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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2019; 06(01): 040-042
DOI: 10.1055/s-0038-1674266
Case Report
Indian Society of Neuroanaesthesiology and Critical Care

An Uncommon Cause of Intraoperative Hypotension: Delayed Red Man Syndrome

Shilpa V. Nagmoti
1   Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
,
Unnikrishnan Prathapadas
1   Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
,
Ajay P. Hrishi
1   Division of Neuroanaesthesia, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
› Author Affiliations Funding None.
Further Information

Publication History

Received: 10 August 2018

Accepted: 25 August 2018

Publication Date:
25 January 2019 (online)

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Abstract

Intraoperative hypotension is commonly encountered under anesthesia. Varied causation of intraoperative hypotension can often delay the recognition of its cause. Vancomycin, a bactericidal antibiotic and often used in neurosurgical setting, is known to cause “red man syndrome.” Prompt recognition of the etiology for intraoperative hypotension could be challenging in intraoperative setting. We present a case of intraoperative hypotension in a patient undergoing endoscopic skull base surgery, which was caused by a delayed red man syndrome. Delayed red man syndrome is a rare clinical entity and must be borne in mind while evaluating a case of intraoperative hypotension in patients who are on vancomycin therapy.

Keywords

vancomycin - hypotension - neurosurgery
 

  • References

  • 1 Südfeld S, Brechnitz S, Wagner JY. et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth 2017; 119 (01) 57-64
    CrossrefPubMedSearch in Google Scholar
  • 2 Chang HS, Hongo K, Nakagawa H. Adverse effects of limited hypotensive anesthesia on the outcome of patients with subarachnoid hemorrhage. J Neurosurg 2000; 92 (06) 971-975
    CrossrefPubMedSearch in Google Scholar
  • 3 Abbott TEF, Pearse RM, Archbold RA. et al. A prospective international multicentre cohort study of intraoperative heart rate and systolic blood pressure and myocardial injury after noncardiac surgery: results of the VISION study. Anesth Analg 2018; 126 (06) 1936-1945
    CrossrefPubMedSearch in Google Scholar
  • 4 Dewachter P, Mouton-Faivre C, Emala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology 2009; 111 (05) 1141-1150
    CrossrefPubMedSearch in Google Scholar
  • 5 Abraham M. Perioperative management of patients with pituitary tumours. J Neuroanaesth Crit Care 2016; 3: 211-218
    PubMedSearch in Google Scholar
  • 6 Laxenaire MC, Mertes PM. Groupe d'Etudes des Réactions Anaphylactoïdes Peranesthésiques. Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth 2001; 87 (04) 549-558
    CrossrefPubMedSearch in Google Scholar
  • 7 Polk RE, Healy DP, Schwartz LB, Rock DT, Garson ML, Roller K. Vancomycin and the red-man syndrome: pharmacodynamics of histamine release. J Infect Dis 1988; 157 (03) 502-507
    CrossrefPubMedSearch in Google Scholar
  • 8 Wong JT, Ripple RE, MacLean JA, Marks DR, Bloch KJ. Vancomycin hypersensitivity: synergism with narcotics and “desensitization” by a rapid continuous intravenous protocol. J Allergy Clin Immunol 1994; 94 (02) Pt 1 189-194
    CrossrefPubMedSearch in Google Scholar
  • 9 Renz CL, Thurn JD, Finn HA, Lynch JP, Moss J. Clinical investigations. Antihistamine prophylaxis permits rapid vancomycin infusion. Crit Care Med 1999; 27 (09) 1732-1737
    CrossrefPubMedSearch in Google Scholar
  • 10 Tole JW, Lieberman P. Biphasic anaphylaxis: review of incidence, clinical predictors, and observation recommendations. Immunol Allergy Clin North Am 2007; 27 (02) 309-326 viii
    CrossrefPubMedSearch in Google Scholar