CardiovascularAnaesthetists Receive New Guidance On Managing Potentially Fatal Anaphylactic Reactions During Surgery
Anaesthetists in the UK and Ireland have been issued with new guidelines on how to
prevent and handle emergencies involving the small, but growing, number of people who
have a severe and potentially fatal allergic reaction during anaesthesia.
"Although anaesthetic anaphylaxis is still relatively rare, we have noticed a rise in the
number of patients being referred to specialist allergy clinics after an adverse reaction
during surgery" says Dr Nigel Harper, one of the country"s leading experts on anaesthesia
and anaphylaxis and Chair of the working party set up by the Association of Anaesthetists
of Great Britain and Ireland (AAGBI). "We believe that this may be due to more patients
having a severe reaction to antibiotics"
"All anaesthetists are trained to deal with anaphylaxis, which can trigger dangerously low
blood pressure and may cause severe breathing problems, but most anaesthetists will only
see a small number of cases during their career. That is why it is so important to keep
them up-to-date with the latest information on diagnosis and treatment and provide
emergency guidance for use in operating theatres."
Studies from France and Australia indicate that the incidence of life-threatening
anaphylaxis during anaesthesia is between one in 10,000 to 20,000 patients. This
suggests that there could be approximately 500 severe reactions in the UK each year and
that they are more common when drugs are administered intravenously.
However, when the working party looked at the UK figures, they found that only 361
reactions had been reported to the UK Medicines Control Agency over six years and ten
per cent of these were fatal. This compared with 789 incidents in France over a two-year
period, which has a comparable population and a well-established culture of reporting
anaesthesia-related reactions.
"It is important to interpret the UK data with caution because it is likely that less-severe
reactions are not reported and the true number could be much higher" stresses Dr Harper.
"The situation in the UK is similar to other countries, where the true incidence of death and
illness relating from such incidents remains poorly defined and the accuracy and
completeness of reporting is not as good as it could be."
Commenting on the launch of the new patient safety guidelines - "Suspected Anaphylactic
Reactions Associated with Anaesthesia" - Dr Harper suggests that having operations
under local anaesthesia rather than general anaesthesia may reduce the risk of some
patients having an allergy-related reaction.
"It is estimated that approximately 60 per cent of adverse reactions are associated with
muscle relaxant drugs, which are only administered when a patient is under a general
anaesthetic" he explains.
A research review carried out by the AAGBI working group also found that:
- Reactions to neuromuscular blocking agents and the latex gloves worn by surgical staff
are more common in female patients.
- Antibiotic anaphylaxis is more common in smokers, possibly because of increased
exposure to repeated courses of antibiotics for respiratory tract infections.
- Patients with a history of allergic skin diseases, asthma and food allergies appear to
face a greater risk from latex, but not from neuromuscular drugs or antibiotics.
- Individuals who have asthma or take beta-blocking drugs may suffer a more severe
reaction.
- People who suffer allergies to common environmental chemicals in toothpastes,
washing detergents, shampoos and cough medicine may be more sensitive to
neuromuscular blocking agents.
- Reactions to local anaesthetics are very uncommon.
"Patients who have concerns about a possible allergy to anaesthesia should talk to the
anaesthetist before they undergo their procedure" says Dr Harper. "And any patients who
are affected should be investigated by specialist allergy clinics."
The AAGBI states that it is widely recognised that more specialist allergy services need to
be made available so that patients don"t have to travel long distances or face delays,
especially when they are waiting for surgery. The expansion of these services will need
extra Department of Health funding.
The detailed guidelines - which are available on http://www.aagbi.org- are being supported by
an A4 laminate, which is designed to be kept in operating theatres so it can be readily
available in an emergency. This covers initial management and drug advice, secondary
management, investigation and later investigations to discover what caused the reaction.
There is also a YouTube video, in which Dr Harper is interviewed by Dr William Harrop-
Griffiths of the AAGBI. This can be accessed by putting AAGBI Anaphylaxis into the
YouTube search box.
-- Anaesthetists are specialist doctors involved in the care of two-thirds of all hospital patients.
Their expertise extends beyond the main operating theatre to acute and chronic pain
management, leading resuscitation teams, managing Intensive Care Units, working in maternity
units, accident and emergency departments and radiology, the care of some dental patients and
the transfer of critically ill patients.
Association of Anaesthetists of Great Britain and Ireland