Mendelson's syndrome

Mendelson's syndrome is chemical pneumonitis or aspiration pneumonitis caused by aspiration during anaesthesia, especially during pregnancy. Aspiration contents may include gastric juice, blood, bile, water or an association of them.[1]

Mendelson's syndrome
SpecialtyRespirology

Presentation

Mendelson's syndrome is characterised by a bronchopulmonary reaction following aspiration of gastric contents during general anaesthesia due to abolition of the laryngeal reflexes. The main clinical features are signs of general hypoxia, two to five hours after anaesthesia. Such features may include cyanosis, dyspnea, fever, pulmonary wheeze, crepitant rales, rhonchi, and tachycardia with a low blood pressure. Decreased arterial oxygen tension is also likely to be evident. Pulmonary edema can cause sudden death or death may occur later from pulmonary complications.

Risk factors

Historically it is said that a patient is at risk if they have:[2]

  • Residual gastric volume of greater than 25ml, with
  • pH of less than 2.5

However these are indirect measurements and are not factors that directly influence aspiration risk.[2]

Patients with a high risk should have a rapid sequence induction. High risk is defined as these factors:[2]

  1. Non-elective surgical procedure
  2. Light anaesthesia/unexpected response to stimulation
  3. Acute or chronic, upper or lower GI pathology
  4. Obesity
  5. Opioid medication
  6. Neurological disease, impaired conscious level, or sedation
  7. Lithotomy position
  8. Difficult intubation/airway
  9. Gastrointestinal reflux
  10. Hiatal hernia

Eponym

It is named for Curtis Mendelson.[3][4]

References
  1. Г.А.Рябов, СИНДРОМЫ КРИТИЧЕСКИХ СОСТОЯНИЙ. Аспирационный пневмонит (синдром Мендельсона), http://surgerycom.net/critical/4/4_3.html
  2. Levy, DM (2006). "Pre-operative fasting—60 years on from Mendelson". Continuing Education in Anaesthesia, Critical Care & Pain. 6 (6): 215–218. doi:10.1093/bjaceaccp/mkl048.
  3. Enersen, OD. "Whonamedit – Mendelson's syndrome". Whonamedit? A dictionary of medical eponyms. Retrieved 2011-04-22.
  4. Mendelson, CL (1946). "The aspiration of stomach contents into the lungs during obstetric anesthesia". American Journal of Obstetrics and Gynecology. 52: 191–205. doi:10.1016/S0002-9378(16)39829-5. PMID 20993766.
Classification
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