Manchester University NHS Foundation Trust, Manchester, UK (British Society for Clinical Allergy and Immunology).
Imperial College London, UK (Research and Audit Federation of Trainees).
Br J Anaesth. 2018 Jul;121(1):146-158. doi: 10.1016/j.bja.2018.04.016. Epub 2018 May 21.
Details of the current UK drug and allergen exposure were needed for interpretation of reports of perioperative anaphylaxis to the 6th National Audit Project (NAP6).
We performed a cross-sectional survey of 356 NHS hospitals determining anaesthetic drug usage in October 2016. All cases cared for by an anaesthetist were included.
Responses were received from 342 (96%) hospitals. Within-hospital return rates were 96%. We collected 15 942 forms, equating to an annual caseload of 3.1 million, including 2.4 million general anaesthetics. Propofol was used in 74% of all cases and 90% of general anaesthetics. Maintenance included a volatile agent in 95% and propofol in 8.7%. Neuromuscular blocking agents were used in 47% of general anaesthetics. Analgesics were used in 88% of cases: opioids, 82%; paracetamol, 56%; and non-steroidal anti-inflammatory drugs, 28%. Antibiotics were administered in 57% of cases, including 2.5 million annual perioperative administrations; gentamicin, co-amoxiclav, and cefuroxime were most commonly used. Local anaesthetics were used in 74% cases and 70% of general anaesthetics. Anti-emetics were used in 73% of cases: during general anaesthesia, ondansetron in 78% and dexamethasone in 60%. Blood products were used in ≈3% of cases, gelatin <2%, starch very rarely, and tranexamic acid in ≈6%. Chlorhexidine and povidone-iodine exposures were 74% and 40% of cases, and 21% reported a latex-free environment. Exposures to bone cement, blue dyes, and radiographic contrast dye were each reported in 2-3% of cases.
This survey provides insights into allergen exposures in perioperative care, which is important as denominator data for the NAP6 registry.
为了解释第六届国家审计项目（NAP6）中报告的围手术期过敏反应，需要了解英国当前的药物和过敏原暴露情况。
我们对 356 家 NHS 医院进行了横断面调查，以确定 2016 年 10 月的麻醉药物使用情况。所有由麻醉师治疗的病例均包括在内。
收到了 342 家（96%）医院的回复。院内回收率为 96%。我们共收集了 15942 份表格，相当于每年 310 万例的工作量，其中包括 240 万例全身麻醉。所有病例中 74%使用丙泊酚，90%的全身麻醉使用丙泊酚。维持治疗中 95%使用挥发性药物，8.7%使用丙泊酚。全身麻醉中 47%使用神经肌肉阻滞剂。88%的病例使用了镇痛药：阿片类药物 82%；对乙酰氨基酚 56%；非甾体抗炎药 28%。57%的病例使用了抗生素，包括每年 250 万例围手术期用药；庆大霉素、复方阿莫西林和头孢呋辛最常用。74%的病例和 70%的全身麻醉中使用了局部麻醉剂。73%的病例使用了止吐药：全身麻醉时，昂丹司琼 78%，地塞米松 60%。约 3%的病例使用了血液制品，不到 2%的病例使用了明胶，很少使用淀粉，约 6%的病例使用了氨甲环酸。氯己定和聚维酮碘的暴露率分别为 74%和 40%，21%的医院报告了无乳胶环境。骨水泥、蓝色染料和放射性对比染料的暴露率分别为 2-3%。
这项调查提供了围手术期护理中过敏原暴露的见解，这对于 NAP6 登记处的分母数据非常重要。
