A 70-year-old man with left lower limb critical ischaemia was admitted to our vascular unit for a femoral-popliteal bypass. He had experienced a skin reaction to chlorhexidine 6 months previously during an angioplasty procedure. After intubation, once in the operating theatre, the patient had a urinary catheter inserted using Instillagel. Around 30 min later the patient had a full-blown anaphylactic reaction that required aggressive medical management and the abandoning of surgery. Postoperative allergy testing confirmed that the suspected primary trigger for the anaphylaxis was indeed chlorhexidine, which was present in Instillagel. The patient was also found to have allergies to atracurium and teicoplanin, which had been given on induction. This case report highlights the importance of recognising that Instillagel contains chlorhexidine, and that indeed intraurethral use during routine urinary catheterisation can be a cause of life-threatening anaphylaxis.
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| http://dx.doi.org/10.1136/bcr-2017-221443 | DOI Listing |
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Life-threatening intraoperative anaphylaxis as a result of chlorhexidine present in Instillagel.
BMJ Case Rep
August 2017
Department of Academic Vascular Surgery, Hull York Medical School, Hull, UK.
A 70-year-old man with left lower limb critical ischaemia was admitted to our vascular unit for a femoral-popliteal bypass. He had experienced a skin reaction to chlorhexidine 6 months previously during an angioplasty procedure. After intubation, once in the operating theatre, the patient had a urinary catheter inserted using Instillagel.
View Article and Find Full Text PDF[Local analgesia during flexible cystoscopy in male patients: A non-inferiority study comparing Xylocaine gel to Instillagel Lido].
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July 2017
Service d'urologie, hôpital Pitié-Salpétrière, AP-HP, 47-83, boulevard de l'Hopital, 75013 Paris, France. Electronic address:
Introduction: Local anesthesia using urethral gel has been proven to reduce discomfort of male patients during flexible cystoscopy. This study was a non-inferiority study between two lidocain-containing urethral gel (Instillagel Lido and Xylocaine gel).
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A A Case Rep
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From the *Institute of Anesthesiology and Pain Medicine, and †Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
In this case report, we describe a healthy urological patient who suffered severe intraoperative anaphylaxis to chlorhexidine, an ingredient contained in frequently used lubricants (Instillagel, Endosgel). Chlorhexidine is a well-known skin disinfectant and antiseptic component in mouthwash or other over the counter antiseptic pharmaceuticals. There is little awareness that commonly used lubricants may contain hidden chlorhexidine.
View Article and Find Full Text PDFAnaphylactic reaction to intraurethral chlorhexidine: sensitisation following previous repeated uneventful administration.
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Instillagel(®) (CliniMed, High Wycombe, UK) is commonly used in urethral catheterisation and to facilitate the passage of instruments into the bladder in urological practice. Its active ingredients include 0.25% chlorhexidine, 2% lidocaine, 0.
View Article and Find Full Text PDFA case report of anaphylaxis to chlorhexidine during urinary catheterisation.
Ann R Coll Surg Engl
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North Devon Healthcare NHS Trust, UK.
Chlorhexidine gluconate is a chemical antiseptic that is effective against Gram positive and negative bacteria and on certain viruses and fungi. A bacteriocidal and bacteriostatic agent, this cationic drug is absorbed on to negatively charged cell surfaces of organisms, disrupting the cell membrane, which results in increased permeability. Its use is mainly topical as a surgical hand antisepsis, site preparation/cleansing and for pre-genitourinary procedures such as urethral catheterisation.
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