Post-Surgical Respiratory Distress In Cats
Associated With Chlorhexidine Surgical Scrubs
This past winter (1996), Dr. Mosley of the LakeviewVeterinaiy
Clinic, Mitchell, South
Dakota, was seeing post-surgical
respiratory distress in cats. The syndrome occured 24-48
hours after surgery and consisted of fever, partial anorexia,
serous nasal discharge, and an abnormal respiratory "rattle"
that seemed to originate from the larynx and nasal cavities.
There were no deaths, and with supportive care the cats
recovered in two to five days. A temporary cessation of
surgeries combined with a thorough cleansing of the surgical
suite and equipment did not resolve the problem. Changes
in anesthetic protocols also did not resolve the problem.
Pharyngeal swabs from three different cats were submitted
for virus isolation during their respiratory distress; one
cat was cultured twice several weeks apart. A virus that
was neutralized by antibody to Feline Syncytial Virus was
isolated from two different cats. Culture attempts from
one cat did not re-isolate the virus. The importance of
these viruses relative to the clinical syndrome is doubtful.
A note concerning this problem was posted on the internet
(American Association of Veterinary Laboratory Diagnosticians
- List). Several suggestions were received, but most had
already been considered and ruled out. A previous report
of adverse reactions to chlorhexidine surgical scrubs was
The clinic involved with the current investigation was
using Nolvasan Surgical Scrub (Fort Dodge Labs) and all
cats with the problem were scrubbed with that 2% chlorhexidine
acetate product. The product was not being used to clean
endotracheal tubes and the problem had occurred in some
cats that had not been intubated. After ceasing use of chlorhexidine
surgical scrub, the problem immediately resolved, highly
suggestive that this was an adverse reaction to chlorhexidine
surgical scrub, centered on the laryngeal/pharyngeal
The problem with chlorhexidine in cats has led one company
(Solvay) to place warning labels against usage on cats and
kittens (Solvahex brand -4% chlorhexidinegluconate).
Fort Dodge Laboratories has not warned against usage in
cats as they report the problem is very rare with their
product and they suspect individual sensitivity is a factor.
Two routes of exposure are possible. The material can be
a residue on endotracheal tubes or the cats can ingest the
surgical scrub after surgery by grooming. One important
variable between different clinics is how much surgical
scrub is left on the hair and skin versus being completely
There has also been discussion regarding the difference
between 4% chlorhexidinegluconate versus 2% chlorhexidine
acetate. If the reaction is to chlorhexidine, then differences
in concentration could certainly be a factor in expression
of the syndrome. However, other chemicals are present in
the scrubs (surfactants, perfumes, etc) and there has been
no published data verifying the precise chemical cause of
the reaction. The solution seems simple: Avoid using chlorhexidine
scrubs to clean cat endotracheal tubes and thoroughly rinse
the product off when using on cats.
- David Zeman
- edited by Stephen Hooser,DVM,PhD
South Dakota Animal Disease Research and Diagnostic Lab,
Brookings,SD and Lakeview Veterinary Clinic, Mitchell, SD.
Proceedings 105th annual meeting, SD Vet MedAssoc, 8/96,