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Adverse effects of vancomycin administered in the perioperative period
Abstract:
Indications for the administration of vancomycin in the perioperative period have expanded in recent years. Used in this situation, vancomycin has caused adverse reactions, the most serious of which is hypotension. We describe five patients who had adverse reactions to vancomycin perioperatively. Vancomycin-induced hypotension usually results from a negative inotropic and vasodilator effect produced in part by a histamine-release phenomenon, which occurs most commonly with rapid intravenous infusion of the drug. Such a release of histamine may also produce an acute urticarial flushing of the upper torso (the "red neck syndrome") and symptoms of pain and muscle spasm in the chest or paraspinal muscles, which may mimic myocardial infarction. These effects usually abate promptly when the infusion of vancomycin is discontinued, and their resolution may be expedited by administration of an antihistamine.
Insights
Vancomycin, when used perioperatively, can cause serious adverse reactions like hypotension and "red neck syndrome" due to histamine release, especially with rapid infusion. These effects are treatable with antihistamines and discontinuing the drug.
Area of Science:
- Pharmacology
- Anesthesiology
- Critical Care Medicine
Background:
- The perioperative use of vancomycin has increased, leading to a broader range of indications.
- Adverse reactions associated with perioperative vancomycin administration are a growing concern.
Observation:
- This report details five patients experiencing adverse reactions during the perioperative period after vancomycin administration.
- The most severe adverse reaction observed was hypotension.
Findings:
- Vancomycin-induced hypotension is linked to negative inotropic and vasodilator effects, partly mediated by histamine release.
- Rapid intravenous infusion of vancomycin is the most common trigger for this histamine release.
- Associated symptoms include "red neck syndrome" (urticarial flushing) and chest/paraspinal pain mimicking myocardial infarction.
Implications:
- Prompt discontinuation of vancomycin infusion can resolve these adverse effects.
- Antihistamine administration can expedite the resolution of vancomycin-induced adverse reactions.
- Awareness of these potential side effects is crucial for safe perioperative vancomycin use.