IV Vancomycin and Rigors

[EDValerieRN, ASN, RN]

I've done a little research, and haven't been able to find much, so I was hoping someone here would be able to help me out.

I had a patient about a week ago who had a resistant pneumonia, so we gave him Vancomycin. I hung it IVPB over 1.5 hours. About 30 minutes after the infusion was done, he started to develop what seemed to be rigors (although I've never seen it before). The doc was in the dept. writing orders, so I notified him of it. He said that it was more than likely just the pt. coming down from his fever. I asked him if I could give something for it, but he said to wait it out. After about an hour, most of his symptoms had gone. The man had a trach and wasn't really responsive even before coming in, so he couldn't verbalize anything to me. He never went hypotensive or turned very red, but he did have an extreme case of tremors and seemed to be very uncomfortable.

This got me thinking about rigors, and the treatment. I looked through a few journals and did a search, and the only thing I could find to treat rigors was Demerol. My hospital doesn't give demerol anymore. Is there anything else that would treat rigors? How does demerol work to counteract the effect? Is there anything I can do to prevent rigors in the future (hang IVPB slower, etc)? Should I have suggested a med to the Doc?

Any help for the new kid on the block would be greatly appreciated!

[dianah, ASN]

I did a search for "treatment post-anesthesia rigors," and found this paragraph of alternative suggestions from the site http://www.jasonprogram.org:

"If meperidine is not available (we have all but eliminated it at our institution), fentanyl (like meperidine, a synthetic phenylpiperidine--in fact, fentanyl is the reverse ester of meperidine, although its primary metabolite, norfentanyl, does not seem to be neurotoxic) is a reasonable alternative since it has very similar structure-activity relationships. Other drugs that have been effective are propafol, chlorpromazine, and the other fentanyl congeners (e.g., alfentanil). To pursue this, the best keywords for a literature search would be "postoperative shivering" and a search of the cardiac anesthesia literature (or textbooks) for studies of this nature. Regards, and happy hunting,"

There is more discussion on the site about how the meperidine helps (mechanism of action) -- this in relation to post-anesthesia "rigors."

You might consult with one of the pharmacists at your facility, as to what they might suggest. Increasing the time the antibiotic is infused might not be a good idea. Pick their brains! :)

Perhaps modifying the words used in your search would give more hits. Good luck! (BTW, I was given Stadol IV for post-epidural rigors, while in PACU, and it helped me. :))

[EDValerieRN, ASN, RN]

Thanks for the help!

[teeituptom, BSN, RN]

I remember the term "Rigors" being used in the olden days. I havent heard that term used in a long long time.