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Gentamicin solution for mediastinal irrigation: systemic absorption, bactericidal activity, and toxicity.

M E Kopel¹, L Riemersma, D C Finlayson

¹Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.

The Annals of Thoracic Surgery

|August 1, 1989

Summary

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Gentamicin sulfate irrigation after heart surgery can lead to toxic blood levels, especially in smaller patients. Monitoring plasma gentamicin is essential to prevent inadequate treatment and toxicity.

Area of Science:

Medicine
Pharmacology
Cardiovascular Surgery

Background:

Neomycin sulfate, a traditional irrigation fluid, is no longer available.
Gentamicin sulfate is a potential alternative for local irrigation.
Post-cardiac surgery complications may necessitate irrigation solutions.

Purpose of the Study:

To evaluate systemic absorption of gentamicin sulfate used for mediastinal irrigation.
To assess the risk of inadequate or toxic blood levels following gentamicin irrigation.
To compare gentamicin irrigation to historical neomycin sulfate regimens.

Main Methods:

Mediastinal irrigation with gentamicin sulfate in 12 post-cardiac surgery patients.
Plasma gentamicin concentrations measured by radioimmunoassay.

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Irrigation duration ranged from one to four days.

Correlation of gentamicin levels with patient size and sex.

Main Results:

Systemic gentamicin absorption occurred in all patients.
Toxic blood levels (>8.0 µg/mL) were observed, particularly in smaller patients and females.
Inadequate gentamicin levels were noted in larger patients.
No significant increases in serum creatinine levels were observed.

Conclusions:

Mediastinal irrigation with gentamicin sulfate leads to systemic absorption.
Plasma gentamicin level monitoring is mandatory to avoid toxicity and ensure efficacy.
Careful patient selection and monitoring are crucial when using gentamicin for irrigation.