半身麻醉病人使用Vancomycin發生Red Man's Syndrome

Red Man's Syndrome Following Administration of Vancomycin in a Patient under Spinal Anesthesia-- A Case Report

手術中使用抗生素是為了減少發生感染的機率。而葡萄球菌則是傷口感染最常見的細菌。Vancomycin是治療嚴重葡萄球菌感染的最佳抗生素。常用於心內膜炎、敗血症、骨隨炎的病人。一位45歲，ASAI，體重75公斤的男性病人，因為右脛骨骨折接受過開放性接骨術及鋼板內固定，現在發生了骨髓炎，所以要將鋼板內固定取出，我們給予半身麻醉，使用0.5％ heavy marcaine 2.5 ml在L3-4很平穩的打進去，麻醉後一切都進行很順利，心跳、血壓都很平穩正常。大約手術了30分鐘，外科醫師要求給予vancomycin 500 mg靜脈輸注，10分鐘後病人血壓自140／80下降至60／30mmHg，心跳變慢，神智有短暫不清，同時臉、頸、手臂、軀幹皮膚出現有斑狀的紅疹。經過加速靜脈注射及麻黃素的注射後，血壓15分鐘內就恢復正常，而紅疹則要再經2至3小時才逐漸消褪。本篇報告是要提醒麻醉同道注意手術中注射抗生素，除了要注意可能加強肌肉鬆弛的作用外，尚要注意可能分泌組織胺發生低血壓，心肌受抑制，末梢血管擴張。嚴重時可能會引起心跳停止。

Prophylactic antibiotics are frequently administered during anesthesia to reduce the incidence of infection. The most common organisms revealed in wound infections are staphylococci. Vancomycin is the antibiotic of choice for resistant staphylococcal infections and bacterial endocarditis in patient allergic to penicillin. We had a case of tibial osteomyelitis, while undergoing removal of implants under spinal anesthesia developed hypotension, bradycardia, consciousness change and skin erythematous macular rash after 0.1% vancomycin slow infusion for 10 min. After appropriate management, the patient recovered well and was discharged on the following day. Our report is intended to alert our colleagues that vancomycin can cause hypotension secondary to histamine release, direct myocardial depression and direct peripheral vasodilation. Even cardiac arrest had been reported in the literatures.