ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

Quality and SafetyContinuedAnaphylaxis toChlorhexidineIn a recent edition of the British Journalof Anaesthesia, Parkes et al provide areport on three cases of anaphylaxis tochlorhexidine 1 . In all three reports theanaphylactic reaction followed the use ofurethral lubricant in the operating theatreand the authors noted that there may bea delayed presentation of cardiovascularcollapse and skin manifestations whichin these cases occurred some time afteradmission to the recovery area.A number of early reports of anaphylaxis tochlorhexidine were reported in urologicaljournals and two reports in Anaesthesia andIntensive Care in 1994 2 and 1995 3 all relatedto the use of urethral lubricants.Of interest is a case report which concerns amale undergoing a neck dissection and freeflap who developed marked hypotensionand tachycardia one hour after induction.A urinary catheter was being inserted atthe time and latex allergy was consideredbut proved negative. The patient made anuneventful recovery and skin testing wasunremarkable. The possibility of sensitivityto chlorhexidine was not considered atthis time.One year later the patient developed anerythematous rash over his entire bodyduring the insertion of intra-arterialand central venous lines (PICC line). Noanaesthetic drugs had been administeredbut the surgery did not proceed. Skin testingrevealed strongly positive reactions to boththe lignocaine-chlorhexidine lubricant usedfor the urinary catheter insertion and forthe subsequent use of chlorhexidine skinpreparation for the invasive monitoring.Anaesthetists are reminded that whenthere is unexplained cardiovascularcollapse, especially in the recovery area,the possibility of anaphylactic reactionsto chlorhexidine should be considered aschlorhexidine is present in a wide varietyof agents used in healthcare as well as inthe community.References1. Parkes AW, Harper N, HerwadkarA, Pumphrey R Anaphylaxis to thechlorhexidine component of Instillagel: acase series. Br J Anaesth 2009; 102: 65-682. Russ BR, Maddem PJ. Anaphylacticreaction to chlorhexidine in urinarycatheter lubricant. Anaesth IntensiveCare 1994; 22611-23. Parker F, Foran S. Chlorhexidine catheterlubricant anaphylaxis. Anaesth IntensiveCare 1995; 23:126Dr Fred RosewarneVictoriaQuality and SafetyCommittee membershipThe Quality and Safety Committee is justone of 12 committees of ANZCA that reportsto the ANZCA Council. While both myselfand Dr Elizabeth Feeney, President, ASA,are observers at the College Council, weare full members of the Quality and SafetyCommittee and therefore have an activerole on this important group.This means that opinions from outsidea direct college framework that reflectthe views of the respective societies’memberships can be expressed andparticularly from the NZSA point of viewthere is an additional New Zealand voiceon the committee. Not all practisinganaesthetists are Fellows but via this forumit is possible for them to have a say in theCollege’s activities.The committee is responsible for advisingand informing Council in matters of bothquality assurance and safety and also reportissues of concern directly to ANZCA fellowsvia the Bulletin or the website, giving allpractising anaesthetists up-to-date andtimely information that may seriously affectpractice. The discussions of the committeeare wide ranging and encompass all aspectsof quality and safety in anaesthesia suchas the Australia and New Zealand TripartiteAnaesthetic Data Committee process andthe preparation of appropriate guidelines.It is an interesting and enjoyable committeeto take part in, and its work is veryimportant for the patients of New Zealandand Australia.Dr Andrew Warmington, President,New Zealand Society of Anaesthetists (NZSA)Auckland, New Zealand48The ANZCA Bulletin June 2009