Shock caused by iodophor immersion irrigation of joint cavity : a case report

Shock caused by iodophor immersion irrigation of joint cavity : a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Shock caused by iodophor immersion irrigation of joint cavity : a case report Yida Amu, Shihong Li, Xiaolong Zheng, Yingchao Tang, Dongfa Liao, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4979088/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Iodophor, as a disinfectant, is widely used for skin disinfection in surgical procedures. Because of its good disinfection and sterilization function, iodophor is used for joint cavity immersion irrigation in orthopedic joint replacement surgery to reduce the incidence of postoperative infection. Adverse reactions caused by the use of iodophor have been rarely reported, and anaphylaxis has been reported in individual cases when iodophor disinfects the skin. Shock reaction caused by iodophor soaking to irrigate the joint cavity was the first finding. Case presentation: A 57-year-old female patient underwent right total hip arthroplasty under general anesthesia due to osteoarthritis secondary to bilateral developmental dysplasia of the hip . Patient had stable vital signs prior to iodophor soak irrigation of joint cavity during surgery. When iodophor was poured into the joint cavity for soaking and flushing after acetabular polishing during the operation, the patient experienced a rapid decrease in blood pressure, with the initial blood pressure of 94/56 mmHg. When the blood pressure rapidly decreased to 53/28 mmHg, vasopressors were given and iodophor was sucked out of the joint cavity and flushed with normal saline. After the blood pressure decreased to 40/20 mmHg, the patient stopped decreasing and gradually increased to normal. Conclusions: When iodophor is poured into the joint cavity for soaking and irrigation, rare shock reactions with rapid decrease of blood pressure occur, which need to be paid enough attention and rescue measures should be prepared in advance. Iodophor Shock Immersion irrigation Joint replacement Figures Figure 1 Figure 2 Figure 3 Background Iodophor has a broad bactericidal spectrum and is a broad-spectrum bactericidal solution. In vitro, iodophor has the ability to penetrate biofilms and has been shown to be effective against a variety of pathogens, including Gram-positive and Gram-negative bacteria, Bacillus, protozoa, and viruses. In addition, iodophor is widely used for skin disinfection in surgical procedures due to its low cytotoxicity and good tolerability without the development of resistant bacteria [ 1 – 6 ]. Iodophor application in wounds can also promote wound healing by increasing the expression of transforming growth factor β [ 7 ]. Iodophor can not only be used for skin disinfection, but literature studies have shown that iodophor soaking irrigation effectively reduces the risk of surgical wound infection without increasing complications [ 8 – 9 ]. Periprosthetic joint infection after arthroplasty is one of the catastrophic complications after artificial joint replacement. It is reported in the literature that the incidence of periprosthetic joint infection is 0.3 ~ 1.7% in patients undergoing primary total hip arthroplasty and 0.8 ~ 1.9% in patients undergoing primary total knee arthroplasty [ 10 – 14 ]. Given its high incidence and serious consequences, many interventions have been introduced to reduce the occurrence of periprosthetic infections. In recent years, iodophor has been more and more widely used to soak and rinse artificial joint replacement wounds to prevent infection, and its clinical effect in preventing infection has been gradually recognized [ 15 ]. Case presentation A 57-year-old female patient with no underlying disease underwent right total hip arthroplasty under general anesthesia for osteoarthritis secondary to bilateral developmental dysplasia of the hip ( Figure a ). Blood pressure was dynamically monitored by radial artery puncture and catheterization of the left wrist before surgery. During the operation, the posterolateral approach of the hip joint was taken, the skin and subcutaneous tissue were incised, the joint capsule was incised, and the femoral head was dislocated. Femoral neck osteotomy was performed with an oscillating instrument, and the femur was