Totty Joshua, Forsyth James, Mekako Anthony, Chetter Ian
Department of Academic Vascular Surgery, Hull York Medical School, Hull, UK.
Department of Vascular Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK.
BMJ Case Rep. 2017 Aug 21;2017:bcr-2017-221443. doi: 10.1136/bcr-2017-221443.
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.
一名患有左下肢严重缺血的70岁男性因股腘动脉搭桥手术入住我们的血管外科病房。他在6个月前的一次血管成形术过程中对氯己定出现了皮肤反应。插管后，进入手术室后，使用凝胶尿道润滑剂为患者插入了导尿管。大约30分钟后，患者出现了严重的过敏反应，需要积极的医疗处理并放弃手术。术后过敏测试证实，疑似过敏反应的主要诱因确实是氯己定，它存在于凝胶尿道润滑剂中。还发现该患者对诱导期使用的阿曲库铵和替考拉宁过敏。本病例报告强调了认识到凝胶尿道润滑剂含有氯己定的重要性，以及在常规导尿过程中尿道内使用确实可能导致危及生命的过敏反应。
