Abstract
Purpose
A case of deafness is reported in a patient undergoing bilateral nephrectomy after single irrigation of the peritoneal cavity with a neomycin containing solution for surgical prophylaxis.
Clinical Features
In this patient, profound, late-postoperative deafness was heralded by prolonged neuromuscular blockade and respiratory insufficiency. Additional risk factors for ototoxicity in this particular patient included the presence of end-stage renal disease requiring daily peritoneal dialysis and, possibly, the concomitant use of clonazepam and clindamycin.
Conclusions
Antibiotic irrigation solutions containing neomycin may produce unwanted adverse systemic effects of deafness and prolonged neuromuscular blockade, even with only brief application within the peritoneal cavity. Concurrent end-stage renal disease, visceral inflammation from chronic dialysis and laparotomy, and the concomitant use of other medications may have contributed to these unwanted effects.
Résumé
Objectif
Un cas de surdité est rapporté chez un patient subissant une néphrectomie bilatérale après l’irrigation simple de la cavité péritonéale avec une solution contenant de la néomycine pour la prophylaxie chirurgicale.
Aspects cliniques
Chez ce patient, une surdité profonde tardive post opératoire a été signalée après l’apparition d’un blocage neuromusculaire prolongé et d’une insuffisance respiratoire. Parmi les facteurs de risque additionnels d’autotoxicité chez ce patient, notons la présence d’une insuffisance rénale terminale exigeant une dialyse péritonéale quotidienne et, peut-être, l’emploi concomitant de clonazépam et de clindamycine.
Conclusion
Les solutions d’irrigation antibiotique contenant de la néomycine peuvent produire des effets généraux défavorables non voulus de surdité et de blocage neuromusculaire prolongé, même avec seulement une brève application dans la cavité péritonéale. L’insuffisance rénale terminale concomitante, l’inflammation viscérale causée par la dialyse péritonéale chronique et la laparotomie, et l’usage concomitant d’autres médicaments peuvent avoir contribué à provoquer ces effets indésirables.
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Gilbert, T.B., Jacobs, S.C. & Quaddoura, A.A. Deafness and prolonged neuromuscular blockade following single-dose peritoneal neomycin irrigation. Can J Anaesth 45, 568–570 (1998). https://doi.org/10.1007/BF03012710
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DOI: https://doi.org/10.1007/BF03012710