Perioperative anaphylaxis management and testing: a quaternary centre audit

Area of Science:

• Anesthesiology
• Allergy and Immunology
• Critical Care Medicine

Background:

• Anaphylaxis is a severe hypersensitivity reaction, frequently implicated in anesthesia-related fatalities.
• Audits are essential for evaluating perioperative anaphylaxis management and allergy testing referral quality.
• Quaternary centers play a vital role in managing complex anesthetic emergencies.

Purpose of the Study:

• To audit the management of perioperative anaphylaxis at a quaternary center.
• To assess the quality of referrals to an anesthesia allergy testing service.
• To identify areas for improvement in patient care and safety protocols.

Main Methods:

• Analysis of 41 patient cases of perioperative anaphylaxis (Jan 2020 - Jan 2022).
• Evaluation of interventions: fluid administration, adrenaline use, CPR, and serum tryptase timing.
• Assessment of referral quality, allergy alert provision, and time to allergy testing against ANZAAG guidelines.

Main Results:

• Compliance with intravenous fluid administration, referral quality, and tryptase sampling was below 80%.
• Tryptase sampling showed particular deficiencies at the 4-hour timepoint.
• Significant deviations from recommended management protocols were observed.

Conclusions:

• Surgical leadership and patient advocacy can enhance post-acute care, testing, and counseling.
• Case-by-case reviews of management compliance are recommended for institutions.
• Prompting updates to institutional allergy alerts on referral forms is advocated to improve patient safety.