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Pneumonia due to aspiration of povidine iodine after induction of general anesthesia -A case report-.

An TH, Ahn BR - Korean J Anesthesiol (2011)

Bottom Line: Mechanical ventilation with PEEP and periodical bronchial toilet with fiberoptic bronchoscopy were carried in the operating room and ICU.Bronchodilators, antibiotics, steroids and diuretics were also used to treat pneumonia.The patient was treated successfully without any complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea.

ABSTRACT
Aspiration pneumonia is usually caused by aspiration of gastric contents during anesthesia. It causes severe pulmonary complications. Povidone iodine was used widely as an oral antiseptic. Although povidone iodine is thought to be a safe and effective antiseptic, severe complications from its aspiration may occur. We present a case of pneumonia secondary to aspiration of povidone iodine in a 16 year old female patient who underwent orofacial surgery. Aspiration pneumonia must be treated immediately. Mechanical ventilation with PEEP and periodical bronchial toilet with fiberoptic bronchoscopy were carried in the operating room and ICU. Bronchodilators, antibiotics, steroids and diuretics were also used to treat pneumonia. The patient was treated successfully without any complication.

No MeSH data available.


Related in: MedlinePlus

Extubated endotracheal tube: the inflating tube between cuff and pilot of the tube is perforated by the wire.
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Figure 2: Extubated endotracheal tube: the inflating tube between cuff and pilot of the tube is perforated by the wire.

Mentions: A 16-year old female patient (45 kg in weight and 157 cm in height) visited our hospital due to left maxillary fracture. The patient had no history of pulmonary disease, such as asthma, and showed no special features in the electrocardiography, biochemical examination of blood, or chest X-ray, all of which were conducted before her operation (Fig. 1). As a preoperative preparation, 0.05 mg/kg of midazolam was injected 1 hour before beginning the operation. Vital signs before anesthesia were blood pressure 110/66 mmHg , heart rate 80 beats/min, and oxygen saturation 99%. After arrival in the operating room, the patient's condition was monitored by a non-invasive blood pressure, pulse oxymeter, and electrocardiograph. The patient lost consciousness following the induction of anesthesia with 2 mg/kg propofol. An injection of 0.6 mg/kg rocuronium stopped spontaneous breathing, leading to positive pressure ventilation. Before a Mallinckrodt tube (Mallincrodt, St. Louis, MO, USA) with an internal diameter of 7.0 mm was inserted, no leakage in the tube cuff was found through ballooning of the cuff. A tracheal intubation was performed after confirmation that the patient's muscles were sufficiently relaxed. 6 ml of air was then inserted and no leakage of air in the mouth was heard. Pressure inside the cuff was also monitored using a control inflator and maintained at 20 mmHg. Following tracheal intubation, normal breathing sound was confirmed through auscultation. A wire was fastened around the tube at the "19 cm" mark to fix the tube to one of the teeth on the lower right side of the mouth. Tidal volume and respiration rate were maintained at 10 ml/kg and 10 per minute, respectively, by an anesthetic machine (Cato, Dräger, Germany). Peak inspiratory pressure was 15 cmH2O, and there was no air leakage in end-inspiration and no non-repletion of the bellow. Anesthesia was maintained by 2 L/min of O2, 2 L/min of N2O, and 2.5 vol% of sevoflurane. For oral irrigation, povidone iodine (Betadine®, Koreapharma, Korea) was used. During irrigation, bubbles formed, so 2 ml of additional air was inserted into the cuff. However, bubbles continued to form and the tube was removed after the povidone iodine inside the mouth was drawn through a suction catheter. Afterwards, tracheal intubation was retaken with a new Mallinckrodt tube the same size as the previous one. 6 ml of air was inserted into the cuff to maintain the inside-cuff pressure at 20 mmHg. The new tube was also 19 cm into the throat and fastened with a wire to one of the teeth on the lower right side of the mouth. Normal breathing sound from both lungs was heard and pulse oxygen saturation was 100%. Moreover, lung compliance and chest movement were normal and thus oral irrigation was resumed. No more air leakage occurred and maximum inspiratory pressure was 17 cmH2O. It was strange that air leakage was found in the first intubation, while no leakage was found in the second trial. Air was inserted into the cuff of the first tube, which was removed, to identify the reason. Consequently, it was found that air came out through a minute hole between the cuff and pipe connecting the pilot (Fig. 2). It was speculated that the tube was damaged when the wire was fastened to the tube.


