NAP6: Perioperative Anaphylaxis

NAP6 Overview

NAP6 was the largest ever prospective study of anaphylaxis related to anaesthesia and surgery.

100% of NHS hospitals participated in NAP6, which studied every case of life-threatening anaphylaxis during 3 million anaesthetics given in the UK over a year long reporting period from November 2015 to November 2016.

Anaphylaxis in the operating theatre is a life-threatening drug reaction that happens suddenly, without warning and can affect anyone. Low blood pressure, impaired circulation and lack of oxygen in the lungs combine to starve the tissues of oxygen, leading to shock which in extreme cases rapidly progresses to cardiac arrest or even death.

The key questions for NAP6 were:

  • What proportion of cases of suspected perioperative anaphylaxis were referred and investigated?
  • How many were proven to be anaphylaxis and what were the culprits?
  • How well did immediate management, referral and investigation match published guidelines?
  • Was there a correlation between immediate management and outcomes?


What were the findings?

The findings of NAP6 were published in a report titled Anaesthesia, Surgery and Life-Threatening Allergic Reactions on 14 May 2018. Key findings are summarised in the infographic below.

NAP6 Publications

Activity Survey

An observational national study of anaesthetic workload and seniority across the week in the UK in 2016: the NAP6 Activity Survey

Activity Survey

Cross-sectional study of perioperative drug and allergen exposure in UK practice in 2016: the NAP6 Allergen Survey

Take a look at individual chapters from the NAP6 report, along with NAP6 tools and other publications.

NAP6 Launch

Click here for launch videos and presentations, filmed at the NAP6 Report Launch held at the Royal Society of Medicine in 2018.

NAP6 have created a summary that provides information particularly for patients, their families or their carers. We hope it is helpful to any patient worried about experiencing anaphylaxis during anaesthesia, or to patients who have had this experience.

Meet the NAP6 team

Prof Nigel Harper

NAP6 Clinical Lead

Prof Tim Cook

RCoA Director of the National Audit Projects

We thank the members of the NAP6 Steering Panel for their hard work and wise advice throughout this project:

  • Dr Mark Bellamy - Faculty of Intensive Care Medicine
  • Dr Bill Egner - Royal College of Physicians/Royal College of Pathologists Joint Committee on Immunology and Allergy
  • Dr Sophie Farooque - Imperial College Healthcare NHS Trust
  • Dr Kathleen Ferguson - Association of Anaesthetists of Great Britain and Ireland
  • Ms Katherina Floss - Royal Pharmaceutical Society of Great Britain
  • Dr Tomaz Garcez - UK Fatal Anaphylaxis Register
  • Mr John Hitchman - RCoA Lay Committee 
  • Dr Surendra Karanam - Sandwell and West Birmingham NHS Trust 
  • Dr Harriet Kemp - Research and Audit Federation of Trainees
  • Dr K-L Kong - Sandwell and West Birmingham NHS Trust 
  • Dr Nuala Lucas - Obstetric Anaesthetists Association
  • Dr Susana Marinho - British Society of Allergy and Clinical Immunology
  • Dr Neil McGuire - Medicines and Healthcare products Regulatory Agency
  • Prof Ramani Moonesinghe - RCoA Health Services Research Centre (now the Centre for Research & Improvement)
  • Dr Shuaib Nasser - British Society of Allergy and Clinical Immunology
  • Dr Guy Scadding - Imperial College Healthcare NHS Trust
  • Dr Mark Thomas - Association of Paediatric Anaesthetists of Great Britain and Ireland
  • Ms Helen Torevell - Bradford Teaching Hospitals NHS Trust
  • Ms Amena Warner - Allergy UK
  • Ms Laura Cortés - Royal College of Anaesthetists
  • Mr James Goodwin - Royal College of Anaesthetists
  • Mr Jose Lourtie - Royal College of Anaesthetists

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