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Incidence and outcome of anaphylaxis in cardiac surgical patients


1 Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK
2 Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK; Department of Anaesthesia and Critical Care, University of Queensland Critical Care Research Group and The Prince Charles Hospital, Brisbane, Australia; Department of Anesthesiology and Intensive Care, Philipps University, Marburg, Germany; Advanced Cardiac and Critical Care, Nazih Zuhdi Transplant Institute, Integris Health, Oklahoma City, USA

Correspondence Address:
Rahul Norawat
Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_170_21

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Year : 2022  |  Volume : 25  |  Issue : 3  |  Page : 323-329

 

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Introduction: Anaphylaxis is a rare but serious and potentially fatal complication of anesthesia. Little is known about the incidence and outcome of anaphylaxis in cardiac surgical patients, which we aimed to investigate. Methods: This was a 21-year retrospective study of cardiac surgical patients at Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK. Results: A total of 19 cases of anaphylaxis were reported among 17,589 patients (0.108%) undergoing cardiac surgery. The majority (15/19) occurred before cardiopulmonary bypass (CPB), mostly during or within 30 min after the induction of anesthesia (10/19). Two occurred within 15 min of going onto CPB. Of these 17 cases, 11 were abandoned, and 6 proceeded. The severity of reactions in the patients who proceeded ranged from grade II to grade IV of the Ring and Messmer classification. Two cases occurred after the completion of surgery. All patients survived to 90 days. However, this did not appear to be related to CPB or protamine as most of the reactions occurred before CPB. Instead, the most common causative agents were gelofusine, antibiotics, muscle relaxants, and chlorhexidine. In 6 cases, surgery proceeded despite the anaphylaxis, in 11 cases the surgery was postponed, and in 2 cases the procedure had already been completed. Conclusion: As all patients survived, our results provide preliminary support for proceeding with surgery although we cannot speculate on the likely outcomes of patients who were postponed, had their surgery proceeded. Based on our data, the incidence of anaphylaxis in cardiac surgical patients may be 10–20 times higher than in the general surgical population.






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1 Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK
2 Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK; Department of Anaesthesia and Critical Care, University of Queensland Critical Care Research Group and The Prince Charles Hospital, Brisbane, Australia; Department of Anesthesiology and Intensive Care, Philipps University, Marburg, Germany; Advanced Cardiac and Critical Care, Nazih Zuhdi Transplant Institute, Integris Health, Oklahoma City, USA

Correspondence Address:
Rahul Norawat
Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL
UK
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_170_21

Rights and Permissions

Introduction: Anaphylaxis is a rare but serious and potentially fatal complication of anesthesia. Little is known about the incidence and outcome of anaphylaxis in cardiac surgical patients, which we aimed to investigate. Methods: This was a 21-year retrospective study of cardiac surgical patients at Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK. Results: A total of 19 cases of anaphylaxis were reported among 17,589 patients (0.108%) undergoing cardiac surgery. The majority (15/19) occurred before cardiopulmonary bypass (CPB), mostly during or within 30 min after the induction of anesthesia (10/19). Two occurred within 15 min of going onto CPB. Of these 17 cases, 11 were abandoned, and 6 proceeded. The severity of reactions in the patients who proceeded ranged from grade II to grade IV of the Ring and Messmer classification. Two cases occurred after the completion of surgery. All patients survived to 90 days. However, this did not appear to be related to CPB or protamine as most of the reactions occurred before CPB. Instead, the most common causative agents were gelofusine, antibiotics, muscle relaxants, and chlorhexidine. In 6 cases, surgery proceeded despite the anaphylaxis, in 11 cases the surgery was postponed, and in 2 cases the procedure had already been completed. Conclusion: As all patients survived, our results provide preliminary support for proceeding with surgery although we cannot speculate on the likely outcomes of patients who were postponed, had their surgery proceeded. Based on our data, the incidence of anaphylaxis in cardiac surgical patients may be 10–20 times higher than in the general surgical population.






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