Pain Research Group, Department of Surgery & Cancer, Imperial College London, Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10?9NH, UK.
Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1?3NG, UK.
Br J Anaesth. 2017 Jul 1;119(1):132-139. doi: 10.1093/bja/aex124.
There is limited information on UK anaesthetists' perspectives and experiences of perioperative anaphylaxis. This baseline survey of the Sixth National Audit Project (NAP6) aimed to identify relevant departmental preparedness and practices, and individual experiences, perceptions and drug-avoidance patterns.
All anaesthetists in 356 UK NHS hospitals were invited to complete an electronic survey.
11 104 anaesthetists (77% crude response rate) from 341 (96%) hospitals responded. Most had immediate access to guidelines for anaphylaxis treatment (87%) and established referral pathways for investigation (82%), but a minority reported access to designated treatment packs (37%) or an anaphylaxis lead (35%). Anaesthetists reported 1734 cases of suspected perioperative anaphylaxis in 2014-5 of which 81% were referred for specialist investigation and 14% reported to the Medicines and Healthcare Products Regulatory Agency (MHRA). In their career, 76% of respondents had seen a case of perioperative anaphylaxis (1:7.25 years of practice) and 4% reported a death (1:311 years of practice), equivalent to 2.3% of events being fatal. Agents most frequently perceived to cause anaphylaxis were antibiotics, particularly penicillins, and neuromuscular blocking agents, notably rocuronium. Suxamethonium and penicillins were avoided by a higher proportion of respondents than events attributed to these drugs whereas the converse was true for atracurium and teicoplanin.
This is the largest ever survey of anaesthetists' practices and experiences relating to perioperative anaphylaxis. It identifies gaps in preparedness and referral for further investigation and to the UK MHRA. It provides important data about drugs implicated in such events and anaesthetists' attitudes to anaphylaxis.
英国麻醉师对围手术期过敏反应的看法和经验有限。第六次国家审计项目（NAP6）的这项基线调查旨在确定相关部门的准备情况和实践情况，以及个人的经验、看法和药物回避模式。
邀请英国 356 家 NHS 医院的所有麻醉师完成电子调查。
来自 341 家（96%）医院的 11104 名麻醉师（77%的粗应答率）做出了回应。大多数麻醉师可立即获得过敏反应治疗指南（87%）和既定的调查转诊途径（82%），但只有少数人报告说可以获得指定的治疗包（37%）或过敏反应负责人（35%）。麻醉师报告称，2014-5 年期间有 1734 例疑似围手术期过敏反应病例，其中 81%被转介进行专科调查，14%报告给药品和保健品管理局（MHRA）。在他们的职业生涯中，76%的受访者曾见过围手术期过敏反应病例（每 7.25 年 1 例），4%报告了死亡病例（每 311 年 1 例），相当于 2.3%的事件是致命的。最常被认为会引起过敏反应的药物是抗生素，特别是青霉素，以及神经肌肉阻滞剂，特别是罗库溴铵。与归因于这些药物的事件相比，更多的受访者避免使用琥珀酰胆碱和青霉素，而相反的情况则适用于阿曲库铵和替考拉宁。
这是迄今为止对麻醉师与围手术期过敏反应相关实践和经验进行的最大规模调查。它确定了在进一步调查和向英国 MHRA 转介方面的准备和转诊方面的差距。它提供了有关此类事件中涉及的药物以及麻醉师对过敏反应的态度的重要数据。
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