RATIONALE: Adverse reactions to local anesthetics (LAs) are frequently reported and patients are referred for skin testing despite the fact that hypersensitivity to the most commonly used amide local anesthetics is rare. In this study, we evaluate whether skin testing for amide local anesthetic is helpful in determining safety of dose challenge. METHODS: Review of patients referred to Washington University for adverse reactions to LAs from 1994-2004. 35 patients (28 F, 7 M; age 22-79) underwent prick and intradermal (ID) skin testing and dose challenge with either preservative free mepivicaine or preservative free lidocaine or both. RESULTS: 35 patients tested with preservative free amide group LAs had negative prick and ID skin test RESULTS: 34 patients to preservative free lidocaine and one patient to preservative free mepivacaine. 6 of the 35 patients were tested with lidocaine and mepivacaine and had negative results to both. All patients tolerated re-challenges with preservative free lidocaine or mepivacaine, or both. CONCLUSIONS: The results of this study demonstrate that hypersensitivity to the amide group local anesthetic is rare and adverse reactions reported are most likely vasovagal or possible hypersensitivity to the preservative e.g., sodium metabisulfite. When performed by a trained individual, dose challenge with preservative free amide anesthetic without skin testing may represent a safe and cheaper alternative.

RATIONALE: Adults with terminal lung disease should have immediate recovery of lung function following bilateral lung transplantation. We examined the pulmonary function status of 5 patients who underwent bilateral lung transplantation up to one year post-operatively. METHODS: We reviewed 5 patients in the Lung Transplant Center who had undergone bilateral lung transplantation from 1994 to 2002. For all patients, PFTs were done pre-operatively (month 0), and at 1, 3, 6 and approximately 12 months after transplantation. FEV1 was examined to demonstrate lung function. The shortest duration of follow-up was 11 months, while the longest was 10 years. RESULTS: There were 2 female and 3 male patients. Ages ranged from 33 to 56 years old. Two patients had severe COPD, 1 had lymphangioleimyomatosis, and 2 had cystic fibrosis. The mean FEV1 at 0, 1, 3, 6, and 12 months was 20% ± 13%; 72% ± 22%; 90% ± 30%; 109% ± 33%; 111% ± 32%. As expected, there was significant improvement in FEV1 between months 0 and 1 (p=0.009). In analyzing the increase in FEV1 between month 1 with months 3, 6, and 12 respectively, we observed a trend of increasing significance, i.e. month 1 v. month 3 (p=0.173), month 1 v. month 6 (p=0.058), month 1 v. month 12 (p=0.036). CONCLUSIONS: We conclude that PFTs do not reflect improvement in lung function in the first year following bilateral lung transplantation. This observation suggests that transplanted lungs may need to time to mature within its adult recipient before providing improved function.