Pub Date : 2024-10-18DOI: 10.1016/j.bja.2024.09.017
Alain F Kalmar,Hugo Vereecke,Steffen Rex
{"title":"Desorption of volatile anaesthetics from CONTRAfluran™ during total intravenous anaesthesia with a high fresh gas flow.","authors":"Alain F Kalmar,Hugo Vereecke,Steffen Rex","doi":"10.1016/j.bja.2024.09.017","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.017","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.bja.2024.09.006
Thomas Cloke,Catherine Ross,Paula Joy,Anthony Carver,Thomas E Potter,Dani Padman,Kate Kanga,Imran Ahmad,Kariem El-Boghdadly,Fiona E Kelly,Timothy M Cook
BACKGROUNDDeaths from unrecognised oesophageal intubation continue despite national campaigns emphasising the importance of capnography to confirm tracheal intubation. A two-person verbal intubation check is recommended in consensus guidelines intended to prevent such deaths. This check can be performed by the intubator with their assistant, either as a one-step process (identification of sustained exhaled carbon dioxide) or as a two-step process (adding identification of the tracheal tube passing through the vocal cords during videolaryngoscopy).METHODSIn two hospitals we introduced two-person checking of tracheal intubation. In one hospital this involved the one-step process and in the other the two-step process. We used anonymous online questionnaires before, during, and after these changes to collect opinions from anaesthetists and their assistants regarding the feasibility and acceptability of these changes.RESULTSMost intubators (116/149, 78%) and intubators' assistants (70/72, 97%) reported that the two-person verbal intubation check would reduce the likelihood of unrecognised oesophageal intubation. Benefits and lack of negative aspects were reported for both one-step and two-step two-person intubation checks in both centres. Intubators judged that the checks improved communication and teamwork (118/149, 79%); intubators' assistants reported feeling more empowered to voice concerns if needed (69/72, 96%), a flattened team hierarchy (53/72, 74%), and feeling more valued as team members (64/72, 89%). Most intubators (122/149, 82%) and intubators' assistants (68/72, 94%) planned to continue using the two-person intubation check for all future intubations.CONCLUSIONSOur results suggest that a two-person verbal intubation check is feasible and acceptable to all members of the intubating team.
{"title":"A two-person verbal check to confirm tracheal intubation: evaluation of practice changes to prevent unrecognised oesophageal intubation.","authors":"Thomas Cloke,Catherine Ross,Paula Joy,Anthony Carver,Thomas E Potter,Dani Padman,Kate Kanga,Imran Ahmad,Kariem El-Boghdadly,Fiona E Kelly,Timothy M Cook","doi":"10.1016/j.bja.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.006","url":null,"abstract":"BACKGROUNDDeaths from unrecognised oesophageal intubation continue despite national campaigns emphasising the importance of capnography to confirm tracheal intubation. A two-person verbal intubation check is recommended in consensus guidelines intended to prevent such deaths. This check can be performed by the intubator with their assistant, either as a one-step process (identification of sustained exhaled carbon dioxide) or as a two-step process (adding identification of the tracheal tube passing through the vocal cords during videolaryngoscopy).METHODSIn two hospitals we introduced two-person checking of tracheal intubation. In one hospital this involved the one-step process and in the other the two-step process. We used anonymous online questionnaires before, during, and after these changes to collect opinions from anaesthetists and their assistants regarding the feasibility and acceptability of these changes.RESULTSMost intubators (116/149, 78%) and intubators' assistants (70/72, 97%) reported that the two-person verbal intubation check would reduce the likelihood of