Document Detail


Intraoperative and postoperative effects of vancomycin administration in cardiac surgery patients: a prospective, double-blind, randomized trial.
MedLine Citation:
PMID:  8339575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: In response to an increased frequency of Staphylococcus epidermidis infections in postoperative cardiac surgery patients, antibiotic prophylaxis was changed to include both vancomycin and cefazolin pre- and intraoperatively. Subsequent to the addition of vancomycin prophylaxis, clinical impression and retrospective analysis supported a correlation between vancomycin administration and post-cardiopulmonary bypass norepinephrine use. DESIGN: A prospective, double-blind, randomized study. SETTING: Tertiary care center in a university hospital. PATIENTS: A total of 58 patients undergoing elective coronary artery bypass surgery under high-dose fentanyl anesthesia. INTERVENTIONS: Patients were randomized to receive cefazolin and either vancomycin or normal saline pre-, intra-, and postoperatively in a double-blinded protocol. MEASUREMENTS AND MAIN RESULTS: Hemodynamic profiles and doses of administered vasoactive agents were calculated and recorded for all patients for both intra- and postoperative time periods. Hypotension consistent with vasodilation was treated with a norepinephrine infusion. The rate and frequency of norepinephrine infusions were tabulated for both groups. Hemodynamic profiles that were obtained after the administration of the initial dose of vancomycin or normal saline and before the induction of general anesthesia and those profiles obtained after the induction of general anesthesia until the initiation of cardiopulmonary bypass showed no difference between groups and no evidence of vasodilation secondary to vancomycin administration. However, subsequent doses of vancomycin in the intra- and postoperative periods were associated with a significantly greater frequency of norepinephrine infusions to maintain normal hemodynamic indices. In the vancomycin group, 50% of patients received a norepinephrine infusion in the intra- and/or postoperative period as compared with 14% in the normal saline group (p < .01). Furthermore, the group of patients who received vancomycin and subsequently required a norepinephrine infusion had significantly lower mean systolic arterial pressure, mean arterial pressure, and systemic vascular resistance as compared with all other groups. There were no differences between groups in the use of vasopressors (other than norepinephrine) or fluid balance. CONCLUSIONS: The results show that a significantly greater number of patients who received vancomycin required a norepinephrine infusion and that, despite norepinephrine infusion therapy, systemic vascular resistance was not normalized in this group of patients. The study supports the conclusion that perioperative administration of vancomycin in cardiac surgery patients may result in hypotension requiring the use of a vasopressor in an attempt to normalize hemodynamic indices.
Authors:
V A Romanelli; M B Howie; P D Myerowitz; D A Zvara; A Rezaei; D L Jackman; D S Sinclair; T D McSweeney
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  21     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1993 Aug 
Date Detail:
Created Date:  1993-09-02     Completed Date:  1993-09-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1124-31     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Ohio State University Hospitals, Columbus 43210.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cefazolin / administration & dosage,  therapeutic use*
Coronary Artery Bypass*
Double-Blind Method
Drug Therapy, Combination
Drug Utilization
Female
Hemodynamics
Humans
Hypotension / chemically induced*,  drug therapy,  epidemiology,  physiopathology
Incidence
Infusions, Intravenous
Intraoperative Period
Male
Middle Aged
Monitoring, Intraoperative
Norepinephrine / administration & dosage,  therapeutic use
Postoperative Complications / drug therapy,  epidemiology,  prevention & control
Postoperative Period
Premedication*
Prospective Studies
Sodium Chloride / administration & dosage,  therapeutic use
Staphylococcal Infections / drug therapy,  epidemiology,  prevention & control
Staphylococcus epidermidis
Vancomycin / administration & dosage,  adverse effects*,  therapeutic use
Vascular Resistance
Chemical
Reg. No./Substance:
1404-90-6/Vancomycin; 25953-19-9/Cefazolin; 51-41-2/Norepinephrine; 7647-14-5/Sodium Chloride
Comments/Corrections
Comment In:
Crit Care Med. 1994 Aug;22(8):1336-7   [PMID:  8045155 ]
Crit Care Med. 1993 Aug;21(8):1107-8   [PMID:  7687945 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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