TopMedTalk

Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)

N.J.N. Harper et al.

Anaphylaxis, a life threatening allergic reaction, is thankfully rare but a very serious complication in the perioperative period, around the time of surgery. The 6th National Audit Project of the Royal College of Anaesthetists (NAP6) collected and reviewed 266 reports of serious anaphylaxis from all UK NHS hospitals over 1 yr.

RESULTS?

The good news is senior anaesthetists resuscitated all patients.

The rest is a mixed bag; Immediate management was judged to be 'good' in 46% but 'poor' in 15%, recognition of anaphylaxis was prompt in 97% and treatment was prompt in 83% of cases.

Epinephrine (ADRENALINE) was administered i.v. in 76%, i.m. in 14%, both in 6%, and not at all in 11% of cases.

A catecholamine infusion was administered in half of cases.

Cardiac arrests (40 cases; 15%) were promptly treated but cardiac compressions were omitted in half of patients with unrecordable BP.

The surgical procedure was abandoned in most cases.

Very sadly, Ten (3.8%) patents died from anaphylaxis, mostly elderly with cardiovascular disease. Fluid administration was deemed inadequate in 19% of cases. Adverse sequelae, psychological, cognitive, or physical, were reported in one-third of cases.

THE BOTTOM LINE:

The authors suggest management of perioperative anaphylaxis could be improved, especially with respect to administration of epinephrine, cardiac compressions, and i.v. fluid.

https://bjanaesthesia.org/article/S0007-0912(18)30321-0/fulltext

The Xtreme Everest project has won numerous awards and received both local, national and international media coverage. Here we have a discussion with some of the key players about oxygen and the Xtreme Everest team's research studies into human adaptation to hypoxia. How can the human body adapt to extreme conditions, we assume it will inevitably cause damage but this is not always the case. How do people who have inherited a tolerance for low levels of oxygen manage?

Professor Monty Mythen, Joff Lacey and Mike Grocott, head of The Xtreme Everest Oxygen Research Consortium; are joined by Dr Dan Martin OBE an anaesthetist and critical care doctor from The Royal Free Hospital in London, a consultant in Intensive Care and an Everest summiteer.

The documentary mentioned in this piece is here: https://www.youtube.com/watch?v=ecCJ8sMVeiU

This taken from a longer piece here: http://www.topmedtalk.com/live-from-boston-asa-2017-life-at-the-extremes-trials-on-everest-adapting-to-hypoxia/

And the Xtreme Everest website is here: http://www.xtreme-everest.co.uk/

The Xtreme Everest project has won numerous awards and received both local, national and international media coverage. Here we have a discussion with some of the key players about oxygen and the Xtreme Everest team's research studies into human adaptation to hypoxia. How can the human body adapt to extreme conditions, we assume it will inevitably cause damage but this is not always the case. How do people who have inherited a tolerance for low levels of oxygen manage?

Professor Monty Mythen, Joff Lacey and Mike Grocott, head of The Xtreme Everest Oxygen Research Consortium; are joined by Dr Dan Martin OBE an anaesthetist and critical care doctor from The Royal Free Hospital in London, a consultant in Intensive Care and an Everest summiteer.

The documentary mentioned in this piece is here: https://www.youtube.com/watch?v=ecCJ8sMVeiU

This taken from a longer piece here: http://www.topmedtalk.com/live-from-boston-asa-2017-life-at-the-extremes-trials-on-everest-adapting-to-hypoxia/

And the Xtreme Everest website is here: http://www.xtreme-everest.co.uk/

Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6)

N.J.N. Harper et al.

Anaphylaxis, a life threatening allergic reaction, is thankfully rare but a very serious complication in the perioperative period, around the time of surgery.

The 6th National Audit Project of the Royal College of Anaesthetists (NAP6) collected and reviewed 266 reports of serious anaphylaxis from all UK NHS hospitals over 1 yr.

RESULTS?

The good news is senior anaesthetists resuscitated all patients.

The rest is a mixed bag; Immediate management was judged to be ‘good’ in 46% but ‘poor’ in 15%, recognition of anaphylaxis was prompt in 97% and treatment was prompt in 83% of cases.

Epinephrine (ADRENALINE) was administered i.v. in 76%, i.m. in 14%, both in 6%, and not at all in 11% of cases.

A catecholamine infusion was administered in half of cases.