Pneumonia due to aspiration of povidine iodine after induction of general anesthesia -A case report-.

An TH, Ahn BR - Korean J Anesthesiol (2011)

Extubated endotracheal tube: the inflating tube between cuff and pilot of the tube is perforated by the wire.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198188&req=5

Figure 2: Extubated endotracheal tube: the inflating tube between cuff and pilot of the tube is perforated by the wire.
Mentions: A 16-year old female patient (45 kg in weight and 157 cm in height) visited our hospital due to left maxillary fracture. The patient had no history of pulmonary disease, such as asthma, and showed no special features in the electrocardiography, biochemical examination of blood, or chest X-ray, all of which were conducted before her operation (Fig. 1). As a preoperative preparation, 0.05 mg/kg of midazolam was injected 1 hour before beginning the operation. Vital signs before anesthesia were blood pressure 110/66 mmHg , heart rate 80 beats/min, and oxygen saturation 99%. After arrival in the operating room, the patient's condition was monitored by a non-invasive blood pressure, pulse oxymeter, and electrocardiograph. The patient lost consciousness following the induction of anesthesia with 2 mg/kg propofol. An injection of 0.6 mg/kg rocuronium stopped spontaneous breathing, leading to positive pressure ventilation. Before a Mallinckrodt tube (Mallincrodt, St. Louis, MO, USA) with an internal diameter of 7.0 mm was inserted, no leakage in the tube cuff was found through ballooning of the cuff. A tracheal intubation was performed after confirmation that the patient's muscles were sufficiently relaxed. 6 ml of air was then inserted and no leakage of air in the mouth was heard. Pressure inside the cuff was also monitored using a control inflator and maintained at 20 mmHg. Following tracheal intubation, normal breathing sound was confirmed through auscultation. A wire was fastened around the tube at the "19 cm" mark to fix the tube to one of the teeth on the lower right side of the mouth. Tidal volume and respiration rate were maintained at 10 ml/kg and 10 per minute, respectively, by an anesthetic machine (Cato, Dräger, Germany). Peak inspiratory pressure was 15 cmH2O, and there was no air leakage in end-inspiration and no non-repletion of the bellow. Anesthesia was maintained by 2 L/min of O2, 2 L/min of N2O, and 2.5 vol% of sevoflurane. For oral irrigation, povidone iodine (Betadine®, Koreapharma, Korea) was used. During irrigation, bubbles formed, so 2 ml of additional air was inserted into the cuff. However, bubbles continued to form and the tube was removed after the povidone iodine inside the mouth was drawn through a suction catheter. Afterwards, tracheal intubation was retaken with a new Mallinckrodt tube the same size as the previous one. 6 ml of air was inserted into the cuff to maintain the inside-cuff pressure at 20 mmHg. The new tube was also 19 cm into the throat and fastened with a wire to one of the teeth on the lower right side of the mouth. Normal breathing sound from both lungs was heard and pulse oxygen saturation was 100%. Moreover, lung compliance and chest movement were normal and thus oral irrigation was resumed. No more air leakage occurred and maximum inspiratory pressure was 17 cmH2O. It was strange that air leakage was found in the first intubation, while no leakage was found in the second trial. Air was inserted into the cuff of the first tube, which was removed, to identify the reason. Consequently, it was found that air came out through a minute hole between the cuff and pipe connecting the pilot (Fig. 2). It was speculated that the tube was damaged when the wire was fastened to the tube.

Bottom Line: Mechanical ventilation with PEEP and periodical bronchial toilet with fiberoptic bronchoscopy were carried in the operating room and ICU.Bronchodilators, antibiotics, steroids and diuretics were also used to treat pneumonia.The patient was treated successfully without any complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea.

ABSTRACT
Aspiration pneumonia is usually caused by aspiration of gastric contents during anesthesia. It causes severe pulmonary complications. Povidone iodine was used widely as an oral antiseptic. Although povidone iodine is thought to be a safe and effective antiseptic, severe complications from its aspiration may occur. We present a case of pneumonia secondary to aspiration of povidone iodine in a 16 year old female patient who underwent orofacial surgery. Aspiration pneumonia must be treated immediately. Mechanical ventilation with PEEP and periodical bronchial toilet with fiberoptic bronchoscopy were carried in the operating room and ICU. Bronchodilators, antibiotics, steroids and diuretics were also used to treat pneumonia. The patient was treated successfully without any complication.

No MeSH data available.


Related in: MedlinePlus