Recurrent allergic reactions to unrecognized chlorhexidine exposure leading to pulseless electrical activity: a case report

Chlorhexidine applied to the skin during catheter insertion can cause allergic reactions; however, its potential to cause perioperative anaphylaxis is often overlooked. Herein, we report a case of recurrent allergic reactions to unrecognized chlorhexidine exposure, leading to pulseless electrical activity. A 66-year-old man exhibited an allergic reaction during anesthesia induction for Y-graft replacement for an abdominal aortic aneurysm, and the planned surgery was aborted. Skin tests for anesthetics were negative. Two months later, he experienced itching after epidural catheter insertion but did not report it. During a second anesthesia induction, the patient experienced another allergic reaction of unknown etiology. Although hemodynamics stabilized after vasopressor administration, insertion of a central venous catheter 1 hour later to prevent further hypotension triggered pulseless electrical activity. Chlorhexidine was used as a skin disinfectant during catheter insertion before all four reactions and was confirmed to have caused the anaphylaxes using diagnostic tests. Chlorhexidine should be considered a potential cause of perioperative anaphylaxis.