Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)
| Autor: | L. Farmer, K. Ferguson, W. Egner, K. Floss, Nigel J.N. Harper, M. Bellamy, K.-L. Kong, N. McGuire, Tomaz Garcez, J. Hitchman, H. Torevell, S. Farooque, Tim Cook, Harriet I. Kemp, S. Karanam, D.N. Lucas, S. Marinho, A. Warner, M. Thomas, S. Nasser |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Allergy medicine.medical_specialty Epinephrine Heart Massage Disease Sugammadex Drug Hypersensitivity 03 medical and health sciences 0302 clinical medicine Anesthesiology 030202 anesthesiology anaphylaxis medicine Humans Vasoconstrictor Agents Anesthesia 030212 general & internal medicine perioperative Rocuronium Child Perioperative Period Medical Audit business.industry 1103 Clinical Sciences anaesthesia Perioperative allergy medicine.disease Cardiopulmonary Resuscitation United Kingdom Surgery Treatment Outcome Anesthesiology and Pain Medicine Surgical Procedures Operative outcome Fluid Therapy business Complication Anaphylaxis medicine.drug |
| Zdroj: | Harper, N J N, Cook, T M, Garcez, T, Lucas, D N, Thomas, M, Kemp, H, Kong, K L, Marinho, S, Karanam, S, Ferguson, K, Hitchman, J, Torevell, H, Warner, A, Egner, W, Nasser, S, McGuire, N, Bellamy, M, Floss, K, Farmer, L & Farooque, S 2018, ' Anaesthesia, surgery, and life-threatening allergic reactions : management and outcomes in the 6th National Audit Project (NAP6) ', British Journal of Anaesthesia, vol. 121, no. 1 . https://doi.org/10.1016/j.bja.2018.04.015 |
| ISSN: | 0007-0912 |
| DOI: | 10.1016/j.bja.2018.04.015 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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