ABSTRACT
Anaphylaxis to chlorhexidine is rare. We report three cases of anaphylaxis attributed to the chlorhexidine component of Instillagel, presenting after urological surgery, while the patients were in the recovery room. In these cases, the cause of the collapse was not immediately obvious as the presentation was delayed. Anaesthetists should be aware that urethral lubricants may contain chlorhexidine that can trigger anaphylaxis in susceptible individuals. Anaphylaxis should be considered a possible diagnosis when a patient collapses in the recovery room. Investigation of suspected anaphylactic reactions related to anaesthesia is important to try and identify a likely trigger for a reaction and to help prevent further exposure and potential harm.
Subject(s)
Anaphylaxis/chemically induced , Chlorhexidine/adverse effects , Drug Hypersensitivity/etiology , Lubricants/adverse effects , Postoperative Complications/chemically induced , Adult , Anti-Infective Agents, Local/adverse effects , Female , Humans , Male , Middle Aged , Urinary Catheterization/methods , Urologic Surgical ProceduresABSTRACT
Two siblings with a distal motor neuropathy experienced cramping and difficulty in relaxing their muscles after voluntary contraction. Electromyographic recordings at rest revealed repetitive high voltage spontaneous electrical discharges that were accentuated after voluntary contraction and during ischaemia. Regional neuromuscular blockage with curare indicated hyperexcitability of peripheral nerve fibres and nerve block suggested that the ectopic activity originated in proximal segments of the nerve. Symptoms were improved with diphenylhydantoin, carbamazepine and tocainide.
