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Suspected anaphylactic reactions associated with anaesthesia ..................................................................................................................................... appears that the incidence may be waning, at least in some countries; possibly as a result of a change or decline in the use of latex gloves. Certain patient groups are more susceptible to latex anaphylaxis (see Appendix II). Antibiotics Approximately 15% of anaesthesia-related anaphylactic episodes are due to antibiotics. This proportion has increased in recent years and may merely mirror increased exposure to antibiotics in the community [2, 11]. The pre-operative history is important. Although only a minority of patients who report allergy to antibiotics have a true allergy, the consequence of anaphylaxis to intravenous antibiotics may be catastrophic, and selfreporting should be taken seriously. Skin testing is only approximately 60% predictive of clinical hypersensitivity. Penicillins and cephalosporins which share the b-lactam ring are responsible for approximately 70% of antibioticinduced anaphylaxis. Many antibiotics possess a b-lactam ring: • Benzylpenicillin, phenoxymethylpenicillin • Flucloxacillin, temocillin • Amoxicillin, ampicillin, co-amoxiclav • Co-fluampicil • Piperacillin, ticarcillin, • Pivmecillinam HCl • Cephalosporins • Aztreonam • Ertapenem, imipenem with cilastatin, meropenem The structure of the side chains attached to the b-lactam ring is also important in determining the response of the immune system. First generation cephalosporins and cefamandole share a similar side chain with penicillin and amoxicillin. A recent meta-analysis suggested that patients who are allergic to penicillin or amoxicillin have a higher incidence of allergic reactions to first generation cephalosporins and cefamandole, but not other cephalosporins [12]. The issue is complicated because the classification of cephalosporins relates to their antimicrobial activity rather than their chemical structure. First generation cephalosporins • Cefalexin (cephalexin)* • Cephaloridine Ó 2009 The Authors 8 Journal compilation Ó 2009 The Association of Anaesthetists of Great Britain and Ireland
Suspected anaphylactic reactions associated with anaesthesia ..................................................................................................................................... • Cephalothin • Cefazolin • Cefradine (cephradine)* • Cefadroxil* Second generation cephalosporins • Cefaclor* • Cefamandole • Cefuroxime* Third generation cephalosporins • Cefixime* • Cefotaxime* • Cefpodoxime* • Ceftazidime* • Ceftriaxone* Fourth generation cephalosporins • Cefepime • Cefpirome *Listed in the British National Formulary. Local anaesthetics Anaphylactic reactions to local anaesthetic drugs are very uncommon. Local anaesthetic esters are more likely than amides to provoke a Type lV allergic reaction. Preservatives such as methyl-paraben or metabisulphites may be responsible in some cases. It has been suggested that inadvertent intravascular injection of a local anaesthetic or the systemic absorption of adrenaline may be responsible for many of the reported reactions. Reactions occurring in the dental chair may also be associated with idiopathic angioedema or latex allergy. Opioids Opioids are an uncommon cause of anaesthesia-related anaphylaxis. Diagnosis is difficult and the true incidence is unknown. Morphine, pethidine and codeine are well-known to cause non-specific histamine release which precludes diagnostic skin testing. The diagnosis of opioid Ó 2009 The Authors Journal compilation Ó 2009 The Association of Anaesthetists of Great Britain and Ireland 9
Page 1 and 2: Recommendations for the Safe Transf
Page 3 and 4: CONTENTS Section I Summary and Reco
Page 5 and 6: SECTION II - BACKGROUND In 1996 the
Page 7 and 8: SECTION IV - ORGANISATION AND COMMU
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Page 11 and 12: A p p ropriate re s p i ra t o ry s
Page 13 and 14: SECTION VII - THE TRANSFER The tran
Page 15 and 16: SECTION VIII - EQUIPMENT AND DRUGS
Page 17 and 18: SECTION IX - EDUCATION AND TRAINING
Page 19 and 20: SECTION X - RESOURCE IMPLICATIONS F
Page 21 and 22: APPENDIX I INDICATIONS FOR INTUBATI
Page 23 and 24: APPENDIX III ADDITIONAL INFORMATION
Page 25 and 26: AAGBI SAFETY GUIDELINE Suspected An
Page 27 and 28: GUIDELINES Suspected Anaphylactic R
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equipment officer is encouraged to
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EU procurement thresholds Threshold
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When negotiating a purchasing agree
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9. Shared equipment Many types of e
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Third party servicing is another op
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11. Replacement 11.1 Planned equipm
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number of re-uses (e.g. re-usable L
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Where new equipment is purchased th
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14. Incident reporting and investig
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available from www.hse.gov.uk 14.4
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DB DoH EBME EC EU FRCA HN HSE IEC I
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8. OPSI. Statutory Instrument 2006
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Eire Tel: 00353 1 676 4971 Website:
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Peri-operative management of the ob
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Guidelines Peri-operative managemen
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Recommendations 1 Every hospital sh
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35 30 25 Prevalance (%) 20 15 10 5
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is an increased incidence of prolon
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Figure 2 Relationship between total
