When to Ask About Allergies in the Perioperative Setting
Allergy history must be obtained during the pre-operative assessment phase (Sign-in), well before the patient enters the operating room. 1
Correct Answer: A - Sign In
The WHO Surgical Safety Checklist designates the "Sign-in" phase as the critical time point for verifying allergy status before induction of anesthesia. 1 This occurs during pre-operative evaluation when the anesthesiologist reviews the patient's medical record and conducts a focused history. 1
Why Sign-in is the Only Appropriate Time
Pre-operative allergy assessment is mandatory because:
- A thorough allergy history, including previous anaphylactic reactions, latex allergy, and drug allergies must be documented before any medications are administered 1
- Approximately 8% of the population is sensitized to latex, with healthcare workers and children with spina bifida at particularly high risk 2, 3
- One-third of patients with previous perioperative allergic reactions will experience recurrence if the culprit agent is not identified and avoided 2
- Latex allergy should be recorded in case notes and on the patient's wrist bracelet before entering the operating theater 2
Why Other Options Are Wrong
Timeout (Option C) is too late because:
- The patient has already been exposed to potential allergens during induction 1
- Neuromuscular blocking agents, latex gloves, and chlorhexidine preparations may have already been used 2
- Anaphylaxis during anesthesia has an incidence of 1/10,000 to 1/20,000 surgeries, with mortality of 3.5-4.8% 4, 5
Sign-out (Option B) and Postoperative (Option D) are completely inappropriate as the patient has already undergone full anesthetic exposure by these time points. 1
Specific Allergy Questions to Ask During Sign-in
Direct questioning should include: 2
- Previous anaphylactic reactions during any medical procedure
- Contact with balloons, condoms, or latex gloves causing itching, rash, or angioedema
- Allergies to fruits (banana, chestnut, avocado) suggesting latex cross-reactivity
- History of multiple surgical procedures, especially in childhood
- Healthcare worker status or occupational latex exposure
- Known drug allergies, particularly to antibiotics, neuromuscular blocking agents, or chlorhexidine
Critical Pitfall to Avoid
Never proceed with elective surgery if allergy history is incomplete or suggests previous perioperative reaction. 2 If a severe reaction occurred previously and the upcoming procedure is elective, the patient must be referred for specialized perioperative allergy investigation before surgery. 2 For emergency surgery with suspected allergy history, avoid all exposures that occurred before the previous reaction, and consider regional or inhalational techniques to minimize intravenous drug exposure. 2