Mendelson’s syndrome, also known as aspiration pneumonitis, is a chemical lung injury caused by the inhalation of acidic gastric contents. It typically occurs in patients under general anesthesia or those who are unconscious, which leads to a loss of the protective airway reflexes. This condition was first described by Dr. Curtis Mendelson in 1946.
Symptoms
The symptoms of Mendelson’s syndrome can vary depending on the severity of the aspiration but may include:
- Acute shortness of breath
- Coughing and wheezing
- Chest pain
- Cyanosis (bluish discoloration of the skin due to lack of oxygen)
- Rapid breathing (tachypnea)
- Fever
- Hypoxemia (low blood oxygen levels)
Causes
The primary cause of Mendelson’s syndrome is the aspiration of acidic gastric contents into the lungs. This can occur in several scenarios, such as:
- During general anesthesia, particularly in emergency surgeries where the stomach is not empty
- In patients with impaired consciousness, such as those with a head injury, stroke, or seizure
- During severe vomiting or regurgitation
- In conditions that impair swallowing reflexes, like neurological disorders or alcohol intoxication
Treatment
The treatment of Mendelson’s syndrome involves both supportive care and specific interventions to manage the condition. These may include:
- Oxygen Therapy: To maintain adequate oxygen levels in the blood.
- Mechanical Ventilation: In severe cases, patients may require ventilatory support.
- Bronchoscopy: To remove aspirated material from the lungs.
- Antibiotics: Not typically indicated unless there is a secondary bacterial infection.
- Corticosteroids: Their use is controversial and not routinely recommended but may be considered in specific cases.
Prevention
Preventive measures are crucial, especially in at-risk patients, and may include:
- Preoperative Fasting: Ensuring patients fast for an adequate period before elective surgeries to reduce the risk of aspiration.
- Proper Anesthesia Techniques: Using techniques like rapid sequence induction and intubation to protect the airway.
- Head Positioning: Keeping the head elevated and in a safe position to prevent aspiration.
- Use of Antacids: In some cases, administering antacids or other medications to neutralize stomach acid before surgery.
Mendelson’s syndrome is a potentially serious condition that requires prompt recognition and appropriate management to prevent complications and improve outcomes.
