2018
DOI: 10.1016/j.bja.2018.04.015
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Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)

Abstract: Management of perioperative anaphylaxis could be improved, especially with respect to administration of epinephrine, cardiac compressions, and i.v. fluid. Sequelae were common.

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Cited by 115 publications
(152 citation statements)
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“…The 6th National Audit Project (NAP6) of the Royal College of Anaesthetists addressed this issue by using a large multidisciplinary panel to assess each potential case of anaphylaxis. 29,45,46 Although we have not formally assessed interrater variability for application of the clinical scoring system, our validity exercise demonstrated the variability of an opinion-based assessment of some relatively straightforward clinical scenarios. We had anticipated that this variability would be greatest when comparing anaesthetists and nonanaesthetists.…”
Section: Discussionmentioning
confidence: 96%
See 1 more Smart Citation
“…The 6th National Audit Project (NAP6) of the Royal College of Anaesthetists addressed this issue by using a large multidisciplinary panel to assess each potential case of anaphylaxis. 29,45,46 Although we have not formally assessed interrater variability for application of the clinical scoring system, our validity exercise demonstrated the variability of an opinion-based assessment of some relatively straightforward clinical scenarios. We had anticipated that this variability would be greatest when comparing anaesthetists and nonanaesthetists.…”
Section: Discussionmentioning
confidence: 96%
“…29,46 A further potential limitation is that we do not expect the clinical scoring system to be reliable when relevant clinical information is missing, emphasising the necessity to include copies of all perioperative records when referring a patient with a suspected IHR for investigation. 7,8,45 When applying the clinical scoring system to evaluate the sensitivity of mast cell tryptase changes or skin test results, the score makes no presumption about the mechanism of the suspected IHR. This means that one can evaluate a test for its sensitivity to detect an IHR but not IHRs with a defined mechanism (allergic or non-allergic).…”
Section: Limitationsmentioning
confidence: 99%
“…This decision has to be evaluated on a case-by-case basis taking into consideration the urgency of surgery, severity of reaction, response to treatment, and underlying comorbidities. 1,11,15 In a recent study, no difference in major hypersensitivity-related complications was found for cases with Grade III reactions, whether surgery had been abandoned or continued, once resuscitation had been achieved. Surgery was frequently postponed in Grade IV reactions, which were associated with a high rate of complications.…”
Section: Extracorporeal Life Supportmentioning
confidence: 98%
“…Glucagon is usually recommended in patients regularly taking b-blocker medications. 1,10,11,15,18 Its use was reported two to three decades ago, in two uninvestigated cases of iodinated contrast-induced anaphylaxis. In one case, fluid replacement was lacking and in the second, high doses of adrenaline may have contributed to refractory hypotension, leading to the need for an intra-aortic balloon pump.…”
Section: Refractory Anaphylactic Hypotensionmentioning
confidence: 99%
“…This is especially important as clinical reviews have suggested that there may be concerns with the intraoperative treatment of true anaphylactic reactions including delayed administration of epinephrine. 92,93 In general, one of the major advantages of sugammadex over neostigmine and other acetylcholinesterase inhibitors is that reversal of neuromuscular blockade is more complete with no residual weakness. With the use of any agent to reverse neuromuscular blockade, a phenomenon known as "recurarization" may be of concern.…”
Section: Miscellaneous Applicationsmentioning
confidence: 99%