unrecognised oesophageal intubation. Benefits and lack of negative aspects were reported for both one-step and two-step two-person intubation checks in both centres. Intubators judged that the checks improved communication and teamwork (118/149, 79%); intubators' assistants reported feeling more empowered to voice concerns if needed (69/72, 96%), a flattened team hierarchy (53/72, 74%), and feeling more valued as team members (64/72, 89%). Most intubators (122/149, 82%) and intubators' assistants (68/72, 94%) planned to continue using the two-person intubation check for all future intubations.CONCLUSIONSOur results suggest that a two-person verbal intubation check is feasible and acceptable to all members of the intubating team.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDPostoperative neurocognitive decline is a frequent complication triggered by unclear signalling mechanisms. This observational case-control study investigated the effects of hip or knee replacement surgery on the composition of circulating extracellular vesicles (EVs), potential periphery-to-brain messengers, and their association with neurocognitive outcomes.METHODSWe mapped the microRNAome and proteome of plasma-derived EVs from 12 patients (six with good and six with poor neurocognitive outcomes at 3 months after surgery) at preoperative and postoperative timepoints (4, 8, 24, and 48 h). Complement C3-EV association was confirmed by flow cytometry in plasma- and cerebrospinal fluid (CSF)-derived EVs, with total plasma and CSF C3 and C3a concentrations determined using enzyme-linked immunosorbent assay.RESULTSDifferential expression analysis found eight dysregulated EV microRNAs (miRNAs) exclusively in the poor neurocognitive outcomes group. Pathway analysis suggested potential downregulation of proliferative pathways and activation of extracellular matrix and inflammatory response pathways in EV target tissues. Proteome analysis revealed a time-dependent increase in immune-related EV proteins, including complement system proteins, notably EV surface-associated C3. Such upward kinetics was detected earlier in the poor neurocognitive outcomes group. Interestingly, CSF-derived EVs from the same group showed a drastic drop of C3 at 48 h with unchanged concentrations in the good neurocognitive outcomes group. Functionally, the complement system was activated in both patient groups in plasma, but only in the poor neurocognitive outcomes group in CSF.CONCLUSIONSOur findings highlight the impact of surgery on plasma- and CSF-derived EVs, particularly in patients with poor neurocognitive outcomes, indicating a potential role for EVs. The small sample size necessitates verification with a larger patient cohort.
{"title":"Changes in circulating extracellular vesicle cargo are associated with cognitive decline after major surgery: an observational case-control study.","authors":"Souren Mkrtchian,Maria Eldh,Anette Ebberyd,Susanne Gabrielsson,Ákos Végvári,Sven-Erik Ricksten,Mattias Danielson,Jonatan Oras,Andreas Wiklund,Lars I Eriksson,Marta Gómez-Galán","doi":"10.1016/j.bja.2024.07.040","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.040","url":null,"abstract":"BACKGROUNDPostoperative neurocognitive decline is a frequent complication triggered by unclear signalling mechanisms. This observational case-control study investigated the effects of hip or knee replacement surgery on the composition of circulating extracellular vesicles (EVs), potential periphery-to-brain messengers, and their association with neurocognitive outcomes.METHODSWe mapped the microRNAome and proteome of plasma-derived EVs from 12 patients (six with good and six with poor neurocognitive outcomes at 3 months after surgery) at preoperative and postoperative timepoints (4, 8, 24, and 48 h). Complement C3-EV association was confirmed by flow cytometry in plasma- and cerebrospinal fluid (CSF)-derived EVs, with total plasma