there were severe adhesions around the uterus. During the surgical procedure, the patient experienced the sudden onset of oxygen desaturation, severe hypotension, and bradycardia. We interrupted the surgery and the patient was given 100% oxygen. The diagnosis of anaphylaxis was not evident during the early period of resuscitation. First, we suspected the cause of shock was a pulmonary gas embolism; we then ruled out other causes, such as cardiogenic shock and hemorrhagic shock. Therefore, we performed a transesophageal echocardiography and chest X-ray. We noticed that her face and chest were flushed. We made a diagnosis of anaphylactic shock and suspected that latex was the cause of anaphylaxis. We changed the urinary catheter, which was made from latex, for a silicone catheter. The patient was resuscitated successfully with manual ventilation, intravenous fluids, and medications. The patient had undergone two laparotomies uneventfully, and later we determined she had atopy.
To prevent anaphylactic shock during surgery, it is important to identify potential risk factors, such as atopy, adverse reactions to foods, and latex items. If latex allergy is confirmed or strongly suspected, patients should be managed in a latexfree environment.