Manchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK; Royal College of Anaesthetists, London, UK.
Royal United Hospital, Bath, UK; University of Bristol School of Medicine, Bristol, UK; Health Services Research Centre, Royal College of Anaesthetists, London, UK.
Br J Anaesth. 2018 Jul;121(1):159-171. doi: 10.1016/j.bja.2018.04.014. Epub 2018 May 21.
Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists.
The 6th National Audit Project (NAP6) on perioperative anaphylaxis collected and reviewed 266 reports of Grades 3-5 anaphylaxis over 1 yr from all NHS hospitals in the UK.
The estimated incidence was ≈1:10 000 anaesthetics. Case exclusion because of reporting delays or incomplete data means true incidence might be ≈70% higher. The distribution of 199 identified culprit agents included antibiotics (94), neuromuscular blocking agents (65), chlorhexidine (18), and Patent Blue dye (9). Teicoplanin comprised 12% of antibiotic exposures, but caused 38% of antibiotic-induced anaphylaxis. Eighteen patients reacted to an antibiotic test dose. Succinylcholine-induced anaphylaxis, mainly presenting with bronchospasm, was two-fold more likely than other neuromuscular blocking agents. Atracurium-induced anaphylaxis mainly presented with hypotension. Non-depolarising neuromuscular blocking agents had similar incidences to each other. There were no reports of local anaesthetic or latex-induced anaphylaxis. The commonest presenting features were hypotension (46%), bronchospasm (18%), tachycardia (9.8%), oxygen desaturation (4.7%), bradycardia (3%), and reduced/absent capnography trace (2.3%). All patients were hypotensive during the episode. Onset was rapid for neuromuscular blocking agents and antibiotics, but delayed with chlorhexidine and Patent Blue dye. There were 10 deaths and 40 cardiac arrests. Pulseless electrical activity was the usual type of cardiac arrest, often with bradycardia. Poor outcomes were associated with increased ASA, obesity, beta blocker, and angiotensin-converting enzyme inhibitor medication. Seventy per cent of cases were reported to the hospital incident reporting system, and only 24% to Medicines and Healthcare products Regulatory Agency via the Yellow Card Scheme.
The overall incidence of perioperative anaphylaxis was estimated to be 1 in 10 000 anaesthetics.
麻醉期间的过敏反应是患者和麻醉师的严重并发症。
第六届全国围手术期过敏反应审计项目（NAP6）在英国所有国民保健制度医院收集并审查了 1 年中来自所有 NHS 医院的 266 份 3-5 级过敏反应报告。
估计发病率约为每 10000 次麻醉 1 次。由于报告延迟或数据不完整而排除病例意味着真实发病率可能约高 70%。199 种确定的罪魁祸首药物的分布包括抗生素（94 种）、神经肌肉阻滞剂（65 种）、洗必泰（18 种）和专利蓝染料（9 种）。替考拉宁占抗生素暴露的 12%，但引起了 38%的抗生素诱导的过敏反应。18 名患者对抗生素测试剂量有反应。琥珀酰胆碱引起的过敏反应，主要表现为支气管痉挛，比其他神经肌肉阻滞剂更常见两倍。阿曲库铵引起的过敏反应主要表现为低血压。非去极化神经肌肉阻滞剂的发生率彼此相似。没有局部麻醉剂或乳胶引起的过敏反应报告。最常见的表现是低血压（46%）、支气管痉挛（18%）、心动过速（9.8%）、氧饱和度下降（4.7%）、心动过缓（3%）和二氧化碳描记图痕迹减少/缺失（2.3%）。所有患者在发作期间均出现低血压。神经肌肉阻滞剂和抗生素的发作迅速，而洗必泰和专利蓝染料则延迟。有 10 人死亡，40 人心脏骤停。无脉性电活动是心脏骤停的常见类型，常伴有心动过缓。不良预后与增加的 ASA、肥胖、β受体阻滞剂和血管紧张素转换酶抑制剂药物有关。70%的病例报告给医院事件报告系统，只有 24%通过黄色卡片计划报告给药品和医疗保健产品监管局。
围手术期过敏反应的总发病率估计为每 10000 次麻醉 1 次。
