Royal United Hospital, Bath, UK; University of Bristol School of Medicine, Bristol, UK; Health Services Research Centre, Royal College of Anaesthetists, London, UK.
Health Services Research Centre, Royal College of Anaesthetists, London, UK; Manchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK.
Br J Anaesth. 2018 Jul;121(1):124-133. doi: 10.1016/j.bja.2018.04.001. Epub 2018 May 21.
Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists.
The Sixth National Audit Project (NAP6) of the Royal College of Anaesthetists examined the incidence, predisposing factors, management, and impact of life-threatening perioperative anaphylaxis in the UK. NAP6 included: a national survey of anaesthetists' experiences and perceptions; a national survey of allergy clinics; a registry collecting detailed reports of all Grade 3-5 perioperative anaphylaxis cases for 1 yr; and a national survey of anaesthetic workload and perioperative allergen exposure. NHS and independent sector (IS) hospitals were approached to participate. Cases were reviewed by a multi-disciplinary expert panel (anaesthetists, intensivists, allergists, immunologists, patient representatives, and stakeholders) using a structured process designed to minimise bias. Clinical management and investigation were compared with published guidelines. This paper describes detailed study methods and reports on project engagement by NHS and IS hospitals. The methodology includes a new classification of perioperative anaphylaxis and a new structured method for classifying suspected anaphylactic events including the degree of certainty with which a causal trigger agent can be attributed.
NHS engagement was complete (100% of hospitals). Independent sector engagement was limited (13% of approached hospitals). We received >500 reports of Grade 3-5 perioperative anaphylaxis, with 266 suitable for analysis. We identified 199 definite or probable culprit agents in 192 cases.
The methods of NAP6 were robust in identifying causative agents of anaphylaxis, and support the accompanying analytical papers.
麻醉期间发生过敏反应是患者和麻醉师的严重并发症。
皇家麻醉师学院第六次国家审计项目（NAP6）调查了英国围手术期危及生命的过敏反应的发生率、易患因素、管理和影响。NAP6 包括：对麻醉师经验和看法的全国性调查；过敏诊所的全国性调查；一个收集所有 3-5 级围手术期过敏反应病例详细报告的登记处，为期 1 年；以及对麻醉工作量和围手术期过敏原暴露的全国性调查。NH S 和独立部门（IS）医院被邀请参与。通过使用旨在最小化偏倚的结构化流程，由多学科专家小组（麻醉师、重症监护医师、过敏专家、免疫学家、患者代表和利益相关者）对病例进行审查。临床管理和调查与已发布的指南进行了比较。本文描述了详细的研究方法，并报告了 NH S 和 IS 医院的项目参与情况。该方法包括围手术期过敏反应的新分类和一种新的结构化方法，用于对疑似过敏反应事件进行分类，包括可以归因于因果触发因素的确定性程度。
NH S 的参与是完整的（100%的医院）。独立部门的参与是有限的（13%的医院）。我们收到了超过 500 份 3-5 级围手术期过敏反应的报告，其中 266 份适合分析。我们在 192 例病例中确定了 199 种确定或可能的罪魁祸首药物。
NAP6 的方法在识别过敏反应的致病剂方面是稳健的，并支持伴随的分析论文。
