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Updated: Nov 22, 2025
Collecting And Measuring Wound Exudate Biochemical Mediators In Surgical Wounds
Published on: October 20, 2012
Circulatory collapse during wound closure in spine surgery with an unknown cause: a possible adverse effect of
Xiaoqing Zhang1, Wenwen Zhai1, Min Li1
1Department of Anesthesiology, Peking University Third Hospital, No. # 49, Huayuan Rd; Haidian Dist, Beijing, China.
Background:
Vancomycin (VCM) is effective in fighting Gram-positive bacteria related severe infections, and topical application of VCM powder is widely used in orthopedic surgery to prevent wound infection. However, VCM could lead to infusion rate-dependent antibody-and complement-independent anaphylaxis reaction by inducing direct release of histamine.
Case Presentation:
We retrospectively analyzed seven cases of severe hypotension and shock during wound closure or immediately after orthopedic surgery with unidentifiable reasons. We found that these cases were all associated with local application of VCM powder during wound closure process. Two patients experienced sudden cardiac arrest. Most of the cases (6/7) with circulatory collapse were discharged without severe sequelae. While one case with application of 3 g VCM developed cardiac arrest and remained in a coma due to hypoxic-hypoxic encephalopathy. The clinical presentations and the time of the shock onset were considered to be related with a VCM induced anaphylaxis reaction. However, as this was a retrospective study, and there was no laboratory examination performed, the conclusion was made upon differential diagnosis based on clinical manifestations and the timing of the shock.
Conclusions:
Local application of VCM may not be as safe as was once believed and may lead to a related anaphylaxis. As VCM induced infusion-rate dependent, non-IgE mediated anaphylaxis is characterized by delayed occurrence, severe hypotension and even circulatory collapse, surgeons and anesthesiologists should be extra vigilant during and after VCM application.
Insights
Topical vancomycin (VCM) powder in orthopedic surgery may cause anaphylaxis. This study found VCM-associated shock and hypotension, highlighting the need for vigilance during and after its application.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Pharmacology
Background:
- Vancomycin (VCM) is effective against Gram-positive bacteria and used topically in orthopedic surgery to prevent infections.
- However, VCM can induce anaphylaxis through direct histamine release, independent of antibodies or complement.
- This reaction is infusion rate-dependent.
Purpose of the Study:
- To investigate potential adverse events associated with topical vancomycin (VCM) powder in orthopedic surgery.
- To identify the characteristics and clinical presentation of VCM-induced anaphylaxis in this context.
Main Methods:
- Retrospective analysis of seven cases presenting with severe hypotension and shock during or after orthopedic surgery.
- Cases were evaluated based on clinical manifestations and timing of shock onset, with differential diagnosis used due to lack of laboratory data.
Main Results:
- All seven cases were linked to the local application of VCM powder during wound closure.
- Two patients experienced sudden cardiac arrest, and six cases showed circulatory collapse.
- Most patients recovered without severe sequelae, but one case with 3g VCM developed cardiac arrest and coma.
Conclusions:
- Local vancomycin (VCM) application in orthopedic surgery may pose safety risks, including anaphylaxis.
- VCM-induced anaphylaxis can manifest as delayed, severe hypotension and circulatory collapse.
- Surgeons and anesthesiologists must exercise caution during and after VCM application due to potential non-IgE mediated anaphylactic reactions.
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