Results of forty years Yellow Card reporting for commonly used perioperative analgesic drugs

Authors

  • Jennifer Richardson MA,

    1. Medical Student, Imperial College London, UK
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  • Anita Holdcroft MB, ChB, MD, FRCA

    Corresponding author
    1. Reader in Anaesthesia, Magill Department of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, UK
    • Magill Department of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK.
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  • Abstract has been published as: Richardson J, Holdcroft A, Results of forty years yellow card reporting for commonly used perioperative analgesic drugs. Br J Anaesth 2006; 96: 276P.

  • No conflict of interest was declared.

Abstract

Background

A variety of analgesics are used perioperatively and associated adverse drug reactions (ADRs) may complicate anaesthesia and recovery.

Methods

We aimed to measure the demographics of reported suspected ADRs to alfentanil, fentanyl, ketorolac, morphine, nalbuphine, papaveretum, pethidine and remifentanil. We report a retrospective analysis of Yellow Card reports of suspected ADRs from 1965–2004 as classified in the Adverse Drug Reaction On-line Tracking database (ADROIT) of the Medicines and Healthcare products Regulatory Agency (MHRA).

Results

In total, 1312 reactions were retrieved. A single drug was reported in 908, 39 were fatal and 219 categorised as ‘allergic’. Allergic phenomenon varied from 2/33 (6%) for remifentanil to 11/53 (21%) for alfentanil. ‘Cardiovascular’ reactions were reported frequently with remifentanil (18/33, 55%) and alfentanil (19/53, 36%) and these generated a signal for possible hazards from proportional reporting ratios (PRRs). The opioid fentanyl was associated with similar hazard signals for muscular and psychiatric ADRs.

Conclusions

Perioperative vigilance may reduce morbidity and mortality from preventable ADRs to analgesic drugs. Denominator and diagnostic data are essential for prospective studies. Copyright © 2007 John Wiley & Sons, Ltd.

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