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techniques, and when used with neur
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Table 5 The STOP-BANG screening que
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Intra-operative care Preparation of
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Figure 3 Ramping position for obese
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eturn of airway reflexes with desfl
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Table 6 Dosing schedule for thrombo
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A review and meta-analysis by the S
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numbers of staff are needed to roll
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Table 7 Equipment for managing obes
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11. Schneider HJ, Glaesmer H, Klots
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44. Edholm D, Kullberg J, Haenni A,
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21 Portland Place, London, W1B 1PY
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This guideline was originally publi
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Anaesthesia 2015 Barker et al. | Gu
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Out of Hours Activity (Anaesthesia)
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Considerations for anaesthetists Th
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OAA / AAGBI Guidelines for Obstetri
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Contents 1. Key recommendations 2 2
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2. Introduction This is the third v
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Recommendations Medical staff The t
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appointed directly from other count
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Peripartum care Pre-operative asses
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Intravenous patient-controlled opio
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depression. In the absence of contr
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of clinical deterioration, as recom
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5. Training and education Each obst
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• Skills and drills training: ana
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• The midwife caring for a woman
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7. Support services, equipment, fac
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Equipment for PCA must be available
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8. The future The delivery of healt
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The following national guidelines s
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19. Obstetric Anaesthetists’ Asso
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At the first meeting held on 9 th M
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Methods to estimate/establish publi
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Recommendations The WP recommends:
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Anaesthesia, 2007, 62, pages 1199-1
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Anaesthesia, 2007, 62, pages 1199-1
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OPTION 3 - PRESUMED CONSENT. ‘Pre
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Power of Attorney) while requiring
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Needle-stick injury and HIV testing
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egain capacity, and the absence of
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treatment if it was understood that
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Management of hypertension before e
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AAGBI Safety Guideline Management o
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Malignant Hyperthermia Crisis Task
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MEMBERSHIP OF THE WORKING PARTY Dr
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Section 1 Recommendations 1. Transf
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Section 3 Introduction In 1997 it w
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This process may require many telep
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Section 6 Accompanying the patient
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Section 7 Monitoring, drugs and equ
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heavily congested areas, but not al
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APPENDIX 1 Departure checklist Do a
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13. Bercault N, Wolf M, Runge I, Fl
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21 Portland Place, London W1B 1PY T
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Membership of the Working Party Dr
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Infection control in anaesthesia An
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AAGBI SAFETY GUIDELINE Immediate Po
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Guidelines Immediate post-anaesthes
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Whitaker et al. | Guidelines: Immed
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The Royal College of Anaesthetists
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Contents ❚ Foreword 4 Introductio
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Introduction ❚ The Good Anaesthet
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Related guidelines and sources of i
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Domain A: knowledge, skills and per
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Day Case and Short Stay Surgery 2 P
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GUIDELINES Day case and short stay
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Guidelines: Day case and short stay
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