Epidemiology of suspected life-threatening perioperative anaphylaxis: a cross-sectional multicentre study in China

Management of Suspected Life-Threatening Perioperative Anaphylaxis and Risk Factors for Near-Fatal and Fatal Outcomes: A Retrospective Study in China

“…The clinical suspicion of anaphylaxis was based on a series of suggestive symptoms and the correlation of their onset with potential triggers. In our preceding study, 3 hypotension and tachycardia were the most common presenting signs (n=424; 94.9%), while respiratory symptoms manifested in 155 (34.7%) patients and skin symptoms manifested in 306 (68.4%) cases. The time between the recognition of a critical clinical symptom and the initial management for suspected anaphylaxis was within 5 min in 402 (89.9%) cases and within 15 min in 443 (99.1%) cases ( Figure 1 ).…”

“… 2 According to an epidemiological study, the incidence rate of life-threatening POA in China was 1 in 11,360 which varied significantly by region. 3 The mortality rate of severe POA was 2%. 3 Many anesthesiologists lack experience in diagnosing and managing life-threatening POA because of the low incidence of severe POA.…”

“… 3 The mortality rate of severe POA was 2%. 3 Many anesthesiologists lack experience in diagnosing and managing life-threatening POA because of the low incidence of severe POA. The National Audit Project (NAP6) study in the UK investigated the management and outcomes of life-threatening POA, leading to an increased focus on this subject.…”

Anaphylaxis mortality in the perioperative setting: Epidemiology, elicitors, risk factors and knowledge gaps

“…The mortality incidence of PA has decreased over the years (Table 1). The incidence of PA mortality is estimated between 3.2 and 5 cases per million procedures in the United Kingdom and the United States, respectively 4–13 . The PA mortality rate is higher than in anaphylaxis due to other triggers 14 (Figure 1).…”

“…Increased age (>65 years), high American Society of Anesthesiologists (ASA) physical status, morbid obesity, coronary artery disease and treatment with beta‐blockers and/or angiotensin‐converting enzyme inhibitors have been identified as risk factors for fatal reactions in the NAP6 project 4,33 . Similarly, in China, the prevalence of coronary artery disease was greater in the patients who died; two of nine (22%) deaths compared with the remaining 438 patients (3.2%; p = .03) had a history of coronary artery disease 11 . In another survey from China, the main characteristics of 32 patients with fatal and near‐fatal suspected PA have been compared to 415 patients with non‐fatal and non‐near‐fatal PA, 34 and the multivariable analysis demonstrated that age ≥65 years (odds ratio [OR] 7.48; 95% confidence interval [CI]: 1.33–41.87, p = .022), ASA physical status IV (OR 17.68; 95% CI: 4.53–68.94; p < .001) and hypotension duration ≥15 min (OR 3.63; 95% CI: 1.11–11.87; p = .033) were risk factors for fatal and near‐fatal outcomes.…”