Cardiac arrests (40 cases; 15%) were promptly treated but cardiac compressions were omitted in half of patients with unrecordable BP.

The surgical procedure was abandoned in most cases.

Very sadly, Ten (3.8%) patents died from anaphylaxis, mostly elderly with cardiovascular disease. Fluid administration was deemed inadequate in 19% of cases. Adverse sequelae, psychological, cognitive, or physical, were reported in one-third of cases.

THE BOTTOM LINE:

The authors suggest management of perioperative anaphylaxis could be improved, especially with respect to administration of epinephrine, cardiac compressions, and i.v. fluid.

https://bjanaesthesia.org/article/S0007-0912(18)30321-0/fulltext

ASER 2017 and the POET acronym - a truly multidisciplinary Perioperative Enhancement Team; responsible for project managing optimisation programmes.

Monty Mythen speaks with Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

This piece is taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/

Join the debate: [email protected]

Also - why not put a bit of poetry into your practice - check out the POETTS CPET (Course Cardiopulmonary Exercise Testing For Pre-operative Assessment Course) here: https://ebpom.org/18th-POETTS-CPET-Course

ASER 2017 and the POET acronym - a truly multidisciplinary Perioperative Enhancement Team; responsible for project managing optimisation programmes.

Monty Mythen speaks with Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

This piece is taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/

Join the debate: [email protected]

Also - why not put a bit of poetry into your practice - check out the POETTS CPET (Course Cardiopulmonary Exercise Testing For Pre-operative Assessment Course) here: https://ebpom.org/18th-POETTS-CPET-Course

A discussion about the importance of screening and risk mitigation regarding cognitive dysfunction and delirium in the perioperative period, with particular focus on elderly patients.

Monty Mythen and Mike Grocott are joined by their guests Dr Liam Brennan, President of the Royal College of Anaesthetists, and Dr Fay Gilder, Addenbrooke's, Cambridge.

This piece taken from a longer piece to be found here: http://www.topmedtalk.com/live-from-boston-asa-2017-perioperative-delirium-2/

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Want to hear more of this sort of discussion? Listen out for Dr Jugdeep Dehsi, and other experts, live from 'Anaesthesia 2018' the Royal College of Anaesthetists annual meeting at the British Museum (May 22nd - 23rd) with the TopMedTalk team.

Subscribe FREE at www.TopMedTalk.com

A discussion about the importance of screening and risk mitigation regarding cognitive dysfunction and delirium in the perioperative period, with particular focus on elderly patients.

Monty Mythen and Mike Grocott are joined by their guests Dr Liam Brennan, President of the Royal College of Anaesthetists, and Dr Fay Gilder, Addenbrooke’s, Cambridge.

This piece taken from a longer piece to be found here: http://www.topmedtalk.com/live-from-boston-asa-2017-perioperative-delirium-2/

-

Want to hear more of this sort of discussion? Listen out for Dr Jugdeep Dehsi, and other experts, live from ‘Anaesthesia 2018’ the Royal College of Anaesthetists annual meeting at the British Museum (May 22nd - 23rd) with the TopMedTalk team.

Subscribe FREE at www.TopMedTalk.com

Dr Ramani Moonesinghe on Standardised Outcomes from Major Surgery.

Dr Joff Lacey and Professor Monty Mythen talk to Dr Ramani Moonesinghe, Director of the Heath Services Research Centre at the Royal College of Anaesthetists and a lead author of the Perioperative Quality Initiative (POQI http://www.poqi.org) guidelines on outcomes from surgery.

Simple objective measures such as Drinking, Eating and Mobilising, Sleep (DrEaMS).

For further reading see this article in Perioperative Medicine: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0062-7

Attend our next meeting: http://www.ebpom.org/EBPOM-USA

This piece is taken from a longer conversation here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/

Dr Ramani Moonesinghe on Standardised Outcomes from Major Surgery.

Dr Joff Lacey and Professor Monty Mythen talk to Dr Ramani Moonesinghe, Director of the Heath Services Research Centre at the Royal College of Anaesthetists and a lead author of the Perioperative Quality Initiative (POQI http://www.poqi.org) guidelines on outcomes from surgery.

Simple objective measures such as Drinking, Eating and Mobilising, Sleep (DrEaMS).

For further reading see this article in Perioperative Medicine:
https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0062-7

Attend our next meeting: http://www.ebpom.org/EBPOM-USA

This piece is taken from a longer conversation here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/