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Life-threatening intraoperative anaphylaxis as a result of chlorhexidine present in Instillagel
  1. Joshua Totty1,
  2. James Forsyth2,
  3. Anthony Mekako2,
  4. Ian Chetter1
  1. 1Department of Academic Vascular Surgery, Hull York Medical School, Hull, UK
  2. 2Department of Vascular Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK
  1. Correspondence to Dr Joshua Totty, joshua.totty{at}


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.

  • vascular surgery
  • drugs and medicines
  • catheterisation/catheter care
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  • Contributors JT was responsible for preparation of the manuscript. JF was responsible for preparation of the manuscript and obtaining consent for publication. AM was the consultant in charge of the patient's care. IC oversaw the preparation of the manuscript. All authors read and approved the final submission.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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