treated with a femoral broach after osteotomy. After femoral treatment, the acetabulum was treated, and the acetabulum was washed with normal saline after acetabular polishing, during which the patient 's vital signs were stable. About 100ml of iodophor was poured into the hip joint for soaking, flushing and disinfection. About 30 s after pouring into iodophor, the patient showed a rapid progressive decrease of blood pressure. Within 10 s, the patient 's blood pressure rapidly decreased from 94/56 mmHg to 53/28 mmHg. At this time, the anesthesiologist immediately gave 10 ug of norepinephrine to increase the pressure. At the same time, the orthopedic surgeon immediately sucked out the iodophor in the acetabulum with a suction device and washed the acetabulum with normal saline for many times. The patient 's blood pressure continued to decrease to the minimum of 40/20 mmHg and then began to increase. Perdipine 0.2 mg was administered to lower blood pressure when the blood pressure increased to 148/94 mmHg. After the blood pressure reached the maximum of 160/96 mmHg, the blood pressure slowly decreased until the blood pressure recovered as before ( Figure b ). After the vital signs were stable, acetabular cup was placed, acetabular screw was implanted, polyethylene liner was installed, femoral stem was installed, femoral head ceramic prosthesis was installed, and hip joint was reduced. The surgical incision was closed in layers after checking that there was no active bleeding. Sterile dressing was applied and the procedure was completed. The patient recovered well after surgery without complications and was discharged uneventfully( Figure c ). Discussion The patient had no history of allergies preoperatively. Preoperative use of iodophor to disinfect the skin around the incision showed no allergy or blood pressure fluctuation; postoperative surgical incision dressing change using iodophor for disinfection showed no allergy or blood pressure fluctuation. The patient was given intravenous cefazolin sodium to prevent infection before the operation, without allergic manifestations; cefazolin sodium was given to prevent infection after the operation, without allergic conditions. The patient was given tranexamic acid to control bleeding before surgery, and there was no allergic manifestation; tranexamic acid was also given to stop bleeding after surgery, and there was no allergic condition. During the surgery, the patient showed sharp drop of blood pressure, which was considered to be caused by shock reaction after pouring iodophor into joint cavity. This condition is very dangerous, and if not detected and managed promptly, the patient is at risk of multiple organ failure and cardiac arrest leading to death. Our review of the literature did not find similar reports. Rare adverse reactions have been reported in the literature when iodophor is administered to humans. Literature data came from a small number of case reports, and some patients developed allergic manifestations after cutaneous application of iodophor [ 16 ]. Some patients have anaphylactic shock when washing the rectum with iodophor [ 17 ]. Some patients have allergic reactions caused by transvaginal iodophor [ 18 ]. Previous literature has reported the risk of iodine-related complications when iodophor is used for intra-articular soaking. High concentrations of exogenous iodine can reduce thyroid hormone synthesis, and transient hypothyroidism can occur in open chest wounds disinfected with iodophor [ 19 ] However, the latest American Academy of Orthopaedic Surgeons, Centers for Disease Control and Prevention, and the World Health Organization support surgical irrigation with iodophor during surgery [ 20 ]. Current literature analysis also suggests that diluted iodophor lavage is significantly superior to saline lavage in preventing periprosthetic infection [ 21 ]. According to statistics, there are about millions of patients undergoing joint replacement surgery every year worldwide, and this number is still increasing. The experience of this patient makes orthopedic surgeons realize that iodophor soaking and flushing the joint cavity may cause fatal hypotension in patients. Early rescue measures can save the lives of such patients. Of course, the situation of this patient is rare, but the consequences are quite serious, not