UK anaesthetists' perspectives and experiences of severe perioperative anaphylaxis: NAP6 baseline survey

Abstract

Background: There is limited information on UK anaesthetists' perspectives and experiences of perioperative anaphylaxis. This baseline survey of the Sixth National Audit Project (NAP6) aimed to identify relevant departmental preparedness and practices, and individual experiences, perceptions and drug-avoidance patterns.

Methods: All anaesthetists in 356 UK NHS hospitals were invited to complete an electronic survey.

Results: 11 104 anaesthetists (77% crude response rate) from 341 (96%) hospitals responded. Most had immediate access to guidelines for anaphylaxis treatment (87%) and established referral pathways for investigation (82%), but a minority reported access to designated treatment packs (37%) or an anaphylaxis lead (35%). Anaesthetists reported 1734 cases of suspected perioperative anaphylaxis in 2014-5 of which 81% were referred for specialist investigation and 14% reported to the Medicines and Healthcare Products Regulatory Agency (MHRA). In their career, 76% of respondents had seen a case of perioperative anaphylaxis (1:7.25 years of practice) and 4% reported a death (1:311 years of practice), equivalent to 2.3% of events being fatal. Agents most frequently perceived to cause anaphylaxis were antibiotics, particularly penicillins, and neuromuscular blocking agents, notably rocuronium. Suxamethonium and penicillins were avoided by a higher proportion of respondents than events attributed to these drugs whereas the converse was true for atracurium and teicoplanin.

Conclusions: This is the largest ever survey of anaesthetists' practices and experiences relating to perioperative anaphylaxis. It identifies gaps in preparedness and referral for further investigation and to the UK MHRA. It provides important data about drugs implicated in such events and anaesthetists' attitudes to anaphylaxis.

Keywords: adverse effects; anaesthesia; anaphylaxis; hypersensitivity; risk reduction behaviour.