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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 after extubation: right lung field shows nearly normalizing.
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Figure 5: Chest x-ray after extubation: right lung field shows nearly normalizing.

Mentions: In the intensive care unit, further suction of povidone iodine was attempted using bronchoscopy, but no such liquid was found (Fig. 4). Tidal volume of the patient was as insufficient as 200-250 ml. Therefore, mechanical ventilation was performed at the pressure support mode with 0.4 of FiO2, while pressure support was 15 cmH2O and PEEP was 10 cmH2O. At this moment, exhaled tidal volume was 350-400 ml and respiration rate was 15-17 per minute. The arterial blood gas analysis conducted 5 hours after the beginning of the mechanical ventilation found a pH of 7.54, PaCO2 20.5 mmHg, PaO2 173.9 mmHg, and SaO2 99.4%. Biochemical examination of blood was also conducted, and the results were as follows: leukocyte counts were 13.840 (103/µl), neutrophils had increased to 88.2%, and her body temperature was 37.4℃ leading to the diagnosis of fever. Accordingly, augmentin (Augmentin®, Ilsung, Korea) along with cefepime (Maxipime®, Boryung, Korea) were prescribed, while 20 mg of methylprednisolone and furosemide each were administered 3 times and twice a day, respectively. At this point, pressure support and PEEP were readjusted to 8 cmH2O and 5 cmH2O, respectively. Arterial blood gas analysis conducted 18 hours after beginning mechanical ventilation presented pH 7.49, PaCO2 21.9 mmHg, PaO2 111.8 mmHg, and SaO2 98.5%. Weaning was performed when 25 hours had passed since the beginning of mechanical ventilation using a T-piece, and 3 L/min of oxygen was provided to the patient. Her blood pressure and heart rate were normal while oxygen saturation remained 98% or higher. The patient's consciousness was so clear that she could follow a pen with her eyes. Removal of the tube was conducted 2 hours after weaning, as arterial blood gas analysis at this time indicated pH 7.36, PaCO2 40.5 mmHg, PaO2 176.5 mmHg, and SaO2 99.2%. After removal of the tube, 2 L/min of oxygen was provided through a nasal cannula, and arterial blood gas analysis conducted 5 hours after this showed pH 7.39, PaCO2 35.7 mmHg, PaO2 182.1 mmHg, and SaO2 99.3%. Oxygen saturation remained 98% or higher, and the amount of oral discharge gradually decreased. The patient's chest X-ray also indicated improvement in her condition (Fig. 5). Fifty hours after the operation, the 16-year old girl was transferred to a general ward without any complication.


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 after extubation: right lung field shows nearly normalizing.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Chest x-ray after extubation: right lung field shows nearly normalizing.
Mentions: In the intensive care unit, further suction of povidone iodine was attempted using bronchoscopy, but no such liquid was found (Fig. 4). Tidal volume of the patient was as insufficient as 200-250 ml. Therefore, mechanical ventilation was performed at the pressure support mode with 0.4 of FiO2, while pressure support was 15 cmH2O and PEEP was 10 cmH2O. At this moment, exhaled tidal volume was 350-400 ml and respiration rate was 15-17 per minute. The arterial blood gas analysis conducted 5 hours after the beginning of the mechanical ventilation found a pH of 7.54, PaCO2 20.5 mmHg, PaO2 173.9 mmHg, and SaO2 99.4%. Biochemical examination of blood was also conducted, and the results were as follows: leukocyte counts were 13.840 (103/µl), neutrophils had increased to 88.2%, and her body temperature was 37.4℃ leading to the diagnosis of fever. Accordingly, augmentin (Augmentin®, Ilsung, Korea) along with cefepime (Maxipime®, Boryung, Korea) were prescribed, while 20 mg of methylprednisolone and furosemide each were administered 3 times and twice a day, respectively. At this point, pressure support and PEEP were readjusted to 8 cmH2O and 5 cmH2O, respectively. Arterial blood gas analysis conducted 18 hours after beginning mechanical ventilation presented pH 7.49, PaCO2 21.9 mmHg, PaO2 111.8 mmHg, and SaO2 98.5%. Weaning was performed when 25 hours had passed since the beginning of mechanical ventilation using a T-piece, and 3 L/min of oxygen was provided to the patient. Her blood pressure and heart rate were normal while oxygen saturation remained 98% or higher. The patient's consciousness was so clear that she could follow a pen with her eyes. Removal of the tube was conducted 2 hours after weaning, as arterial blood gas analysis at this time indicated pH 7.36, PaCO2 40.5 mmHg, PaO2 176.5 mmHg, and SaO2 99.2%. After removal of the tube, 2 L/min of oxygen was provided through a nasal cannula, and arterial blood gas analysis conducted 5 hours after this showed pH 7.39, PaCO2 35.7 mmHg, PaO2 182.1 mmHg, and SaO2 99.3%. Oxygen saturation remained 98% or higher, and the amount of oral discharge gradually decreased. The patient's chest X-ray also indicated improvement in her condition (Fig. 5). Fifty hours after the operation, the 16-year old girl was transferred to a general ward without any complication.

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