and CSF C3 and C3a concentrations determined using enzyme-linked immunosorbent assay.RESULTSDifferential expression analysis found eight dysregulated EV microRNAs (miRNAs) exclusively in the poor neurocognitive outcomes group. Pathway analysis suggested potential downregulation of proliferative pathways and activation of extracellular matrix and inflammatory response pathways in EV target tissues. Proteome analysis revealed a time-dependent increase in immune-related EV proteins, including complement system proteins, notably EV surface-associated C3. Such upward kinetics was detected earlier in the poor neurocognitive outcomes group. Interestingly, CSF-derived EVs from the same group showed a drastic drop of C3 at 48 h with unchanged concentrations in the good neurocognitive outcomes group. Functionally, the complement system was activated in both patient groups in plasma, but only in the poor neurocognitive outcomes group in CSF.CONCLUSIONSOur findings highlight the impact of surgery on plasma- and CSF-derived EVs, particularly in patients with poor neurocognitive outcomes, indicating a potential role for EVs. The small sample size necessitates verification with a larger patient cohort.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.bja.2024.09.019
Guanyu Yang
{"title":"Effect of a comfort scale compared with a pain numerical rate scale on opioids consumption in postanaesthesia care unit: the COMFORT study. Comment on Br J Anaesth 2024; 133: 839-45.","authors":"Guanyu Yang","doi":"10.1016/j.bja.2024.09.019","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.019","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.bja.2024.09.012
Karen Wouters,Benjamin J Blaise
{"title":"Combined approach to the young infant airway.","authors":"Karen Wouters,Benjamin J Blaise","doi":"10.1016/j.bja.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.012","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.bja.2024.09.018
Zhongpeng Sun,Dong Yang
{"title":"Impact of spinal versus general anaesthesia on perioperative obstructive sleep apnoea severity in patients undergoing hip arthroplasty. Comment on Br J Anaesth 2024; 133: 416-423.","authors":"Zhongpeng Sun,Dong Yang","doi":"10.1016/j.bja.2024.09.018","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.018","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.bja.2024.09.007
Fraser J D Morris,Rasmus Åhman,Alison Craswell,Helén Didriksson,Carina Jonsson,Manda Gisselgård,Henrik A Andersson,Yoke-Lin Fung,Michelle S Chew
BACKGROUNDPreoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes.METHODSThis was a prospective observational study among patients aged ≥50 yr undergoing elective major noncardiac surgery from four Swedish hospitals. The co-primary outcomes were 1-yr major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause mortality. The secondary outcome was a composite of 30-day mortality, MACCEs, acute kidney injury (AKI), pulmonary embolism, anastomotic leak, and postoperative infection. Mediation analyses were conducted with preoperative haemoglobin as the exposure and RBC transfusion as a mediator.RESULTSAmong 1060 patients (mean age 70 [SD 9] yr; 472 [45%] women), 171 patients (16.1%) developed 1-yr MACCEs, and 105 patients (9.9%) died within 1 yr. Preoperative haemoglobin levels were significantly associated with both 1-yr MACCEs (b=-0.015, P=0.041) and all-cause mortality (b=-0.028, P<0.001). Volume of RBC transfusion was not directly associated with the outcomes and did not mediate the relationship between preoperative haemoglobin levels and 1-yr MACCEs (b=-0.001, P=0.451) or all-cause mortality (b=-0.002, P=0.293). For the secondary outcome, RBC transfusions had a significant mediating effect between preoperative haemoglobin and the composite 30-day outcome; however, no direct association was observed (b=0.006, P=0.554).CONCLUSIONSPreoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.
