Deafness and prolonged neuromuscular blockade following single-dose peritoneal neomycin irrigation.
OBJECTIVE
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.


METHODS
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.
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA. tgilbert@anesth.ab.umd.edu
T B
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Gilbert
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SC
Jacobs
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Quaddoura
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002981:Clindamycin / Q000009:adverse effects; D002998:Clonazepam / Q000009:adverse effects; D003051:Cochlea / Q000187:drug effects; D003638:Deafness / Q000139:chemically induced*; D005260:Female; D018757:GABA Modulators / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage / Q000009:adverse effects*; D009392:Nephrectomy; D019148:Neuromuscular Blockade; D010530:Peritoneal Dialysis; D010533:Peritoneal Lavage; D011183:Postoperative Complications / Q000139:chemically induced*; D011292:Premedication; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012307:Risk Factors; D013997:Time Factors
D000900:Anti-Bacterial Agents; D018757:GABA Modulators; D002981:Clindamycin; D002998:Clonazepam; D009355:Neomycin