only orthopedic surgeons, but other surgeons will also pour iodophor into the incision or in vivo immersion irrigation and disinfection, these operations have the risk of iodophor-induced shock reaction, this patient 'experience deserves enough attention from all our surgeons. At the same time, the experience of this patient also suggests that routine arterial puncture monitoring of blood pressure during surgery is necessary, and it is difficult to imagine that if this patient does not undergo arterial puncture blood pressure monitoring, we cannot detect changes in blood pressure in a timely manner, then the consequences will be catastrophic. Our study also has some limitations, because the consequences are serious and life-threatening, and we can no longer pour iodophor into the joint cavity of patients to verify that the dramatic progressive decrease in blood pressure in patients is caused by iodophor, so our conclusions also lack validation and further studies are needed. Declarations Ethics approval and consent to participate The patient received prior information before providing her written, informed consent in accordance with the Declaration of Helsinki. The article was approved by the ethics committee of the General Hospital of Western Theater Command. Acknowledgements Not applicable. Clinical trial number Not applicable. Author contributions Wei Wang,Qingyun Xie and Dongfa Liao performed the surgery. Song Chen, Shihong Li and Xiaolong Zheng,YingchaoTang,Yida Amu helped with surgery. Yida Amu helped draft the manuscript. All authors read and approved the final manuscript. Funding This research was Supported by Sichuan Science and Technology Program (2023YFS0052) and Project of Sichuan Provincial Administration of Traditional Chinese Medicine (2023MS215). Data availability The data used and/or analyzed during the current study are available from the corresponding author on reasonable request. Consent for publication The authors confirm that informed consent was obtained from the patient for publication of this case report. Competing interests The authors declare no competing interests. References Messager S, Goddard PA, Dettmar PW, et al．Comparison of two in vivo and two ex vivo tests to assess the antibacterial activity of several antiseptics［J］． J Hosp Infect,2004,58( 2) : 115 － 121． Wutzler P, Sauerbrei A, Kl cking R, et al．Virucidal activity and cytotoxicity of the liposomal formulation of povidone-iodine［J］． Antiviral Res，2002，54( 2) : 89 － 97． Reimer K, Wichelhaus TA, Sch fer V, et al．Antimicrobial effectiveness of povidone-iodine and consequences for new application areas［J］． Dermatology，2002，204( Suppl 1) : 114 － 120． Cherry M, Daly CG, Mitchell D, et al．Effect of rinsing with povidone-iodine on bacteraemia due to scaling: a randomized-controlled trial［J］． J Clin Periodontol，2007，34 ( 2 ) : 148 － 155． Seguin P, Tanguy M, Laviolle B, et al．Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma［J］．Crit Care Med， 2006，34( 5) : 1514 － 1519． Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA. Povidone iodine in wound healing: A review of current concepts and practices. Int J Surg. 2017 Aug; 44:260-268. Barreto R, Barrois B, Lambert J, Malhotra-Kumar S, Santos-Fernandes V, Monstrey S. Addressing the challenges in antisepsis: focus on povidone iodine. Int J Antimicrob Agents. 2020 Sep;56(3):106064. Cheng MT, Chang MC, Wang ST, et al． Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery［J］． Spine ( Phila Pa 1976) ，2005，30 ( 15) : 1689 － 1693． Chundamala J, Wright JG． The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review［J］． Can J Surg，2007，50 ( 6 ) : 473 － 481. Jmsen E, Huhtala H, Puolakka T, et al． Risk factors for infection after knee arthroplasty． A register-based analysis of 43149 cases［J］． J Bone Joint Surg Am，2009，91( 1) : 38 － 47． Peersman G, Laskin R, Davis J, et al． Infection in total knee replacement: a retrospective review of 6489 total knee replacements ［J］． Clin Orthop Relat Res，2001，392( 392) : 15 － 23． Pulido L, Ghanem E, Joshi A, et al． Periprosthetic joint infection: The incidence，timing，and predisposing factors［J］． Clin Orthop Relat Res，2008，466( 7) : 1710 － 1715． Choong PF, Dowsey MM, Carr D, et al． Risk factors associated with acute hip prostheticjoint infections and outcome of treatment with a rifampin-based regimen［J］． Acta Orthop，2007，78( 6) : 755 － 765． Phillips JE, Crane TP, Noy M, et al． The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey［J］． J Bone Joint Surg Br，2006，88( 7) : 943 － 948． OTANI T, FUJII H, KAWAGUCHI Y, et al. Treatment of periprosthetic hip infection with retention of a well-fixed stem: six to 13-year outcomes. Arthroplasty. 