N J N Harper1, T M Cook2, T Garcez3, D N Lucas4, M Thomas5, H Kemp6, K-L Kong7, S Marinho8, S Karanam7, K Ferguson9, J Hitchman10, H Torevell, A Warner11, W Egner12, S Nasser13, N McGuire14, M Bellamy15, K Floss16, L Farmer10, S Farooque17. 1. Manchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK; Royal College of Anaesthetists, London, UK. 2. Royal United Hospital, Bath, UK; University of Bristol School of Medicine, Bristol, UK; Health Services Research Centre, Royal College of Anaesthetists, London, UK. Electronic address: timcook007@gmail.com. 3. Manchester University NHS Foundation Trust, Manchester, UK (United Kingdom Fatal Anaphylaxis Register). 4. Northwick Park Hospital, Harrow, UK (Obstetric Anaesthetists' Association). 5. Great Ormond Street Hospital, London, UK (Association of Paediatric Anaesthetists of Great Britain and Ireland). 6. Imperial College London, UK (Research and Audit Federation of Trainees). 7. Sandwell and West Birmingham NHS Trust, Birmingham, UK. 8. Manchester University NHS Foundation Trust, Manchester, UK (British Society for Allergy and Clinical Immunology). 9. Aberdeen Royal Infirmary, Aberdeen, UK. 10. Royal College of Anaesthetists, London, UK. 11. Allergy UK, London, UK (Association of Anaesthetists of Great Britain and Ireland). 12. Sheffield Teaching Hospitals NHS Trust, Sheffield, UK (Rotyal college of Physicians/Royal college of Pathologists Joint Committee on Immunology and Allergy); Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK. 13. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK (British Society for Allergy and Clinical Immunology). 14. Medicines and Healthcare products Regulatory Agency, London, UK. 15. Leeds Teaching Hospitals NHS Trust, Leeds, UK (Faculty of Intensive Care Medicine); Leeds University, Leeds, UK. 16. Oxford University Hospitals NHS Trust, Oxford, UK (Royal Pharmaceutical Society of Great Britain). 17. Imperial College Healthcare NHS Trust, London, UK.
Abstract
BACKGROUND: Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists. There is little published information on management and outcomes of perioperative anaphylaxis in the UK. METHODS: The 6th National Audit Project of the Royal College of Anaesthetists (NAP6) collected and reviewed 266 reports of Grade 3-5 anaphylaxis from all UK NHS hospitals over 1 yr. Quality of management was assessed against published guidelines. RESULTS: Appropriately senior anaesthetists resuscitated all patients. Immediate management was 'good' in 46% and 'poor' in 15%. Recognition and treatment of anaphylaxis were prompt in 97% and 83% of cases, respectively. Epinephrine was administered i.v. in 76%, i.m. in 14%, both in 6%, and not at all in 11% of cases. A catecholamine infusion was administered in half of cases. Cardiac arrests (40 cases; 15%) were promptly treated but cardiac compressions were omitted in half of patients with unrecordable BP. The surgical procedure was abandoned in most cases, including 10% where surgery was urgent. Of 54% admitted to critical care, 70% were level 3, with most requiring catecholamine infusions. Ten (3.8%) patents (mostly elderly with cardiovascular disease) died from anaphylaxis. Corticosteroids and antihistamines were generally administered early. We found no clear evidence of harm or benefit from chlorphenamine. Two patients received vasopressin and one glucagon. Fluid administration was inadequate in 19% of cases. Treatment included sugammadex in 19 cases, including one when rocuronium had not been administered. Adverse sequelae (psychological, cognitive, or physical) were reported in one-third of cases. CONCLUSIONS: Management of perioperative anaphylaxis could be improved, especially with respect to administration of epinephrine, cardiac compressions, and i.v. fluid. Sequelae were common.
BACKGROUND: Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists. There is little published information on management and outcomes of perioperative anaphylaxis in the UK. METHODS: The 6th National Audit Project of the Royal College of Anaesthetists (NAP6) collected and reviewed 266 reports of Grade 3-5 anaphylaxis from all UK NHS hospitals over 1 yr. Quality of management was assessed against published guidelines. RESULTS: Appropriately senior anaesthetists resuscitated all patients. Immediate management was 'good' in 46% and 'poor' in 15%. Recognition and treatment of anaphylaxis were prompt in 97% and 83% of cases, respectively. Epinephrine was administered i.v. in 76%, i.m. in 14%, both in 6%, and not at all in 11% of cases. A catecholamine infusion was administered in half of cases. Cardiac arrests (40 cases; 15%) were promptly treated but cardiac compressions were omitted in half of patients with unrecordable BP. The surgical procedure was abandoned in most cases, including 10% where surgery was urgent. Of 54% admitted to critical care, 70% were level 3, with most requiring catecholamine infusions. Ten (3.8%) patents (mostly elderly with cardiovascular disease) died from anaphylaxis. Corticosteroids and antihistamines were generally administered early. We found no clear evidence of harm or benefit from chlorphenamine. Two patients received vasopressin and one glucagon. Fluid administration was inadequate in 19% of cases. Treatment included sugammadex in 19 cases, including one when rocuronium had not been administered. Adverse sequelae (psychological, cognitive, or physical) were reported in one-third of cases. CONCLUSIONS: Management of perioperative anaphylaxis could be improved, especially with respect to administration of epinephrine, cardiac compressions, and i.v. fluid. Sequelae were common.
Authors: Hussam Al Hussein; Hamida Al Hussein; Carmen Sircuta; Ovidiu S Cotoi; Ionela Movileanu; Dan Nistor; Bogdan Cordos; Radu Deac; Horatiu Suciu; Klara Brinzaniuc; Dan T Simionescu; Marius M Harpa Journal: Tissue Eng Regen Med Date: 2020-08-29 Impact factor: 4.169
Authors: Carsten Lott; Anatolij Truhlář; Anette Alfonzo; Alessandro Barelli; Violeta González-Salvado; Jochen Hinkelbein; Jerry P Nolan; Peter Paal; Gavin D Perkins; Karl-Christian Thies; Joyce Yeung; David A Zideman; Jasmeet Soar Journal: Notf Rett Med Date: 2021-06-10 Impact factor: 0.826