{"title":"Effect of perioperative blood transfusion on preoperative haemoglobin levels as a risk factor for long-term outcomes in patients undergoing major noncardiac surgery: a prospective multicentre observational study.","authors":"Fraser J D Morris,Rasmus Åhman,Alison Craswell,Helén Didriksson,Carina Jonsson,Manda Gisselgård,Henrik A Andersson,Yoke-Lin Fung,Michelle S Chew","doi":"10.1016/j.bja.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.007","url":null,"abstract":"BACKGROUNDPreoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes.METHODSThis was a prospective observational study among patients aged ≥50 yr undergoing elective major noncardiac surgery from four Swedish hospitals. The co-primary outcomes were 1-yr major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause mortality. The secondary outcome was a composite of 30-day mortality, MACCEs, acute kidney injury (AKI), pulmonary embolism, anastomotic leak, and postoperative infection. Mediation analyses were conducted with preoperative haemoglobin as the exposure and RBC transfusion as a mediator.RESULTSAmong 1060 patients (mean age 70 [SD 9] yr; 472 [45%] women), 171 patients (16.1%) developed 1-yr MACCEs, and 105 patients (9.9%) died within 1 yr. Preoperative haemoglobin levels were significantly associated with both 1-yr MACCEs (b=-0.015, P=0.041) and all-cause mortality (b=-0.028, P<0.001). Volume of RBC transfusion was not directly associated with the outcomes and did not mediate the relationship between preoperative haemoglobin levels and 1-yr MACCEs (b=-0.001, P=0.451) or all-cause mortality (b=-0.002, P=0.293). For the secondary outcome, RBC transfusions had a significant mediating effect between preoperative haemoglobin and the composite 30-day outcome; however, no direct association was observed (b=0.006, P=0.554).CONCLUSIONSPreoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.bja.2024.09.001
Muthuraj Kanakaraj,Adithya D Bhat,Narinder P Singh,Sennaraj Balasubramanian,Abhay Tyagi,Rohan Aathreya,Preet M Singh
BACKGROUNDOver the last two decades, significant research interest has led to the development of a wide variety of supraglottic airways (SGAs) for anaesthesia providers to choose from.METHODSIn this network meta-analysis, we analysed 111 studies, enrolling 12 045 patients undergoing airway management with 29 SGAs. We targeted outcomes that contribute to clinicians' choice of one SGA over another. The primary outcome was the incidence of postoperative sore throat (POST). Secondary outcomes were first-attempt insertion success, bleeding complications, and oropharyngeal leak pressure (OLP). Based on credible intervals, we created a 'rank order' to guide decision-making for clinicians.RESULTSThe highest-ranking devices based on credible intervals for POST, bleeding complications, first-attempt insertion success, and OLP were LMA Ambu, Jcerity Endoscoper, LMA Blockbuster, and LMA Baska Mask, respectively. Air-Q and i-gel ranked favourably across multiple outcomes, with i-gel being the only device to rank within the top six SGAs for POST, bleeding, and first-attempt success despite ranking poorly for OLP.CONCLUSIONSOur data support the use of LMA-Ambu, Jcerity-Endoscoper, Air-Q, and i-gel when considering patient-centred outcomes. Clinician familiarity with these devices and their continued expansion into anaesthetic practice will have important implications on the perioperative patient experience.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD42022383136).
{"title":"Choice of supraglottic airway devices: a network meta-analysis of randomised controlled trials.","authors":"Muthuraj Kanakaraj,Adithya D Bhat,Narinder P Singh,Sennaraj Balasubramanian,Abhay Tyagi,Rohan Aathreya,Preet M Singh","doi":"10.1016/j.bja.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.001","url":null,"abstract":"BACKGROUNDOver the last two decades, significant research interest has led to the development of a wide variety of supraglottic airways (SGAs) for anaesthesia providers to choose from.METHODSIn this network meta-analysis, we analysed 111 studies, enrolling 12 045 patients undergoing airway management with 29 SGAs. We targeted outcomes that contribute to clinicians' choice of one SGA over another. The primary outcome was the incidence of postoperative sore throat (POST). Secondary outcomes were first-attempt insertion success, bleeding complications, and oropharyngeal leak pressure (OLP). Based on credible intervals, we created a 'rank order' to guide decision-making for clinicians.RESULTSThe highest-ranking devices based on credible intervals for POST, bleeding complications, first-attempt insertion success, and OLP were LMA Ambu, Jcerity Endoscoper, LMA Blockbuster, and LMA Baska Mask, respectively. Air-Q and i-gel ranked favourably across multiple outcomes, with i-gel being the only device to rank within the top six SGAs for POST, bleeding, and first-attempt success despite ranking poorly for OLP.CONCLUSIONSOur data support the use of LMA-Ambu, Jcerity-Endoscoper, Air-Q, and i-gel when considering patient-centred outcomes. Clinician familiarity with these devices and their continued expansion into anaesthetic practice will have important implications on the perioperative patient experience.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD42022383136).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1016/j.bja.2024.07.042
