BACKGROUNDChlorhexidine is used widely in different preparations for its antiseptic properties. The potential for developing sensitivity to chlorhexidine is very high as it is commonly used by the general population in mouthwash, toothpaste and skin disinfections. We report a case of a near fatal anaphylactic reaction to chlorhexidine. Subsequent skin testing suggests sensitivity to chlorhexidine, which had been used in the form of Instillagel (CliniMed, High Wycombe, UK) for urethral lubrication. CASE PRESENTATIONA 49-year-old man presented for cystolithotripsy. He had a history of rheumatoid arthritis with recurrent renal and bladder stones. He was a chronic smoker and had no known allergies. Previous anaesthetics (general and spinal) were uneventful. Anaesthesia was induced and maintained with propofol and remifentanil. A laryngeal mask airway (LMA) was used to secure the airway. Intraoperatively he received ciprofl oxacin, gentamicin, diamorphine, hyoscine butylbromide (buscopan) and ondansetron. Fifty minutes from the start of anaesthesia, the patient developed unexplained tachycardia associated with a drop in saturation (89%) and ETCO 2 (2.5 kpa). The LMA was changed to an endotracheal tube. The patient continued to desaturate, which was followed by pulseless electrical activity (PEA). Cardiopulmonary resuscitation was initiated rapidly and the patient received three doses of epinephrine (1 mg each) and one dose of atropine (1 mg). The PEA changed to ventricular fi brillation for which the patient was defi brillated. This was followed by a normal sinus rhythm. An epinephrine infusion was started to maintain the blood pressure. He was ventilated over night. Blood samples were sent for troponin-T and mast cell tryptase assays. He made an uneventful recovery and he was extubated next day. The mast cell tryptase level was elevated to 73 μg/litre (normal <11.4 μg/litre) supporting the diagnosis of anaphylactic reaction. Troponin-T (1.03 ng/ml) was raised, which could have resulted from cardiopulmonary resuscitation.

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Summary In hospitals of the developing world where financial constraints limit the procurement of even the most basic medical equipment, improvisation has become important and necessary. We describe a reliable, low‐cost, locally produced laryngoscope constructed out of wood.

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