Imperial College London
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Dr Harriet Kemp

Faculty of Medicine, Department of Surgery & Cancer

Clinical Lecturer
 
 
 
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Contact

 

h.kemp

 
 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Harper:2018:10.1016/j.bja.2018.04.015,
author = {Harper, NJN and Cook, TM and Garcez, T and Lucas, DN and Thomas, M and Kemp, H and Kong, K-L and Marinho, S and Karanam, S and Ferguson, K and Hitchman, J and Torevell, H and Warner, A and Egner, W and Nasser, S and McGuire, N and Bellamy, M and Floss, K and Farmer, L and Farooque, S},
doi = {10.1016/j.bja.2018.04.015},
journal = {British Journal of Anaesthesia},
pages = {172--188},
title = {Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)},
url = {http://dx.doi.org/10.1016/j.bja.2018.04.015},
volume = {121},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - 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.
AU  - Harper,NJN
AU  - Cook,TM
AU  - Garcez,T
AU  - Lucas,DN
AU  - Thomas,M
AU  - Kemp,H
AU  - Kong,K-L
AU  - Marinho,S
AU  - Karanam,S
AU  - Ferguson,K
AU  - Hitchman,J
AU  - Torevell,H
AU  - Warner,A
AU  - Egner,W
AU  - Nasser,S
AU  - McGuire,N
AU  - Bellamy,M
AU  - Floss,K
AU  - Farmer,L
AU  - Farooque,S
DO  - 10.1016/j.bja.2018.04.015
EP  - 188
PY  - 2018///
SN  - 1471-6771
SP  - 172
TI  - Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)
T2  - British Journal of Anaesthesia
UR  - http://dx.doi.org/10.1016/j.bja.2018.04.015
UR  - https://www.ncbi.nlm.nih.gov/pubmed/29935569
UR  - http://hdl.handle.net/10044/1/61035
VL  - 121
ER  -
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