21 results found
Egner W, Cook TM, Garcez T, et al., 2018, Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) Investigation of Perioperative Anaphylaxis., Clin Exp Allergy
BACKGROUND: The Royal College of Anaesthetists 6th National Audit Project examined Grade 3-5 perioperative anaphylaxis for one year in the UK. OBJECTIVE: To describe the causes and investigation of anaphylaxis in the NAP6 cohort, in relation to published guidance and previous baseline survey results. METHODS: We used a secure registry to gather details of Grade 3-5 perioperative anaphylaxis. Anonymous reports were aggregated for analysis and reviewed in detail. Panel consensus diagnosis, reaction grade, review of investigations and clinic assessment are reported and compared to the prior NAP6 baseline clinic survey. RESULTS: 266 cases met inclusion criteria between November 2015 and 2016, detailing reactions and investigations. 192/266 (72%) had anaphylaxis with a trigger identified, of which 140/192(75%) met NAP6 criteria for IgE-mediated allergic anaphylaxis, 13% lacking evidence of positive IgE tests were labelled "non-allergic anaphylaxis". 3% were non-IgE mediated anaphylaxis. Adherence to guidance was similar to the baseline survey for waiting time for clinic assessment. However, lack of testing for chlorhexidine and latex, non-harmonised testing practices and poor coverage of all possible culprits was confirmed. Challenge testing may be under-used and many have unacceptably delayed assessments, even in urgent cases. Communication or information provision for patients was insufficient, especially for avoidance advice and communication of test results. Insufficient detail regarding skin test methods was available to draw conclusions regarding techniques. CONCLUSION & CLINICAL RELEVANCE: Current clinical assessment in the UK is effective but harmonisation of approach to testing, access to services and MHRA reporting is needed. Expert anaesthetist involvement should increase to optimise diagnostic yield and advice for future anaesthesia. Dynamic tryptase evaluation improves detection of tryptase release where peak tryptase is <14mcg/L and should
Kemp HI, Rice ASC, Adonis A, et al., 2018, Human T-lymphotrophic virus-a neglected cause of chronic pain?, Pain
Rice ASC, Finnerup NB, Kemp HI, et al., 2018, Sensory profiling in animal models of neuropathic pain: a call for back-translation., Pain, Vol: 159, Pages: 819-824
Salman MM, Kemp HI, Cauldwell MR, et al., 2018, Anaesthetic management of pregnant patients with cardiac implantable electronic devices: case reports and review, INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, Vol: 33, Pages: 57-66, ISSN: 0959-289X
Kemp H, Petropoulos IN, Rice ASC, 2017, Use of corneal confocal microscopy to evaluate small nerve fibers in patients with human immunodeficiency virus (vol 135, pg 795, 2017), JAMA OPHTHALMOLOGY, Vol: 135, Pages: 1006-1006, ISSN: 2168-6165
Kemp HI, Bantel C, Gordon F, et al., 2017, Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom, ANAESTHESIA, Vol: 72, Pages: 737-748, ISSN: 0003-2409
Kemp HI, Cook TM, Thomas M, et al., 2017, UK anaesthetists' perspectives and experiences of severe perioperative anaphylaxis: NAP6 baseline survey, BRITISH JOURNAL OF ANAESTHESIA, Vol: 119, Pages: 132-139, ISSN: 0007-0912
Kemp HI, Petropoulos IN, Rice ASC, et al., 2017, Use of Corneal Confocal Microscopy to Evaluate Small Nerve Fibers in Patients With Human Immunodeficiency Virus, JAMA OPHTHALMOLOGY, Vol: 135, Pages: 795-799, ISSN: 2168-6165
Kennedy DL, Kemp HI, Ridout D, et al., 2016, Reliability of conditioned pain modulation: a systematic review, PAIN, Vol: 157, Pages: 2410-2419, ISSN: 0304-3959
Rice A, Wordsworth H, Moyle G, et al., 2016, An interim report of a study investigating longitudinal changes in sensory profiles in HIV-positive patients with and without HIV-associated sensory neuropathy, Publisher: WILEY-BLACKWELL, Pages: 46-47, ISSN: 1464-2662
Tatham KC, Laycock H, Wordsworth H, 2016, Pain Assessment In Cardiothoracic Intensive Care Units: A Snapshot Audit Of Practice In London Intensive Care Units, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Whiten CAC, Kemp H, Coppel SARL, et al., 2016, OSCE Questions for the Primary FRCA, Publisher: Oxford University Press, USA, ISBN: 9780198753063
The 'Mock OSCE' chapter at the end of the book presents the reader with 10 OSCE style questions followed by all answers, ensuring the reader has, not only the knowledge to the pass the exam, but can practice the technique and approach ...
Wickham A, Highton D, Martin D, et al., 2016, Care of elderly patients: A prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London, Perioperative Medicine, Vol: 5
ï¿½ 2016 Wickham et al. Background: Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK. Methods: We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH. Results: Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures < 50, < 60, and < 70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients. Conclusions: IOH is common and use of DOA monitors is less than implied by guidelines. Improved management of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group.
Kemp H, Laycock HC, 2015, Pain in the intensive care unit, Key Topics in Management of the Critically Ill, Editors: Vizcaychipi, Corredor, Publisher: Springer, ISBN: 9783319223773
This book is designed to assist clinicians who are new to intensive care by providing information on a range of important and novel topics of relevance in the day-to-day management of critically ill patients.
Laycock H, Wordsworth H, Casely E, et al., 2015, Do value judgements of analgesic drugs alter between the expert and junior doctor?, Winter Scientific Meeting of the Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI), Publisher: WILEY-BLACKWELL, Pages: 38-38, ISSN: 0003-2409
Laycock H, Wordsworth H, Pan-London Peri-operative Research and Audit Network PLAN and South East Anaesthetic Research CHain SEARCH, 2015, Pain assessment in intensive care: who puts pen to paper?
Wordsworth H, Bellew B, Galton S, 2015, Familiarity of London trainees with regional anaesthesia: the development of a trainee-led ultrasound guided regional anaesthesia course, AAGBI GAT Annual Scientific Meeting, Publisher: WILEY-BLACKWELL, Pages: 100-100, ISSN: 0003-2409
Wordsworth H, Wickham A, Bellew B, et al., 2015, Attitudes towards safety of regional anaesthesia in trauma patients: a survey of surgeons and anaesthetists in a Major Trauma Centre and a Specialist Hand Unit, AAGBI GAT Annual Scientific Meeting, Publisher: WILEY-BLACKWELL, Pages: 100-100, ISSN: 0003-2409
Pandit JJ, Wordsworth H, Little E, et al., 2014, The Peripheral Actions of the Central Neuropeptide Somatostatin on Control of Breathing: Effect on Metabolic Rate and Chemoreflex Responses in Humans, CENTRAL NERVOUS SYSTEM CONTROL OF RESPIRATION, Vol: 209, Pages: 331-340, ISSN: 0079-6123
Wordsworth H, Laycock H, Yentis S, 2014, Costs incurred by anaesthetic trainees and students presenting posters at the 2014 AAGBI Winter Scientific Meeting, Annual Scientific Meeting of the Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI) GAT, Publisher: WILEY-BLACKWELL, Pages: 124-124, ISSN: 0003-2409
Wordsworth HI, Raja Y, Harrison S, 2011, Sugammadex and rocuronium-induced anaphylaxis, BRITISH JOURNAL OF ANAESTHESIA, Vol: 106, Pages: 911-912, ISSN: 0007-0912
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