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Page 16 | Bulletin 93 | September 2015 niaa@rcoa.ac.uk www.niaa.org.uk themes (for example, improving care in emergency surgery, or improving post-operative recovery in the elderly) are clearly amenable not just to investigation via research studies, but also through local and national quality improvement and audit initiatives. In other words, you do not need to be ‘research active’ to get involved in helping answer them! With an estimated ten million surgical procedures being performed every year in the UK, the scope for collecting patient data to help answer these questions is vast. The NAP and SNAP projects already provide a shining example of what can be achieved through effective collaboration of anaesthetists throughout the UK; trainee networks are likewise demonstrating the effectiveness of harnessing collective enthusiasm at a regional level in delivering large scale research and quality improvement projects. The PSP’s legacy: Alongside its role in informing the research agenda, the PSP has yielded two other benefits. First, it represents the most wide ranging example to date of engaging patients and the public in setting the research agenda, and should help promote patient and public involvement in future research. Secondly, it offered all anaesthetists – not just those already plugged into academic circles – an opportunity to propose ideas for future research. Many thanks to all those who contributed to either survey; and for those who didn’t, watch this space – because the research priorities will almost certainly need updating in 5-10 years’ time! BRITISH OXYGEN COMPANY RESEARCH GRANT NIAA National Institute of Academic Anaesthesia In 1958, the British Oxygen Company (BOC), made a charitable donation in support of anaesthesia research. The BOC Chair of Anaesthesia Fund was created using this donation and is a subsidiary charity of the Royal College of Anaesthetists. The object of the charity is the endowment of a research fellowship in a department of Anaesthesia. On behalf of the Royal College of Anaesthetists, the National Institute of Academic Anaesthesia (NIAA) is inviting applications for this grant. The RCoA wishes to utilise these funds in support of an anaesthetist who is working towards a senior fellowship or developing a credible application for a Chair in Anaesthesia (or related specialties) in the next five years. Applications from basic scientists with a similar ambition are also invited. Funding of £60,000 per annum is available. This can support the costs of research sessions, projects or infrastructure. The grant is available for four years (reviewed after two years). Applicants must demonstrate an existing research record, the support of a senior mentor/supervisor, a credible research proposal and evidence of a supportive research environment. Application forms are available from the NIAA website (www.niaa.org.uk). The deadline for applications is 8 am on Monday 16 November 2015. For more information please contact Miss Clare Bunnell, NIAA Administrator, at info@niaa.org.uk. 1 Equity and Excellence: Liberating the NHS. DoH http://bit.ly/1g6YkNw. 2 JLA. The James Lind Alliance www.jla.nihr.ac.uk/2014 [cited 2015 June]. 3 NICE. UK Database of Uncertainties about the Effects of Treatments (DUETs) www.library.nhs.uk/duets/ [cited 2015 April].
Page 17 | Bulletin 93 | September 2015 www.niaa-hsrc.org.uk The 6th National Audit Project Perioperative Anaphylaxis Nigel Harper, MAHSC Honorary Clinical Professor of Anaesthesia and Perioperative Medicine, University of Manchester Tim Cook, Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital Bath and Director of the National Audit Projects Perioperative Anaphylaxis was selected from a general call for submissions as the subject for the 6th National Audit Project (NAP) of the Royal College of Anaesthetists (RCoA) and, like previous NAPs, will involve every NHS hospital in the UK. This article is an introduction to the latest NAP. Why? Perioperative anaphylaxis is a rare lifethreatening event that is unexpected and unannounced, requiring immediate and skillful management followed by expert investigation. Anaphylaxis may not be the first diagnosis that comes to mind; there are much more common causes of perioperative hypotension and bronchospasm, for example. An individual anaesthetist may encounter only a handful of cases during their career, although many colleagues may consider they have already seen more than their quota. Important questions abound. What is the UK incidence of perioperative anaphylaxis? How many patients experience cardiac arrest as a result of perioperative anaphylaxis? What is the burden on intensive care services? What are the outcomes of perioperative anaphylaxis and what are the factors associated with poor outcome? Are some drugs more likely to cause anaphylaxis than others? Is perioperative anaphylaxis to chlorhexidine on the increase? Is latex allergy no longer a significant problem? Is there an epidemic of anaphylaxis to blue dye during breast surgery? How common and how severe is nonallergic perioperative anaphylaxis? Is the problem less or more frequent in children? Are some patients more prone to develop perioperative anaphylaxis than others? How many patients experience cardiac arrest as a result of perioperative anaphylaxis? What proportion of cases are reported to the Medicines and Healthcare products Regulatory Agency (MHRA) through the yellow-card system? Then there are questions relating to the immediate management of perioperative anaphylaxis. Is adrenaline really necessary in every patient? How much variation is there in the dose of adrenaline required? How often is it necessary to administer an infusion of adrenaline? How often is noradrenaline, vasopressin, glucagon or sugammadex used to treat perioperative anaphylaxis? How much intravenous fluid is actually administered during resuscitation? We have partial answers to a few of these many questions, but only a large UK-wide audit can offer the prospect of more complete knowledge and consequent patient benefit. Referring a patient for further investigation of suspected perioperative anaphylaxis should be straightforward, but how established are the referral routes from anaesthetist to allergy clinic? How many such specialist clinics exist in the UK? Is there geographical variation in specialist allergy clinic provision? Do the clinics provide a good service and do they make helpful recommendations to patients and anaesthetists? NAP6 also seeks to answer some of these questions and to point the way to potential service improvement with the collaboration of allergy professionals and patient groups. What and when? NAP6 is being conducted by the RCoA through the Health Services Research Centre (HSRC). The steering panel was convened in March 2015 and includes representation from the Association of Anaesthetists of Great Britain & Ireland, the Association of Paediatric Anaesthetists of Great Britain & Ireland, the Association for Perioperative Practice, the Faculty of Intensive Care Medicine, the HSRC, the MHRA, the Obstetric Anaesthetists’ Association, the Research & Audit Federation of Trainees, the Royal Pharmaceutical Society and the Safe Anaesthesia Liaison Group, and also professional allergy organisations and patient groups. NAP6 will seek reports of every case meeting the following criteria during the data collection period: ■■ Grade 3, 4 and 5 reactions (i.e. – severe reactions, life-threatening reactions and deaths). Minor reactions such as localized rash or anticipated hypotension or bronchospasm will be excluded).
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