2019;1(1):3. Pedrosa C, Costa H, Oliveira G, Romariz J, Praça F. Anaphylaxis to povidone in a child. Pediatr Allergy Immunol. 2005 Jun;16(4):361-2. Palobart C, Cros J, Orsel I, Nathan N. Choc anaphylactique à la povidone iodée [Anaphylactic shock to iodinated povidone]. Ann Fr Anesth Reanim. 2009 Feb;28(2):168-70. Ono T, Kushikata T, Tsubo T, Ishihara H, Hirota K. [A case of asystole following povidone iodine administration]. Masui. 2011 Apr;60(4):499-501. Tomoda C, Kitano H, Uruno T, et al． Transcutaneous Iodine absorption in adult patients with thyroid cancer disinfected with povidone-iodine at operation［J］． Thyroid, 2005, 15( 6) : 600 － 603 Chambers MM, Namdari S. A Review of Surgical Irrigation Solutions for Infection Prevention in Orthopaedic Surgery. JBJS Rev. 2023 Dec 1;11(12). Kobayashi N, Kamono E, Maeda K, Misumi T, Yukizawa Y, Inaba Y. Effectiveness of diluted povidone-iodine lavage for preventing periprosthetic joint infection: an updated systematic review and meta-analysis. J Orthop Surg Res. 2021 Sep 22;16(1):569. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4979088","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":351510755,"identity":"93da8704-2495-4950-9645-253a18acd788","order_by":0,"name":"Yida Amu","email":"","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":false,"prefix":"","firstName":"Yida","middleName":"","lastName":"Amu","suffix":""},{"id":351510756,"identity":"846b4884-05c7-4fb8-8c2c-bc14999978bd","order_by":1,"name":"Shihong Li","email":"","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":false,"prefix":"","firstName":"Shihong","middleName":"","lastName":"Li","suffix":""},{"id":351510757,"identity":"1df429c7-12d2-4234-bddf-203a88e14737","order_by":2,"name":"Xiaolong Zheng","email":"","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":false,"prefix":"","firstName":"Xiaolong","middleName":"","lastName":"Zheng","suffix":""},{"id":351510758,"identity":"0931b277-535b-4f9b-aa96-76dc59bfecd2","order_by":3,"name":"Yingchao Tang","email":"","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":false,"prefix":"","firstName":"Yingchao","middleName":"","lastName":"Tang","suffix":""},{"id":351510759,"identity":"aeded533-2aef-4df2-99f0-3e37b2518e92","order_by":4,"name":"Dongfa Liao","email":"","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":false,"prefix":"","firstName":"Dongfa","middleName":"","lastName":"Liao","suffix":""},{"id":351510760,"identity":"d4ec6f4c-dac2-43b2-b325-6eee1cdc2366","order_by":5,"name":"Song Chen","email":"","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":false,"prefix":"","firstName":"Song","middleName":"","lastName":"Chen","suffix":""},{"id":351510761,"identity":"a21b5eaf-d17b-4178-ac65-134f6c9b8440","order_by":6,"name":"Wei Wang","email":"","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Wang","suffix":""},{"id":351510762,"identity":"6a68ee8b-4502-417d-a9ad-4f45aa46e36b","order_by":7,"name":"Qingyun Xie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYFACxgYwxc/MfPgBaVok29nSDEizzOA8j4IEcSqPJ7c9/Np2OM/4MA+DAUONTTRBLZI9D9uNZdsOF5sd5j3wgOFYWm4DIS38Eolt0pJthxO3HeZLMGBsOExYCxtMy+ZmHgMJorSAbJH8CNSygZlYLUC/tEkznEtPnHEYGMgJxPjF4Hj6M8kfZdaJ/f2HDz/4UGNDWAsDQwIDMy8bnE0USGBg/PGHOKWjYBSMglEwQgEAI25AaIUBgkwAAAAASUVORK5CYII=","orcid":"","institution":"The General Hospital of Western Theater Command PLA","correspondingAuthor":true,"prefix":"","firstName":"Qingyun","middleName":"","lastName":"Xie","suffix":""}],"badges":[],"createdAt":"2024-08-26 15:36:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4979088/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4979088/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67099029,"identity":"6ed51d62-dbdd-4fb5-8738-e11ee9b49238","added_by":"auto","created_at":"2024-10-21 07:56:04","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24874,"visible":true,"origin":"","legend":"\u003cp\u003eFigure a. Preoperative Pelvic X-ray .\u003c/p\u003e","description":"","filename":"a.