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Suspected anaphylactic reactions associated with anaesthesia ..................................................................................................................................... concentration is therefore a marker of anaphylaxis, but anaphylaxis does not always cause a raised concentration. The greater the rise in concentration, the greater the probability this was caused by an anaphylactic reaction but a normal concentration does not disprove anaphylaxis. 5 A rise in serum tryptase simply indicates mast cell degranulation and does not discriminate between allergic and non-allergic anaphylaxis. It has been stated that the rise in serum tryptase concentration may be less marked in non-allergic anaphylaxis. 6 During anaphylaxis, tryptase peaks by approximately 1 h and its half-life in the circulation is about 2 h: the concentration therefore falls rapidly following an anaphylactic reaction. 7 The most widely used assay for tryptase is the ImmunoCAP Ò fluorescence enzyme immunoassay (FEIA) which measures the sum of a and b-tryptase concentrations. A raised resting concentration is usually due to a-tryptase, secreted constitutively by the increased numbers of mast cells in systemic mastocytosis. 8 Although the current tryptase assay has a high specificity, its sensitivity is relatively low and some cases of anaphylaxis may be missed. 9 The sensitivity and specificity of the tryptase assay depends on the cutoff point that is chosen to indicate anaphylaxis. Because there is a wide variation in the base-line plasma concentration of tryptase, the change in tryptase concentration is more helpful than the absolute concentration in reaching a diagnosis. 10 Intravenous fluid replacement is usually required during treatment of a reaction. This fluid will dilute the blood and causes a fall in the concentration of tryptase measured. This must be taken into account when evaluating the measured concentration. 11 Following death, the circulation stops and tryptase is no longer removed from the circulation; samples taken postmortem are helpful in evaluating whether the terminal events were related to anaphylaxis. A raised tryptase concentration found at autopsy has lower predictive value than a sample taken during life. b-tryptase may be raised in trauma or myocardial infarction. Further reading Fisher MM, Baldo BA. Mast cell tryptase in anaesthetic anaphylactoid reactions. British Journal of Anaesthesia 1998; 80: 26–29. Enrique E, Garcia-Ortega P, Sotorra O, Gaig P, Richart C. Usefulness of UniCAP Tryptase fluoroimmunoassay in the diagnosis of anaphylaxis. Allergy 1999; 54: 602–606. Ó 2009 The Authors 26 Journal compilation Ó 2009 The Association of Anaesthetists of Great Britain and Ireland
Suspected anaphylactic reactions associated with anaesthesia ..................................................................................................................................... Payne V, Kam PCA. Mast cell tryptase: a review of its physiology and clinical significance. Anaesthesia 2004; 59: 695–703. Brown SGA, Blackman KE, Heddle RJ. Can serum mast cell tryptase help diagnose anaphylaxis? Emergency Medicine Australasia 2004; 16: 120–124. Appendix IV Useful websites http://www.aagbi.org The Association of Anaesthetists of Great Britain and Ireland http://www.bsaci.org The British Society for Allergy and Clinical Immunology http://www.immunology.org The British Society for Immunology http://www.resus.org.uk Resuscitation Council UK http://www.eaaci.net The European Academy of Allergology and Clinical Immunology http://www.mhra.gov.uk The Medicines and Healthcare products Regulatory Agency Supporting Information Additional Supporting information may be found in the online version of this article: Appendix S1 Anaesthetic Anaphylaxis Referral Form. Please note: Wiley-Blackwell are not responsible for the content or functionality of any Supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. Ó 2009 The Authors Journal compilation Ó 2009 The Association of Anaesthetists of Great Britain and Ireland 27
Page 1 and 2: Recommendations for the Safe Transf
Page 3 and 4: CONTENTS Section I Summary and Reco
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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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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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Methods to estimate/establish publi
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Recommendations The WP recommends:
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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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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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AAGBI SAFETY GUIDELINE Immediate Po
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Guidelines Immediate post-anaesthes
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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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Day Case and Short Stay Surgery 2 P
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GUIDELINES Day case and short stay
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