Anaesthetic emergencies

This chapter discusses anaesthetic emergencies. It begins with a description of adult basic life support (BLS) and advanced life support (ALS). It goes on to describe post resuscitation care; severe bradycardia; tachycardia; severe hypo- or hypertension; severe hypoxia; laryngospasm; air/ gas embolism; gastric aspiration; severe bronchospasm; pulmonary oedema; anaphylaxis; latex allergy; intra-arterial injection; incomplete reversal of neuromuscular blockade; local anaesthetic toxicity; failed intubation; the can’t-intubate-can’t-oxygenate (CICO) scenario and malignant hyperthermia (MH).

Sequence of mixed ophthalmic operating lists: A national survey of UK consultants

Ophthalmic surgical operating lists include intraocular and extraocular procedures, as well as clean non-infectious and dirty infectious cases. Patient age, diabetic status, local or general anaesthesia must be considered during ophthalmic theatre scheduling. Traditionally children and ‘clean cases’ are prioritised. However, factors such as the need for an interpreter, patient transport and latex allergy affect the sequencing of ophthalmic lists. An electronic survey was sent to all UK ophthalmology consultants through the Royal College of Ophthalmologists registry, enquiring about their preference in sequencing mixed theatre lists, what operations they considered clean and dirty, and the presence of departmental protocol for list sequencing. There was a 16.9% response rate ( n = 222/1311). A majority of 75.2% ( n = 167/222) had mixed operating lists of intraocular and extraocular cases. Of those performing mixed operating lists, 44.3% ( n = 74/167) stated they would operate on intraocular cases before extraocular cases, and 92.8% ( n = 155/167) would perform ‘clean’ before ‘dirty’ cases. Fifty-nine per cent ( n = 98/167) have a departmental protocol to help determine list order. This survey has demonstrated that there is a trend to perform ‘clean’ before ‘dirty’ and intraocular before extraocular cases. Given the results of the survey, we outline our recommendation on how to sequence mixed ophthalmic theatre lists.

Jackfruit Anaphylaxis in a Latex Allergic Non-Healthcare Worker

Introduction Anaphylaxis to jackfruit (Artocarpus heterophyllus) is rare. Two previously reported cases have been published in two healthcare workers from jackfruit endemic regions. Latex allergy and birch pollen cross reactivity have both been associated with jackfruit anaphylaxis, providing two separate mechanisms of sensitization. We present a case of jackfruit anaphylaxis in a young latex allergic non-healthcare worker in a non-endemic region. Case Report A 21-year-old male had an anaphylactic reaction immediately after ingesting dried jackfruit. He had a history of allergic rhinitis and latex allergy. He was born premature and required neonatal intensive care and multiple surgeries in infancy, which could possibly be the source of his latex sensitization. Skin prick testing was positive for jackfruit and latex. Discussion Jackfruit anaphylaxis has only been described in conjunction with a latex allergy or a birch pollen allergy. As jackfruit becomes more available across the world, it is important for physicians and patients with these sensitivities to be aware of these possible cross reactions. Fruit sensitivities in latex allergic patients have been well established as Latex-fruit syndrome. Our case highlights the association of latex sensitization and jackfruit anaphylaxis. Conclusion We present a case of Jackfruit anaphylaxis associated with latex allergy in a non-healthcare worker from Midwestern United States. As jackfruit becomes more popular in non-endemic regions, its possible cross reactivity with latex, as well as birch pollen should be recognized.