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4979088/v1/3b2d5bbcbe3c2d276d5d124d.jpg"},{"id":67099031,"identity":"53dd9570-78a5-4629-9371-04b9cd8dc9db","added_by":"auto","created_at":"2024-10-21 07:56:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28596,"visible":true,"origin":"","legend":"\u003cp\u003eFigure b. Intraoperative blood pressure changes.\u003c/p\u003e","description":"","filename":"b.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4979088/v1/2cb13b448b426f75b39f1199.jpg"},{"id":67099030,"identity":"175d74b7-24c6-43e4-a3a3-fec15a29f6a5","added_by":"auto","created_at":"2024-10-21 07:56:05","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":21365,"visible":true,"origin":"","legend":"\u003cp\u003eFigure c. Postoperative pelvic radiograph\u003c/p\u003e","description":"","filename":"c.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4979088/v1/872546d8f4e2dec76666e64f.jpg"},{"id":67101185,"identity":"e70e1818-65eb-4edd-a994-92a249254a50","added_by":"auto","created_at":"2024-10-21 08:12:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":330268,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4979088/v1/545895dc-062e-440a-80b3-afdf0934b3ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Shock caused by iodophor immersion irrigation of joint cavity : a case report","fulltext":[{"header":"Background","content":"\u003cp\u003eIodophor has a broad bactericidal spectrum and is a broad-spectrum bactericidal solution. In vitro, iodophor has the ability to penetrate biofilms and has been shown to be effective against a variety of pathogens, including Gram-positive and Gram-negative bacteria, Bacillus, protozoa, and viruses. In addition, iodophor is widely used for skin disinfection in surgical procedures due to its low cytotoxicity and good tolerability without the development of resistant bacteria [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Iodophor application in wounds can also promote wound healing by increasing the expression of transforming growth factor β [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Iodophor can not only be used for skin disinfection, but literature studies have shown that iodophor soaking irrigation effectively reduces the risk of surgical wound infection without increasing complications [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Periprosthetic joint infection after arthroplasty is one of the catastrophic complications after artificial joint replacement. It is reported in the literature that the incidence of periprosthetic joint infection is 0.3\u0026thinsp;~\u0026thinsp;1.7% in patients undergoing primary total hip arthroplasty and 0.8\u0026thinsp;~\u0026thinsp;1.9% in patients undergoing primary total knee arthroplasty [\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Given its high incidence and serious consequences, many interventions have been introduced to reduce the occurrence of periprosthetic infections. In recent years, iodophor has been more and more widely used to soak and rinse artificial joint replacement wounds to prevent infection, and its clinical effect in preventing infection has been gradually recognized [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 57-year-old female patient with no underlying disease underwent right total hip arthroplasty under general anesthesia for osteoarthritis secondary to bilateral developmental dysplasia of the hip\u0026nbsp;(\u003cstrong\u003eFigure\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ea\u003c/strong\u003e). Blood pressure was dynamically monitored by radial artery puncture and catheterization of the left wrist before surgery. During the operation, the posterolateral approach of the hip joint was taken, the skin and subcutaneous tissue were incised, the joint capsule was incised, and the femoral head was dislocated. Femoral neck osteotomy was performed with an oscillating instrument, and the femur was treated with a femoral broach after osteotomy. After femoral treatment, the acetabulum was treated, and the acetabulum was washed with normal saline after acetabular polishing, during which the patient \u0026apos;s vital signs were stable. About 100ml of iodophor was poured into the hip joint for soaking, flushing and disinfection. About 30 s after pouring into iodophor, the patient showed a rapid progressive decrease of blood pressure. Within 10 s, the