There is a list of diseases that do not givethe sick have a chance to continue their lives normally. Appearing quite suddenly, they completely change a person, and he has very little chance of continuing normal life activity. One of these pathological conditions is acid-aspiration syndrome, which is also known as Mendelssohn's syndrome.
Description
The onset of the disease is due tothe respiratory tract of acidic gastric juice, resulting in a person develops acute inflammation. Most cases of the onset of a pathological condition are known in obstetric anesthesiology. In patients with different diagnoses that are under anesthetic or without anesthesia, the acidic contents of the stomach rich in enzymes can get into the lower respiratory organs.
Mendelssohn's Syndrome is Deadlycomplication of anesthesia. In general medical practice in almost 60% of cases there is a fatal outcome. In obstetric anesthesia, this figure reaches 70%.
Causes
The main factor that provokes the occurrenceacid-aspiration symptom, is regurgitation or vomiting, which arose during anesthesia, when the functionality of the protective reflexes of the larynx is reduced. Mendelssohn's syndrome is mainly caused by regurgitation, with a passive flow of gastric contents into the oropharynx.
Increased risk of developing complications appearswith a full stomach, drug depression, alcohol intoxication, lethargy. Regurgitation may occur during pregnancy (from 22-23 weeks), when gastrin production is reduced due to hormonal adjustment, which leads to the development of gastric hypertension. Other factors include increased intragastric and intra-abdominal pressure, abdominal distension, inflammatory processes in the esophagus, obesity, and the presence of acute surgical diseases of the digestive system. The greatest risk of the syndrome occurs during operative delivery in obstetrics or in the practice of emergency surgery.
Pathogenesis
Синдром Мендельсона имеет своеобразный механизм development. The first option is when particles of undigested food get into the respiratory tract along with gastric juice. At the level of the middle bronchi, mechanical obstruction leads to the development of acute respiratory failure. In the second case, a very acidic gastric juice, if inhaled, can cause a chemical burn of the bronchial and tracheal mucosa. Further, mucosal edema provokes the development of bronchial obstruction.
Mendelssohn syndrome: symptoms
Clinical picture of the disease is almostcoincides with symptoms of severe respiratory failure. The patient's condition is characterized by pulmonary edema, tachycardia, dyspnea, cyanosis, and bronchospasm. Against the background of strongly pronounced initial changes, cardiac arrest may occur. In the patient's body, the common and pulmonary blood flow is disturbed, arterial hypertension is progressing. Together with severe hypoxemia, the pressure in the arteries of the lungs increases with a simultaneous increase in pulmonary vascular resistance. Metabolic acidosis and respiratory alkalosis develop as a result of violations of tissue perfusion.
Clinical and pathophysiological changesviolations associated with damage to the lung tissue. Sometimes the symptoms are less pronounced. Morphological changes in the respiratory organs are clearly manifested a day after aspiration. Only a day or two from the moment when Mendelssohn’s syndrome arose, the symptoms of respiratory failure begin to progress. You can save a person only if you provide him with urgent medical care.
Mendelssohn's syndrome in obstetrics
In women with obstetric operations or with generallabor pain most often occurs. There must be two conditions for aspiration into the airways. The first is general anesthesia (during obstetric operations, childbirth, surgical pathology of the abdomen), the second is a violation of the bulbar mechanism in coma, regurgitation, and vomiting. In most cases, the patient will die, if he has Mendelssohn syndrome. There is no doubt that this gives the right to put the disease on a par with the most dangerous, fatal complications of anesthesia.
Пище в желудке у рожениц свойственно delayed due to a slowdown in her passage during pregnancy due to a decrease in gastrin level and an increase in intra-abdominal pressure. It is gastrin that regulates the motility of the stomach, and its insufficient amount leads to the development of acid-aspiration syndrome during anesthesia.
Urgent care
Первое, что должны провести больному с синдромом Mendelssohn is to remove the aspirated contents of the stomach from the airways. The oral cavity is then cleaned with a suction or gauze swab. Tracheal intubation should be done at the prehospital stage. Next, you need to do an urgent bronchoscopy under anesthesia in combination with injection mechanical ventilation. To wash the bronchi, a solution of sodium bicarbonate (2%) with the drug "Hydrocortisone" or a warm isotonic sodium chloride solution is used. After tracheal intubation, the stomach is thoroughly washed with an alkaline solution through a tube. Atropine and Eufillin solutions are administered intravenously.
In the case when the patient’s condition is moderate,mechanical ventilation can be replaced by spontaneous breathing with resistance to expiration. For this procedure, you will need a special mask, if it is not there, you need to teach the patient to exhale through a rubber tube dropped into the water by the end.
Mendelssohn's Syndrome (photo above showswhich part of the system suffers in the first place) can lead to the death of the patient if assistance is not provided in time. Even with a quick relief of laryngo- and bronchospasm, the patient needs to be hospitalized in order to prevent the development of serious complications.
Treatment
If a patient is diagnosed with Mendelssohn’s syndrome,treatment should include those measures that help relieve acute respiratory failure and prevent the development of infectious complications. Mechanical ventilation is carried out when arterial hypoxia cannot be eliminated in conditions of spontaneous respiration. In an extremely serious condition of the patient, the procedure is carried out for several days, until the indicators of pulmonary gas exchange improve. Sometimes hyperbaric oxygenation is used, which in some cases gives positive results. Drug treatment consists in the use of symptomatic agents, antibiotics and corticosteroids in large doses.
Mendelssohn's syndrome in 30-60% of cases leads to the death of the patient. Those who have suffered it may develop severe restrictive or obstructive disorders to varying degrees.
Prevention
There are a number of actions that mayprevent the development of such a serious complication as Mendelssohn’s syndrome. Prevention consists of several steps. The first is the use of drugs whose action is aimed at lowering the secretion of the stomach (Ranitidine, Cimetidine). Clear and correct actions of the anesthetist can prevent the occurrence of complications. The drug Atropine should be replaced with Metacin, the patient should be administered smoothly and quickly into a state of anesthesia. The doctor should be well versed in the technique of intubation and laryngoscopy of the trachea and use Selik's technique.
Sometimes a gastric tube is inserted, leaving it onthroughout the operation to prevent ingestion of gastric contents into the respiratory tract. Some experts are against this technique, because the probe can play the role of a wick and aggravate the condition. In obstetrics, prevention should consist in the correct position of the woman in labor on the operating table, the head end of which should be slightly raised.
