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.


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