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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

Chest X-ray taken after reintubation: pneumonic infiltration and atelectasis shown on right lung field.
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Figure 3: Chest X-ray taken after reintubation: pneumonic infiltration and atelectasis shown on right lung field.

Mentions: A chest X-ray was conducted on suspicion of aspiration pneumonia. For continuous arterial blood gas analyses, an invasive arterial catheter was inserted into the left radial artery after collateral circulation was confirmed through the Modified Allen's test. Results were as follows: FiO2 0.5, pH 7.34, PaCO2 42.9 mmHg, PaO2 69.4 mmHg, and SaO2 93% (Table 1). Following the analysis, salbutamol (Ventolin®, GSK, UK) was nebulized through the tracheal tube while conducting mechanical ventilation with 10 cmH2O of positive end-expiratory pressure (PEEP). In addition, 90 mg of methylprednisolone and 20 mg of furosemide were injected. Meanwhile, the chest X-ray determined aspiration pneumonia in the right lung (Fig. 3). Thirty minutes after administration of drug treatment and mechanical ventilation, arterial blood gas analysis was conducted again. The analysis showed improvement in the patient's condition as follows: pH 7.35, PaCO2 39.6 mmHg, PaO2 253.3 mmHg, and 99% SaO2. Accordingly, the operation was resumed and finished 30 minutes later. After the operation, 10 mg pyridostigmine and 0.4 mg glycopyrrolate were used to reverse muscle relaxation. As the patient's spontaneous respiration recovered, brownishtinged liquid was discharged while her lung compliance decreased. Afterwards, suction through the tube was administered resulting in substantial aspiration of povidone iodine. Additional suction of povidone iodine was performed after the trachea and bronchi were cleaned with sterile saline solution under the guidance of fiberoptic bronchoscopy. Subsequently, compliance of the reservoir bag improved and arterial blood gas analysis at this point showed FiO2 1.0, pH 7.36, PaCO2 36.9 mmHg, PaO2 131.8 mmHg, and SaO2 98.6%. The patient was transferred to the intensive care unit with the tracheal tube still inside.


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

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

Chest X-ray taken after reintubation: pneumonic infiltration and atelectasis shown on right lung field.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Chest X-ray taken after reintubation: pneumonic infiltration and atelectasis shown on right lung field.
Mentions: A chest X-ray was conducted on suspicion of aspiration pneumonia. For continuous arterial blood gas analyses, an invasive arterial catheter was inserted into the left radial artery after collateral circulation was confirmed through the Modified Allen's test. Results were as follows: FiO2 0.5, pH 7.34, PaCO2 42.9 mmHg, PaO2 69.4 mmHg, and SaO2 93% (Table 1). Following the analysis, salbutamol (Ventolin®, GSK, UK) was nebulized through the tracheal tube while conducting mechanical ventilation with 10 cmH2O of positive end-expiratory pressure (PEEP). In addition, 90 mg of methylprednisolone and 20 mg of furosemide were injected. Meanwhile, the chest X-ray determined aspiration pneumonia in the right lung (Fig. 3). Thirty minutes after administration of drug treatment and mechanical ventilation, arterial blood gas analysis was conducted again. The analysis showed improvement in the patient's condition as follows: pH 7.35, PaCO2 39.6 mmHg, PaO2 253.3 mmHg, and 99% SaO2. Accordingly, the operation was resumed and finished 30 minutes later. After the operation, 10 mg pyridostigmine and 0.4 mg glycopyrrolate were used to reverse muscle relaxation. As the patient's spontaneous respiration recovered, brownishtinged liquid was discharged while her lung compliance decreased. Afterwards, suction through the tube was administered resulting in substantial aspiration of povidone iodine. Additional suction of povidone iodine was performed after the trachea and bronchi were cleaned with sterile saline solution under the guidance of fiberoptic bronchoscopy. Subsequently, compliance of the reservoir bag improved and arterial blood gas analysis at this point showed FiO2 1.0, pH 7.36, PaCO2 36.9 mmHg, PaO2 131.8 mmHg, and SaO2 98.6%. The patient was transferred to the intensive care unit with the tracheal tube still inside.

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