Antibiotics are frequently administered for prophylaxis during anesthesia. Vancomycin has increasingly become the antibiotic of choice due to the rising incidence of resistant staphylococcal infections. Patients allergic to penicillin are
candidates for
vancomycin.
Commonly reported adverse reactions of vancomycin include ; fever, chills, nausea, pain at the injection site, phlebitis, nephrotoxicity, ototoxicity, hypotension, cardiac arrest, bronchospasm, noncardiogenic pulmonary edema and the so-called
Red-Man's
syndrome or Red Neck syndrome, Recently, we encountered two patients who had adverse reactions of vancomycin perioperatively.
Vancomycin-induced hypotension usually results from a negative inortopic and vasodilator effect produced by 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 ("Red Neck syndrome"), pain and muscle spasm in the chest or parasternal 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 inotropic agent
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