patient \u0026apos;s blood pressure rapidly decreased from 94/56 mmHg to 53/28 mmHg. At this time, the anesthesiologist immediately gave 10 ug of norepinephrine to increase the pressure. At the same time, the orthopedic surgeon immediately sucked out the iodophor in the acetabulum with a suction device and washed the acetabulum with normal saline for many times. The patient \u0026apos;s blood pressure continued to decrease to the minimum of 40/20 mmHg and then began to increase. Perdipine 0.2 mg was administered to lower blood pressure when the blood pressure increased to 148/94 mmHg. After the blood pressure reached the maximum of 160/96 mmHg, the blood pressure slowly decreased until the blood pressure recovered as before\u0026nbsp;(\u003cstrong\u003eFigure b\u003c/strong\u003e). After the vital signs were stable, acetabular cup was placed, acetabular screw was implanted, polyethylene liner was installed, femoral stem was installed, femoral head ceramic prosthesis was installed, and hip joint was reduced. The surgical incision was closed in layers after checking that there was no active bleeding. Sterile dressing was applied and the procedure was completed. The patient recovered well after surgery without complications and was discharged uneventfully(\u003cstrong\u003eFigure c\u003c/strong\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe patient had no history of allergies preoperatively. Preoperative use of iodophor to disinfect the skin around the incision showed no allergy or blood pressure fluctuation; postoperative surgical incision dressing change using iodophor for disinfection showed no allergy or blood pressure fluctuation. The patient was given intravenous cefazolin sodium to prevent infection before the operation, without allergic manifestations; cefazolin sodium was given to prevent infection after the operation, without allergic conditions. The patient was given tranexamic acid to control bleeding before surgery, and there was no allergic manifestation; tranexamic acid was also given to stop bleeding after surgery, and there was no allergic condition. During the surgery, the patient showed sharp drop of blood pressure, which was considered to be caused by shock reaction after pouring iodophor into joint cavity. This condition is very dangerous, and if not detected and managed promptly, the patient is at risk of multiple organ failure and cardiac arrest leading to death. Our review of the literature did not find similar reports. Rare adverse reactions have been reported in the literature when iodophor is administered to humans. Literature data came from a small number of case reports, and some patients developed allergic manifestations after cutaneous application of iodophor [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Some patients have anaphylactic shock when washing the rectum with iodophor [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Some patients have allergic reactions caused by transvaginal iodophor [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Previous literature has reported the risk of iodine-related complications when iodophor is used for intra-articular soaking. High concentrations of exogenous iodine can reduce thyroid hormone synthesis, and transient hypothyroidism can occur in open chest wounds disinfected with iodophor [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] However, the latest American Academy of Orthopaedic Surgeons, Centers for Disease Control and Prevention, and the World Health Organization support surgical irrigation with iodophor during surgery [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Current literature analysis also suggests that diluted iodophor lavage is significantly superior to saline lavage in preventing periprosthetic infection [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. According to statistics, there are about millions of patients undergoing joint replacement surgery every year worldwide, and this number is still increasing. The experience of this patient makes orthopedic surgeons realize that iodophor soaking and flushing the joint cavity may cause fatal hypotension in patients. Early rescue measures can save the lives of such patients. Of course, the situation of this patient is rare, but the consequences are quite serious, not only orthopedic surgeons, but