• Alex Ho, Jeffrey Zaltzman, Hare Gregory M T GMT Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada., Lucy Chen, Lisa Fu, Susan M Tarlo, and Peter Vadas.
• Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
• Can J Anaesth. 2019 Dec 1; 66 (12): 1483-1488.

PurposeAlthough intraoperative anaphylaxis during surgery is a rare event, we describe five patients who experienced perioperative anaphylactic reactions during renal transplantation and were referred for investigation.Clinical FeaturesSkin-prick and intradermal skin tests were done to investigate potential allergies to drugs given perioperatively prior to the development of anaphylaxis, including basiliximab, propofol, cefazolin, cis-atracurium, fentanyl, latex, remifentanil, and chlorhexidine. In addition, in vitro serologic testing for specific IgE was done in patients suspected to have had chlorhexidine anaphylaxis. All five patients were male, with a mean age of 48 yr (range 30-69). Skin testing for all drugs was non-reactive except for chlorhexidine, which was positive in four of five patients (one patient refused intradermal testing). In vitro test results for chlorhexidine-specific IgE were positive in all of the patients. Anesthetic records showed that intraoperative anaphylaxis had occurred immediately after insertion of a chlorhexidine-coated central venous catheter.ConclusionsIntraoperative insertion of chlorhexidine-coated central venous catheters can trigger life-threatening anaphylaxis in susceptible patients undergoing renal transplantation.

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