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Perioperative Allergy Investigation — FRCA Final MCQ

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ModeratePreoperative AssessmentPerioperative Allergy InvestigationFRCA Final

A 35-year-old woman, ASA physical status 1, is assessed before elective laparoscopic cholecystectomy. During a previous general anaesthetic 2 years ago, she developed abrupt profound hypotension and bronchospasm shortly after induction and required adrenaline. No alternative cause was established, no culprit exposure was identified, and she did not undergo allergy investigation. What is the most appropriate preoperative management?

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Correct answer: C — Defer the elective operation and refer her to a specialist perioperative allergy clinic

The correct answer is C. The previous combination of abrupt hypotension and bronchospasm requiring adrenaline is strongly suggestive of perioperative anaphylaxis. Because the culprit remains unidentified and the proposed operation is elective, surgery should be deferred pending specialist perioperative allergy investigation. This uses the original anaesthetic record and appropriately timed specialist testing to identify likely culprit and safe alternative agents. Premedication with an antihistamine or corticosteroid does not reliably prevent anaphylaxis and may obscure minor features. Avoiding neuromuscular blocking agents alone is inadequate because antibiotics, chlorhexidine and other perioperative exposures are also important causes. Regional anaesthesia does not remove all perioperative allergen exposure and is not a substitute for investigation. Skin testing requires specialist expertise, validated concentrations and interpretation; it should not be undertaken in the anaesthetic room.

Reference: Royal College of Anaesthetists. Anaesthesia, Surgery and Life-Threatening Allergic Reactions: Report and Findings of the Sixth National Audit Project (NAP6), Key Findings and Recommendations 56 and 63. 2018. https://www.rcoa.ac.uk/media/33366