other surgeons will also pour iodophor into the incision or in vivo immersion irrigation and disinfection, these operations have the risk of iodophor-induced shock reaction, this patient 'experience deserves enough attention from all our surgeons. At the same time, the experience of this patient also suggests that routine arterial puncture monitoring of blood pressure during surgery is necessary, and it is difficult to imagine that if this patient does not undergo arterial puncture blood pressure monitoring, we cannot detect changes in blood pressure in a timely manner, then the consequences will be catastrophic. Our study also has some limitations, because the consequences are serious and life-threatening, and we can no longer pour iodophor into the joint cavity of patients to verify that the dramatic progressive decrease in blood pressure in patients is caused by iodophor, so our conclusions also lack validation and further studies are needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate The patient received prior information before providing her written, informed consent in accordance with the Declaration of Helsinki. The article was approved by the ethics committee of the General Hospital of Western Theater Command.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWei Wang,Qingyun Xie and Dongfa Liao performed the surgery. Song Chen, Shihong Li and Xiaolong\u0026nbsp;Zheng,YingchaoTang,Yida Amu helped with surgery. Yida Amu helped draft the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was Supported by Sichuan Science and Technology Program (2023YFS0052) and Project of Sichuan Provincial Administration of Traditional Chinese Medicine (2023MS215).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that informed consent was obtained from the patient for publication of this case report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMessager S, Goddard PA, Dettmar PW, et al．Comparison of two in vivo and two ex vivo tests to assess the antibacterial activity of several antiseptics［J］． J Hosp Infect,2004,58( 2) : 115 － 121． \u003c/li\u003e\n\u003cli\u003eWutzler P, Sauerbrei A, Kl cking R, et al．Virucidal activity and cytotoxicity of the liposomal formulation of povidone-iodine［J］． Antiviral Res，2002，54( 2) : 89 － 97．\u003c/li\u003e\n\u003cli\u003eReimer K, Wichelhaus TA, Sch fer V, et al．Antimicrobial effectiveness of povidone-iodine and consequences for new application areas［J］． Dermatology，2002，204( Suppl 1) : 114 － 120．\u003c/li\u003e\n\u003cli\u003eCherry M, Daly CG, Mitchell D, et al．Effect of rinsing with povidone-iodine on bacteraemia due to scaling: a randomized-controlled trial［J］． J Clin Periodontol，2007，34 ( 2 ) : 148 － 155．\u003c/li\u003e\n\u003cli\u003eSeguin P, Tanguy M, Laviolle B, et al．Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma［J］．Crit Care Med， 2006，34( 5) : 1514 － 1519． \u003c/li\u003e\n\u003cli\u003eBigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA. Povidone iodine in wound healing: A review of current concepts and practices. Int J Surg. 2017 Aug; 44:260-268. \u003c/li\u003e\n\u003cli\u003eBarreto R, Barrois B, Lambert J, Malhotra-Kumar S, Santos-Fernandes V, Monstrey S. Addressing the challenges in antisepsis: focus on povidone iodine. Int J Antimicrob Agents. 2020 Sep;56(3):106064.\u003c/li\u003e\n\u003cli\u003eCheng MT, Chang MC, Wang ST, et al． Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery［J］． Spine ( Phila Pa 1976) ，2005，30 ( 15) : 1689 － 1693． \u003c/li\u003e\n\u003cli\u003eChundamala J, Wright JG． The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review［J］． Can J Surg，2007，50 ( 6 ) : 473 － 481.\u003c/li\u003e\n\u003cli\u003eJmsen E, Huhtala H, Puolakka T, et al． Risk factors for infection after knee arthroplasty． A register-based analysis of 43149 cases［J］． J Bone Joint Surg Am，2009，91( 1) : 38 － 47． \u003c/li\u003e\n\u003cli\u003ePeersman G, Laskin R, Davis J, et al． Infection in total knee replacement: a retrospective review of 6489 total knee replacements ［J］． Clin Orthop Relat Res，2001，392( 392) : 15 － 23． \u003c/li\u003e\n\u003cli\u003ePulido L, Ghanem E, Joshi A, et al． Periprosthetic joint infection: The incidence，timing，and predisposing factors［J］． Clin Orthop Relat Res，2008，466( 7) : 1710 － 1715． \u003c/li\u003e\n\u003cli\u003eChoong PF, Dowsey MM, Carr D, et al． Risk factors associated with acute hip prostheticjoint infections and outcome of treatment with a rifampin-based regimen［J］． Acta Orthop，2007，78( 6) : 755 － 765． \u003c/li\u003e\n\u003cli\u003ePhillips JE, Crane TP, Noy M, et al． The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey［J］． J Bone Joint Surg Br，2006，88( 7) : 943 － 948．