Danielle Crimmins,Helen Crilly,Christian van Nieuwenhuysen,Kate Ziser,Syeda Zahir,Gemma Todd,Leanne Ryan,David Heyworth-Smith,Liam Balkin,Annabelle Harrocks,Anton W G Booth
BACKGROUNDSugammadex hypersensitivity is an emerging safety concern. We aimed to describe the clinical and diagnostic features of perioperative hypersensitivity to sugammadex, and secondarily to provide an estimate of perioperative sugammadex hypersensitivity incidence in Australia.METHODSWe retrospectively analysed cases of hypersensitivity to sugammadex diagnosed by positive intradermal or skin prick testing at six perioperative allergy clinics in Australia. We included all grades of hypersensitivity and compared life-threatening with non-life-threatening presentations. Incidence of hypersensitivity events was estimated relative to the estimated number of sugammadex administrations across two health services between January 1, 2010 and June 30, 2023.RESULTSThirty cases were included (15 life-threatening and 15 non-life-threatening). The most common clinical signs were hypotension (n=25, 83.3%) and flushing/erythema (n=21, 70%). The median time to recognition of hypersensitivity was 5 (interquartile range 2-7.5) min. Five cases were recognised 10-30 min after administration. Serum tryptase was measured in 28 (93.3%) patients. Tryptase was positive in 15 (100%) life-threatening cases and nine (69.2%) non-life-threatening cases. The estimated incidence of sugammadex hypersensitivity was 0.004% (95% confidence interval 0.002-0.008%).CONCLUSIONSSugammadex hypersensitivity presents similarly to other causes of perioperative hypersensitivity, however recognition can be delayed. The combination of positive serum tryptase and positive skin tests suggests an IgE-mediated mechanism of hypersensitivity. The estimated incidence of sugammadex hypersensitivity in Australia is lower than earlier reports.
{"title":"Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort.","authors":"Danielle Crimmins,Helen Crilly,Christian van Nieuwenhuysen,Kate Ziser,Syeda Zahir,Gemma Todd,Leanne Ryan,David Heyworth-Smith,Liam Balkin,Annabelle Harrocks,Anton W G Booth","doi":"10.1016/j.bja.2024.07.042","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.042","url":null,"abstract":"BACKGROUNDSugammadex hypersensitivity is an emerging safety concern. We aimed to describe the clinical and diagnostic features of perioperative hypersensitivity to sugammadex, and secondarily to provide an estimate of perioperative sugammadex hypersensitivity incidence in Australia.METHODSWe retrospectively analysed cases of hypersensitivity to sugammadex diagnosed by positive intradermal or skin prick testing at six perioperative allergy clinics in Australia. We included all grades of hypersensitivity and compared life-threatening with non-life-threatening presentations. Incidence of hypersensitivity events was estimated relative to the estimated number of sugammadex administrations across two health services between January 1, 2010 and June 30, 2023.RESULTSThirty cases were included (15 life-threatening and 15 non-life-threatening). The most common clinical signs were hypotension (n=25, 83.3%) and flushing/erythema (n=21, 70%). The median time to recognition of hypersensitivity was 5 (interquartile range 2-7.5) min. Five cases were recognised 10-30 min after administration. Serum tryptase was measured in 28 (93.3%) patients. Tryptase was positive in 15 (100%) life-threatening cases and nine (69.2%) non-life-threatening cases. The estimated incidence of sugammadex hypersensitivity was 0.004% (95% confidence interval 0.002-0.008%).CONCLUSIONSSugammadex hypersensitivity presents similarly to other causes of perioperative hypersensitivity, however recognition can be delayed. The combination of positive serum tryptase and positive skin tests suggests an IgE-mediated mechanism of hypersensitivity. The estimated incidence of sugammadex hypersensitivity in Australia is lower than earlier reports.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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