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ANESTHETIC PHARMACOLOGY

Hetastarch Allergy and Positive Latex Radioallergosorbent Test in a Patient Suffering Cardiovascular Decompensation During Multiple Perioperative Periods

R. Michael Ritchey, MD^*, Robert F. Helfand, MD^*, Samuel A. Irefin, MD^*, Maged Argalious, MD^*, and John E. Tetzlaff, MD^*

*Division of Anesthesiology, Critical Care Medicine, and Comprehensive Pain Management, The Cleveland Clinic Foundation, and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic Foundation, Cleveland, Ohio

Address correspondence and reprint requests to R. Michael Ritchey, MD, Division of Anesthesiology and Critical Care Med, The Cleveland Clinic Foundation, E-30, 9500 Euclid Avenue, Cleveland, Ohio 44195. Address e-mail to ritcher{at}ccf.org.

The cause of sudden cardiovascular collapse in the perioperative period can be elusive. Allergy may be overlooked as a cause. When allergy is considered, latex is often suspected. Because hetastarch is frequently used in situations involving hypovolemia and hypotension, and because allergic reactions to it are rare, it may be overlooked as a possible allergen. We report a case of a patient suffering cardiovascular decompensation during four nonconsecutive perioperative periods before it was determined that she was allergic to hetastarch. She also had a very highly positive latex radioallergosorbent test, suggesting a latex allergy.