(Reproduced, with permission, from Katzung BG [editor]: Basic & Clinical Pharmacology, 8th ed. McGraw-Hill, 2001.)

Immediate Hypersensitivity

Clinical Manifestations

• Atopic: Affects the skin and respiratory tract

• Nonatopic:

Diagnosis: Hypotension, tachycardia, arrhythmias, bronchospasm, cough, dyspnea, pulmonary edema, laryngeal edema, hypoxia, urticaria, facial edema, and pruritus are all manifestations of a hypersensitivity reaction. The patient may not remember initial exposure because no hypersensitivity reaction occurred.

Preoperative management: Avoid inciting agents.

Intraoperative management: Stop the triggering agent. Provide supportive care by maintaining the airway, fluids, steroids, H2 blockers, and epinephrine.

Postoperative management: If exposure results in severe hemodynamic instability, the patient may have to be transferred to the intensive care unit. Notify the patient of the allergy and reaction to avoid reexposure in the future.

Infectious Diseases

Health care workers are at a higher risk of contracting the following infectious diseases. The use of hypodermic (hollow needles such as those used in peripheral IV catheters) create a greater risk than surgical needles (solid needles such as those attached to suture).

• Herpetic whitlow (herpes simplex virus 1 or 2): Painful vesicles appear on a previously injured finger after exposure of open skin to infected oral secretions. Treatment involves topical application of acyclovir ointment. Wearing gloves is the most effective way to prevent infection.

• Hepatitis B: Risk of infection is directly proportional to years in anesthetic practice. Transmission occurs after contact with infected body fluid. If exposure results in fulminant hepatitis, the mortality rate is 60% (occurs in 1% of acute infections). If exposure results in chronic active hepatitis (<5% of all cases), there is an increased risk of developing cirrhosis and hepatocellular carcinoma. Hepatitis B can be prevented by vaccination.

• Hepatitis C: Transmission occurs after contact with infected body fluid. It has the highest rate of serocon-version after exposure. Most infections (≤90%) result in chronic hepatitis that may progress to liver failure and death. Screening of blood and blood products has decreased the risk of transmission but has not eliminated the risk. No vaccination is available.

• HIV: Transmission occurs after contact with infected body fluid. Seroconversion after a single needlestick injury is 0.4% to 0.5%.

Management of Needlestick Injury

• Clean the wound.

• Notify appropriate authority (e.g., occupational health).

• Be aware of the institutional policies to follow after injury.

Prevention (Universal Precautions)

• Wear gloves.

• Do not recap needles.

• Immediately dispose of needles.

• Use extra precaution used in patients with a diagnosis of HIV or hepatitis.

• Wash hands frequently.

• Proper dispose of and disinfect contaminated materials.

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