Red Man's syndrome following administration of vancomycin in a patient under spinal anesthesia--a case report

Area of Science:

• Anesthesiology
• Infectious Diseases
• Pharmacology

Background:

• Prophylactic antibiotics, including vancomycin, are commonly used during anesthesia to prevent infections.
• Staphylococci are frequent culprits in surgical wound infections, making vancomycin a critical treatment option for resistant strains and penicillin-allergic patients.
• Vancomycin is indicated for serious infections like bacterial endocarditis and osteomyelitis.

Observation:

• A patient undergoing tibial implant removal under spinal anesthesia experienced hypotension, bradycardia, altered consciousness, and a macular rash.
• These adverse events occurred during a slow infusion of 0.1% vancomycin over 10 minutes.
• The patient's condition stabilized with appropriate management, and they were discharged the next day.

Findings:

• Vancomycin administration can precipitate severe hemodynamic instability, including hypotension and bradycardia.
• Adverse reactions may be linked to histamine release, direct myocardial depression, and peripheral vasodilation.
• The case highlights the potential for serious, even life-threatening, cardiovascular events with vancomycin infusion.

Implications:

• Anesthesiologists and clinicians should be vigilant for vancomycin-induced adverse reactions, particularly hypotension and bradycardia.
• Careful monitoring during vancomycin infusion, especially in patients undergoing procedures under anesthesia, is essential.
• This case underscores the importance of recognizing vancomycin's potential for rapid and severe cardiovascular side effects, including rare reports of cardiac arrest.