title: Cetrimide-chlorhexidine-induced multiorgan failure in surgery of pulmonary hydatid cyst.
abstract: Savlon (0.5% cetrimide/0.05% chlorhexidine) is used as a scolicidal during surgery of hydatid cysts. It is considered a safe and effective agent. However, there are no recommendations for the appropriate concentration or dosage of these agents. Previously reported to cause severe metabolic acidosis, its effects on the pulmonary system have not been explored. We present a case of acute lung injury and respiratory distress along with acute cardiopulmonary distress, severe metabolic acidosis, and renal failure following its use during surgical removal of pulmonary hydatid cyst. The agent may act as a chemical sclerosant causing pulmonary parenchymal damage through bronchial openings present in the pericyst. Till safe dose limits are known, use of this agent should be limited, especially in large or multiple cyst surgery.
authors.affiliation: Department of Trauma and Emergency Medicine, AIIMS, Bhubaneswar, Odisha, India.
authors.forename: Swagata
authors.initials: S
authors.lastname: Tripathy
authors.affiliation: Department of General Surgery, AIIMS, Bhubaneswar, Odisha, India.
authors.forename: Prakash
authors.initials: P
authors.lastname: Sasmal
authors.affiliation: Department of Anaesthesia, AIIMS, Bhubaneswar, Odisha, India.
authors.forename: P Bhaskar
authors.initials: PB
authors.lastname: Rao
authors.affiliation: Department of General Surgery, AIIMS, Bhubaneswar, Odisha, India.
authors.forename: Tushar S
authors.initials: TS
authors.lastname: Mishra
authors.affiliation: Department of Anaesthesia, AIIMS, Bhubaneswar, Odisha, India.
authors.forename: Sukdev
authors.initials: S
authors.lastname: Nayak
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D002593:Cetrimonium Compounds / Q000009:adverse effects*; D002710:Chlorhexidine / Q000009:adverse effects*; D004338:Drug Combinations; D004445:Echinococcosis, Pulmonary / Q000601:surgery*; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000139:chemically induced*
chemical_list: D000891:Anti-Infective Agents, Local; D002593:Cetrimonium Compounds; D004338:Drug Combinations; C012027:savlon; D002710:Chlorhexidine