Mendelson's syndrome - Acute aspiration pneumonia develops as a result of inhalation of acidic gastric contents. Most often it occurs as a complication of anesthesia. Mendelson's syndrome Clinic takes place in a matter of hours and includes shortness of breath, fever, respiratory failure, pneumonia, bacterial adherence. The syndrome is diagnosed on clinical grounds, auscultation and radiological data. First aid involves content aspiration of the respiratory tract, the elimination of bronchospasm, the patient's transfer to the ventilator, the therapeutic bronchoscopy. Later appointed decongestants and anti-bacterial therapy.
pulmonology, obstetrics, anesthesiology and resuscitation.
pulmonary edema and adult respiratory distress syndrome (form hypoxemic respiratory failure).
In some cases, together with gastric juice into the airways can enter undigested food particles, causing blockage of the mechanical medium caliber bronchi (asphyxial form respiratory failure). In both cases will eventually develop bronchial obstruction.
For the occurrence of clinical syndrome Mendelsohn sufficient to reach a respiratory way even small volume (20-30 ml) with the low gastric pH. The most severe damage occurs when a large amount of acid aspiration of contents (> 0.4 ml /kg) having a pH of 5.
Factors predisposing to aspiration or regurgitation of stomach contents and the development of the syndrome of Mendelssohn, are the impairment of consciousness due to general anesthesia, alcohol or drugs, the influence of sedatives, traumatic brain injury, coma. Most often, Mendelson's syndrome occurs as a complication of emergency surgery (most celiac operations and caesarean section), when it is not given due attention to training the gastrointestinal tract. Additional risk factors are the increase in intra-abdominal pressure (in pregnant women in the III trimester of obesity, bowel paresis), gastrointestinal disorders (peptic ulcer and duodenum, esophagitis, gastritis, expansion of the esophagus, esophageal diverticulum, hiatal hernia).
acute respiratory failure.
In the first minutes after the aspiration as a result of a reflex constriction of the bronchioles occurs cough, expiratory dyspnea, cyanosis of skin, tachycardia, decreased blood pressure. The first phase Mendelson's syndrome is often mistaken for a bronchial asthma attack. In light tapped mixed wet and wheezing; there is an increase in CVP, swelling of the neck veins. Rapidly developing ARF I-III of Article .; at the first stage of the possible death from asphyxia.
The second phase is marked by spontaneous partial extension of the bronchioles and some clinical improvement. The patient's condition temporarily stabilized: shortness of breath decreases, pressure decreases. Approximately 48 hours later comes the third phase of the syndrome of Mendelssohn. During this period, rapidly growing phenomenon of bronchiolitis and pneumonitis, which causes a new deterioration of the patient and the progression of respiratory failure. Join a bacterial complications - developing aspiration pneumonia (fever, cough, leukocytosis). Fatal outcome usually comes from pulmonary edema.
blood gas PaO2 a decline to 35-45 mm Hg. Art. Auscultation picture is characterized by the presence of multiple wheezing (in the lower - kripitiruyuschih wheezing).
During the bronchoscopy revealed edema and hyperemia of the mucous membrane, the presence in the lumen of the bronchi aspirated fluid, often with lumps of food. The X-ray lung lesions seen hypoventilation, diffuse darkening lung fields ( "shock lung"). With the addition of a secondary bacterial pneumonia appear foci of infiltration.
bronchoalveolar lavage used sterile saline. Treatment of patients with the syndrome of Mendelssohn performed in the ICU together Anaesthetist and pulmonologists.
With a view to eliminating bronhiolospazma atropine, aminophylline, prednisone or dexamethasone, ortsiprenalin. Always made percussion massage chest. To neutralize the high acidity made alkaline with sodium hydrogen carbonate solution inhalation. Carried electrolyte infusion solutions, glucose, fresh frozen plasma, albumin; stimulation of diuresis. Antibiotic therapy is indicated for the prevention and treatment of aspiration pneumonia. Extubation performed after recovery of spontaneous breathing and self-ability to maintain adequate gas exchange.
Prediction and prevention of Mendelson's syndrome
Lethal outcomes in the event of the syndrome of Mendelssohn observed in 60% of cases, and in obstetric practice - more than 70% of cases. To prevent this serious complication, before emergency operations necessary to evacuate the stomach contents using a probe (except when it is contraindicated - for example, when the gastric bleeding). Before elective surgery is prohibited eat or drink for 10-12 hours prior to the intervention, assigned antacids, H2 blockers and prokinetic if necessary. In order to prevent Mendelson's syndrome is necessary to observe the correct algorithm of anesthesia during emergency surgery.