Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)

被引：113

作者：

Harper, N. J. N. ^{[1
,2
,3
]}

Cook, T. M. ^{[4
,5
,6
]}

Garcez, T. ^{[7
]}

Lucas, D. N. ^{[8
]}

Thomas, M. ^{[9
]}

Kemp, H. ^{[10
]}

Kong, K. -L. ^{[11
]}

Marinho, S. ^{[12
]}

Karanam, S. ^{[11
]}

Ferguson, K. ^{[13
]}

Hitchman, J. ^{[3
]}

Torevell, H.

Warner, A. ^{[14
]}

Egner, W. ^{[15
,16
]}

Nasser, S. ^{[17
]}

McGuire, N. ^{[18
]}

Bellamy, M. ^{[19
,20
]}

Floss, K. ^{[21
]}

Farmer, L. ^{[3
]}

Farooque, S. ^{[22
]}

机构：

[1] Manchester Univ NHS Fdn Trust, Manchester, Lancs, England

[2] Univ Manchester, Manchester Acad Heath Sci Ctr, Manchester, Lancs, England

[3] Royal Coll Anaesthetists, London, England

[4] Royal United Hosp, Bath, Avon, England

[5] Univ Bristol, Sch Med, Bristol, Avon, England

[6] Royal Coll Anaesthetists, Hlth Serv Res Ctr, London, England

[7] Manchester Univ NHS Fdn Trust, United Kingdom Fatal Anaphylaxis Register, Manchester, Lancs, England

[8] Northwick Pk Hosp & Clin Res Ctr, Obstet Anaesthetists Assoc, Harrow, Middx, England

[9] Great Ormond St Hosp Sick Children, Assoc Paediat Anaesthetists Great Britain & Irela, London, England

[10] Imperial Coll London, Res & Audit Federat Trainees, London, England

[11] Sandwell & West Birmingham NHS Trust, Birmingham, W Midlands, England

[12] Manchester Univ NHS Fdn Trust, British Soc Allergy & Clin Immunol, Manchester, Lancs, England

[13] Aberdeen Royal Infirm, Aberdeen, Scotland

[14] Allergy UK, Assoc Anaesthetists Great Britain & Ireland, London, England

[15] Sheffield Teaching Hosp NHS Trust, Rotyal Coll Phys, Royal Coll Pathologists Joint Comm Immunol & Alle, Sheffield, S Yorkshire, England

[16] Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Sheffield, S Yorkshire, England

[17] Cambridge Univ Hosp NHS Fdn Trust, British Soc Allergy & Clin Immunol, Cambridge, England

[18] Med & Healthcare Prod Regulatory Agcy, London, England

[19] Leeds Teaching Hosp NHS Trust, Fac Intens Care Med, Leeds, W Yorkshire, England

[20] Univ Leeds, Leeds, W Yorkshire, England

[21] Oxford Univ Hosp NHS Trust, Royal Pharmaceut Soc Great Britain, Oxford, England

[22] Imperial Coll Healthcare NHS Trust, London, England

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2018年 / 121卷 / 01期

关键词：

allergy; anaesthesia; anaphylaxis; outcome; perioperative; INDUCED ANAPHYLACTIC SHOCK; PERIOPERATIVE ANAPHYLAXIS; ROYAL-COLLEGE; GUIDELINES; SUGAMMADEX; UK; VASOPRESSIN; EPINEPHRINE; RESUSCITATION; HYPOTENSION;

D O I：

10.1016/j.bja.2018.04.015

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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 3e5 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.

引用

页码：172 / 188

页数：17

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