The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: clinical signs, severity, and therapeutic agents

Sugiyama, Yuki; Takazawa, Tomonori; Watanabe, Nozomi; Bito, Kiyoko; Fujiyoshi, Tetsushiro; Hamaguchi, Shinsuke; Haraguchi, Takashi; Horiuchi, Tatsuo; Kamiya, Yuichi; Maruyama, Noboru; Masumo, Hitoshi; Nakazawa, Harumasa; Nagumo, Kazuhiro; Orihara, Masaki; Sato, Jun; Sekimoto, Kenichi; Takahashi, Kenichiro; Uchiyama, Mutsumi; Takahashi, Kazunobu; Yamaguchi, Masao; Kawamata, Mikito

doi:10.1016/j.bja.2023.02.023

Cited by 13 publications

(6 citation statements)

References 26 publications

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“…In this case, the panel judged that cardiac arrest would likely have been avoided by early use of intravenous adrenaline. A recent Japanese study of less severe peri‐operative anaphylaxis (43 cases, only two with cardiac arrests) reported more rapid and sustained improvements in cardiovascular variables when adrenaline was given intravenously rather than intramuscularly [26]. The accompanying editorial also advocated for intravenous over intramuscular administration [27].…”

Section: Discussionmentioning

confidence: 99%

Peri‐operative cardiac arrest due to suspected anaphylaxis as reported to the 7th National Audit Project of the Royal College of Anaesthetists

Cook,

Kane,

Armstrong

et al. 2024

Anaesthesia

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SummaryThe 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. Among 59 cases reported as possible anaphylaxis, 33 (56%) were judged to be so by the review panel with high or moderate confidence. Causes in excluded cases included: isolated severe hypotension; bronchospasm; and oesophageal intubation. Severe bronchospasm leading to cardiac arrest was uncommon, but notably in one case led to a reported flat capnograph. In the baseline survey, anaesthetists estimated anaphylaxis as the cause of 10% of cases of peri‐operative cardiac arrests and to be among the four most common causes. In a year‐long registry of peri‐operative cardiac arrest, suspected anaphylaxis was the seventh most common cause accounting for 4% of reports. Initial management was most often with low‐dose intravenous adrenaline, and this was without complications. Both the NAP7 baseline survey and case registry provided evidence of reluctance to starting chest compressions when systolic blood pressure had fallen to below 50 mmHg and occasionally even when it was unrecordable. All 33 patients were resuscitated successfully but one patient later died. The one death occurred in a relatively young patient in whom chest compressions were delayed. Overall, peri‐operative anaphylaxis leading to cardiac arrest occurred with a similar frequency and patterns of presentation, location, initial rhythm and suspected triggers in NAP7 as in the 6th National Audit Project (NAP6). Outcomes in NAP7 were generally better than for equivalent cases in NAP6.

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Section: Discussionmentioning

confidence: 99%

Peri‐operative cardiac arrest due to suspected anaphylaxis as reported to the 7th National Audit Project of the Royal College of Anaesthetists

Cook,

Kane,

Armstrong

et al. 2024

Anaesthesia

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“…The absorption of intramuscular adrenaline is slower, less predictable and dependent on adequate circulation which is more likely to be compromised in perioperative anaphylaxis [18]. The use of intravenous adrenaline facilitates more rapid improvement than via the intramuscular route and enables the closer titration of doses to effect [11]. For adults, an initial intravenous dose of 50 lg (0.5 ml of 1 mg.10 ml -1 [1:10,000] strength) adrenaline is recommended by the RCUK algorithm and Quick Reference Handbook [4], although some patients may respond to smaller doses (10-50 lg) titrated to effect.…”

Section: Treatment Of Peri-operative Anaphylaxismentioning

confidence: 99%

“…Grade 3 and 4 reactions demonstrate life-threatening organ involvement, fulfilling the criteria for severe anaphylaxis. Grade 3 peri-operative anaphylaxis typically presents with sudden onset, lifethreatening hypotension [6,11], with or without tachycardia or bradycardia [7]. Bronchospasm as a presenting sign is more common in patients with underlying airway disease (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Emergency treatment of peri‐operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists

Dodd,

Turner,

Soar

et al. 2024

Anaesthesia

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SummaryPeri‐operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri‐operative anaphylaxis highlights the importance of early intravenous adrenaline and fluid resuscitation and provides guidance on the treatment of refractory anaphylaxis and immediate follow‐up. This algorithm is endorsed by the Royal College of Anaesthetists, Association of Anaesthetists, British Society of Allergy and Clinical Immunology and Clinical Immunology Professional Network of the British Society for Immunology. This document was produced by the Perioperative Allergy Network steering committee in collaboration with the Resuscitation Council UK.

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“…The fundamental cause of this pattern is still a mystery; nevertheless, it may be attributed to the influences of either the environment or genetics; therefore, additional research is required. Suigiyama , 2023 16…”

Section: Hong Kongmentioning

confidence: 99%

Perioperative Anaphylaxis: A Systematic Review

Ma’bud

2023

JARMHS

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Background: Perioperative anaphylaxis can be associated with antibiotics, neuromuscular blocking agents, dyes, latex, and disinfectants. This article evaluates the condition's epidemiology, pathophysiology, and treatment, including an allergy assessment. Aim: This investigation aims to investigate the possibility that perioperative anaphylaxis develops. Methods: The study met the PRISMA 2020 guidelines through self-evaluation. The investigators ensured the study's current became feasible. Publications from 2015 to 2023 were searched using various online reference databases, including Pubmed and SagePub. Excluded were review papers, pre-existing publications, and incomplete articles. Result: The search generated 552 and 321 articles in the PubMed and SagePub databases, respectively. 54 articles were found for PubMed and 21 for SagePub in the investigation conducted for the last year of 2015. A total of 18 papers were collected, with 12 generated from PubMed and 6 from SagePub. We included five studies that met the criteria. Conclusion: The presence of anesthetics, surgical settings, and various medications and substances may complicate the process of accurate diagnosis. A systematic approach was used to identify the reaction, perpetrator, and future management. Effective management of perioperative anaphylaxis requires close coordination among anesthesiology, surgery, and allergy specialists.

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The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: clinical signs, severity, and therapeutic agents

Cited by 13 publications

References 26 publications

Peri‐operative cardiac arrest due to suspected anaphylaxis as reported to the 7th National Audit Project of the Royal College of Anaesthetists

Peri‐operative cardiac arrest due to suspected anaphylaxis as reported to the 7th National Audit Project of the Royal College of Anaesthetists

Emergency treatment of peri‐operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists

Perioperative Anaphylaxis: A Systematic Review

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