An Uncommon Cause of Intraoperative Hypotension: Delayed Red Man Syndrome

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
• 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
• 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
• 4 Dewachter P, Mouton-Faivre C, Emala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology 2009; 111 (05) 1141-1150
• 5 Abraham M. Perioperative management of patients with pituitary tumours. J Neuroanaesth Crit Care 2016; 3: 211-218
• 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
• 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
• 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
• 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
• 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