Anaphylactic reaction to chlorhexidine in urinary catheter lubricant.

A 52-year-old man suffering from poorly controlled epilepsy required general anaesthesia for temporal lobectomy. His past medical history was limited to allergic rhinitis, with no symptoms of asthma or eczema. He had previously received two general anaesthetics (over fifteen years ago) without incident. Regular medication included phenytoin, clonazepam, and chlorpheniramine. Following oral premedication with temazepam 20 mg, intravenous and intra-arterial cannulae were inserted using 1070 lignocaine. Anaesthesia was induced with thiopentone, fentanyl, and vecuronium then maintained with nitrous oxide and isoflurane in oxygen with intermittent positive pressure ventilation. After 30 minutes of anaesthesia and following urinary catheter insertion the scalp was prepared with chlorhexidine solution, skull pins were inserted and surgery commenced. Shortly after cephamandole 1.0 g was administered intravenously, the patient developed hypotension (systolic blood pressure 80 mmHg) and relative tachycardia (110 beats per minute). The presence of bronchospasm was suggested by an increase in the airway pressure from 25 to 40 cm of water and confirmed by auscultation. Oxygen saturation fell from 96% to 90% and a truncal erythematous rash developed. Resuscitation was commenced with 100% oxygen, intravenous polygelene solution and increments of ephedrine to a total of 9 mg. As there was no response, 1 ml of 1:10,000 adrenaline was given intravenously and the blood pres-