Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK.
Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK; Department of Anaesthesia and Critical Care, University of Queensland Critical Care Research Group and The Prince Charles Hospital, Brisbane, Australia; Department of Anesthesiology and Intensive Care, Philipps University, Marburg, Germany; Advanced Cardiac and Critical Care, Nazih Zuhdi Transplant Institute, Integris Health, Oklahoma City, USA.
Ann Card Anaesth. 2022 Jul-Sep;25(3):323-329. doi: 10.4103/aca.aca_170_21.
Anaphylaxis is a rare but serious and potentially fatal complication of anesthesia. Little is known about the incidence and outcome of anaphylaxis in cardiac surgical patients, which we aimed to investigate.
This was a 21-year retrospective study of cardiac surgical patients at Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK.
A total of 19 cases of anaphylaxis were reported among 17,589 patients (0.108%) undergoing cardiac surgery. The majority (15/19) occurred before cardiopulmonary bypass (CPB), mostly during or within 30 min after the induction of anesthesia (10/19). Two occurred within 15 min of going onto CPB. Of these 17 cases, 11 were abandoned, and 6 proceeded. The severity of reactions in the patients who proceeded ranged from grade II to grade IV of the Ring and Messmer classification. Two cases occurred after the completion of surgery. All patients survived to 90 days. However, this did not appear to be related to CPB or protamine as most of the reactions occurred before CPB. Instead, the most common causative agents were gelofusine, antibiotics, muscle relaxants, and chlorhexidine. In 6 cases, surgery proceeded despite the anaphylaxis, in 11 cases the surgery was postponed, and in 2 cases the procedure had already been completed.
As all patients survived, our results provide preliminary support for proceeding with surgery although we cannot speculate on the likely outcomes of patients who were postponed, had their surgery proceeded. Based on our data, the incidence of anaphylaxis in cardiac surgical patients may be 10-20 times higher than in the general surgical population.
过敏反应是麻醉的一种罕见但严重且潜在致命的并发症。关于心脏手术患者过敏反应的发生率和结局知之甚少，我们旨在对此进行研究。
这是对英国曼彻斯特皇家医院、曼彻斯特基金会信托基金会的心脏手术患者进行的一项 21 年回顾性研究。
在接受心脏手术的 17589 名患者中，报告了 19 例过敏反应（0.108%）。大多数（15/19）发生在体外循环（CPB）之前，主要发生在麻醉诱导期间或之后 30 分钟内（10/19）。有 2 例发生在 CPB 开始后 15 分钟内。在这 17 例中，有 11 例被放弃，6 例继续进行。继续进行的患者的反应严重程度从 Ring 和 Messmer 分类的 II 级到 IV 级不等。有 2 例发生在手术完成后。所有患者均存活至 90 天。然而，这似乎与 CPB 或鱼精蛋白无关，因为大多数反应发生在 CPB 之前。相反，最常见的致病药物是凝胶氟脲素、抗生素、肌肉松弛剂和洗必泰。在 6 例中，尽管发生了过敏反应仍继续进行手术，在 11 例中推迟了手术，在 2 例中已经完成了手术。
由于所有患者均存活，我们的结果初步支持尽管我们无法推测推迟手术、继续进行手术的患者的可能结局，但仍应继续进行手术。根据我们的数据，心脏手术患者过敏反应的发生率可能是普通外科人群的 10-20 倍。