\u003c/li\u003e\n\u003cli\u003eOTANI T, FUJII H, KAWAGUCHI Y, et al. Treatment of periprosthetic hip infection with retention of a well-fixed stem: six to 13-year outcomes. Arthroplasty. 2019;1(1):3.\u003c/li\u003e\n\u003cli\u003ePedrosa C, Costa H, Oliveira G, Romariz J, Pra\u0026ccedil;a F. Anaphylaxis to povidone in a child. Pediatr Allergy Immunol. 2005 Jun;16(4):361-2. \u003c/li\u003e\n\u003cli\u003ePalobart C, Cros J, Orsel I, Nathan N. Choc anaphylactique \u0026agrave; la povidone iod\u0026eacute;e [Anaphylactic shock to iodinated povidone]. Ann Fr Anesth Reanim. 2009 Feb;28(2):168-70. \u003c/li\u003e\n\u003cli\u003eOno T, Kushikata T, Tsubo T, Ishihara H, Hirota K. [A case of asystole following povidone iodine administration]. Masui. 2011 Apr;60(4):499-501.\u003c/li\u003e\n\u003cli\u003eTomoda C, Kitano H, Uruno T, et al． Transcutaneous Iodine absorption in adult patients with thyroid cancer disinfected with povidone-iodine at operation［J］． Thyroid, 2005, 15( 6) : 600 － 603\u003c/li\u003e\n\u003cli\u003eChambers MM, Namdari S. A Review of Surgical Irrigation Solutions for Infection Prevention in Orthopaedic Surgery. JBJS Rev. 2023 Dec 1;11(12).\u003c/li\u003e\n\u003cli\u003eKobayashi N, Kamono E, Maeda K, Misumi T, Yukizawa Y, Inaba Y. Effectiveness of diluted povidone-iodine lavage for preventing periprosthetic joint infection: an updated systematic review and meta-analysis. J Orthop Surg Res. 2021 Sep 22;16(1):569. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Iodophor, Shock, Immersion irrigation, Joint replacement","lastPublishedDoi":"10.21203/rs.3.rs-4979088/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4979088/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Iodophor, as a disinfectant, is widely used for skin disinfection in surgical procedures. Because of its good disinfection and sterilization function, iodophor is used for joint cavity immersion irrigation in orthopedic joint replacement surgery to reduce the incidence of postoperative infection. Adverse reactions caused by the use of iodophor have been rarely reported, and anaphylaxis has been reported in individual cases when iodophor disinfects the skin. Shock reaction caused by iodophor soaking to irrigate the joint cavity was the first finding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e A 57-year-old female patient underwent right total hip arthroplasty under general anesthesia due to osteoarthritis secondary to bilateral developmental dysplasia of the hip . Patient had stable vital signs prior to iodophor soak irrigation of joint cavity during surgery. When iodophor was poured into the joint cavity for soaking and flushing after acetabular polishing during the operation, the patient experienced a rapid decrease in blood pressure, with the initial blood pressure of 94/56 mmHg. When the blood pressure rapidly decreased to 53/28 mmHg, vasopressors were given and iodophor was sucked out of the joint cavity and flushed with normal saline. After the blood pressure decreased to 40/20 mmHg, the patient stopped decreasing and gradually increased to normal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e When iodophor is poured into the joint cavity for soaking and irrigation, rare shock reactions with rapid decrease of blood pressure occur, which need to be paid enough attention and rescue measures should be prepared in advance.\u003c/p\u003e","manuscriptTitle":"Shock caused by iodophor immersion irrigation of joint cavity : a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-21 07:56:00","doi":"10.21203/rs.3.rs-4979088/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6381bf1-140f-4aae-83d6-310fdf5f2e25","owner":[],"postedDate":"October 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T07:56:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-21 07:56:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4979088","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4979088","identity":"rs-4979088","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}