Vancomycin
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Red man syndrome and cerebral hypoperfusion: case report A 24-year-old woman developed red man syndrome and cerebral hypoperfusion during treatment with vancomycin for infective endocarditis prophylaxis. The woman was hospitalised for redosternotomy and relief of left ventricular outflow tract obstruction due to recurrent subaortic membrane. Previously, she had been operated during infancy for repair of coarctation of aorta via left thoracotomy, for which, she underwent 3 surgeries via sternotomy for mitral valve replacement. Four years ago, she had been diagnosed with an allergy to ceftriaxone, and she had been administered with vancomycin to treat sepsis with blood cultures positive for methicillin resistant staphylococcus aureus. At current presentation, her various laboratory test were normal. Before induction of anesthesia with lidocaine, she received methylprednisolone. Standard techniques were employed for endotracheal intubation and induction of anesthesia. Later, she was administered with vancomycin 1g, which was scheduled to be administered over 60 min, for infective endocarditis prophylaxis during the surgery. Within 10 minutes of infusion, she developed redness over face and torso. A diagnosis of red man syndrome was made. The woman’s treatment with vancomycin was stopped for 10 minutes, and the course was completed over the following hour. She was found to be haemodynamically stable, and received lactated Ringer’s solution. Blood gases were found to be normal. After 10–15 minutes of vancomycin administration, cerebral oximetry values were found to be elevated indicating cerebral hypoperfusion, which returned to the baseline value after 4 hours. Her further course was uneventful. Kandachar S, et al. NIRS: So near yet so far (From the brain). Annals of Cardiac Anaesthesia 23: 505-507, No. 4, Oct-Dec 2020. Available from: URL: https://www.annals.in/ temp/AnnCardAnaesth234505-2974753_081547.pdf 803519359
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Reactions 5 Dec 2020 No. 1833
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