Evan J. Goodman

Cephalosporins Can Be Given to Penicillin-allergic Patients Who Do Not Exhibit an Anaphylactic Response

STUDY OBJECTIVES To assess the risk of intraoperative allergic reactions to cephalosporins in patients who claim to be allergic to penicillin. DESIGN Retrospective chart review. SETTING University-affiliated hospital. MEASUREMENTS 2,933 intraoperative anesthesia records of all adult orthopedic patients treated at our institution during a 14-month period (7/96-8/97) were reviewed for antibiotic use and allergic reactions. MAIN RESULTS Most of the 2,933 orthopedic patients, including 413 patients who were allergic to penicillin, received a cephalosporin (usually cefazolin) during their procedure. Only one of the penicillin-allergic patients may have had an allergic reaction to the cephalosporin, because diphenhydramine and hydrocortisone were given at the beginning of the case. However, no mention was made on the chart about itching or a rash or hives. One of the non-penicillin-allergic patients did develop a rash while the cephalosporin was infusing, requiring discontinuation of the antibiotic. CONCLUSIONS Given the low incidence of allergic reactions, it appears to be safe to administer cephalosporins to patients who claim to be allergic to penicillin. However, no conclusion can be made concerning patients who report severe or anaphylactic reactions to penicillin, because these patients probably were excluded from the study.

The rate of successful reactivation of labor epidural catheters for postpartum tubal ligation surgery

Background and Objectives. Epidural catheters placed for analgesia during labor and delivery can be reused in the postpartum period for postpartum tubal ligation anesthesia. This study examined the success rate of such reactivation of epidural catheters. Methods. We studied all patients who had received an epidural anesthetic for labor and delivery and who had the epidural catheter reactivated at a later time to provide anesthesia for a postpartum tubal ligation (PPTL) procedure between January, 1993 and June, 1995. The patients were divided into four groups based on the interval between delivery and PPTL incision: (a) less than 8 hours, (b) 8 hours to less than 16 hours, (c) 16 hours to less than 24 hours and (d) 24 hours or more. Results. Overall, 92% (129/140) of the patients had their epidural catheters successfully reactivated. The success rate in all but the last group was over 90%, while only 80% of catheters could be reactivated if left in place for more than 24 hours. Conclusions. Epidural catheters can be reactivated reliably for as long as 24 hours after they are placed.

Reusable Laryngeal Mask Airways can be used more than 40 times

STUDY OBJECTIVE To compare the mechanical properties of classic, reusable Laryngeal Mask Airways (LMAs) that have been used more than 100 times with one unused LMA. DESIGN Laboratory testing of devices used clinically. SETTING Metropolitan university hospital. MEASUREMENTS Cuff and tube specimens from LMAs that had been used at least 100 times were tested for elongation, tensile strength, stiffness, and tear strength using standard American Society of Testing and Materials protocols. Samples from an unused LMA were analyzed in the same manner for comparison. MAIN RESULTS Tensile strength of the cuff samples was found to increase by approximately 25%. There was an increase in cuff stiffness and decreased tear strength similar to the manufacturer-reported trends. Cuff elongation decreased by 30%. Results for the LMA tube differed depending on whether the samples were taken in the machine direction or transverse direction. Tensile strength decreased by 30% in machine direction and, on average, very little in transverse direction. CONCLUSIONS The material in reusable classic LMAs does not lose its strength after 100 uses to the extent that its manufacturer claims. At least 100 uses may be considered safe for these devices.

The PAXpress airway causes more pharyngeal irritation than the reusable laryngeal mask airway.

This study aimed to determine whether the PAXpress airway (Vital Signs, Totawa, NJ) should replace the standard laryngeal mask airway (LMA Classic) in our practice. Records of patients who had been ventilated with a PAXpress airway or an LMA were examined. Responses of patients in the postanesthesia care unit (PACU) or from routine postoperative calls the following day were noted. Insertion of the airway was easy in all of the LMA patients but in only 20% of the PAXpress patients. Blood was noticed on 27% (4/15) of the PAXpress airways but on none of the LMAs. None of the LMA patients complained of pharyngeal soreness in the PACU, whereas 33% (5/15) in the PAXpress group had a sore throat. The next day, only 2 patients in the LMA group (13%) complained of a slightly sore throat. In the PAXpress group, all but 2 of the 13 patients interviewed (85%) reported a sore throat. The average degree of soreness for this group (4.5) was significantly higher than that reported in the LMA group (P < .001). The PAXpress airway is more likely to cause irritation (often severe) of the airway and, therefore, should not replace the standard LMA in our practice.