There is a list of diseases that do not give patients a chance to continue their normal lives. Arising quite suddenly, they completely change a person, and he has very little chance of continuing his normal life. One such pathological condition is acid aspiration syndrome, also known as Mendelssohn's syndrome.
Description
The occurrence of the disease is associated with the ingestion of acidic gastric juice into the respiratory tract, as a result of which a person develops acute inflammation. Most cases of the appearance of a pathological condition are known in obstetric anesthesiology. In patients with various diagnoses, who are under or without anesthesia, the acidic contents of the stomach, rich in enzymes, can enter the lower respiratory organs.
Mendelssohn's syndrome is a deadly complication of anesthesia. In general medical practice, almost 60% of cases are fatal. ATobstetric anesthesia, this figure reaches 70%.
Reasons
The main factor that provokes the occurrence of an acid-aspiration symptom is regurgitation or vomiting that occurs during anesthesia, when the functionality of the protective reflexes of the larynx is reduced. Mendelssohn's syndrome is predominantly caused by regurgitation, with passive leakage of gastric contents into the oropharynx.
Increased risk of developing complications appears with a full stomach, drug depression, alcohol intoxication, lethargy. Regurgitation can occur during pregnancy (from 22-23 weeks), when gastrin production decreases due to hormonal changes, which leads to the development of gastric hypertension. Among other factors: increased intragastric and intra-abdominal pressure, bloating, inflammatory processes in the esophagus, obesity, 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
Mendelssohn's syndrome has a peculiar mechanism of development. The first option is when particles of undigested food enter the respiratory tract along with gastric juice. At the level of the middle bronchi, mechanical blockage leads to the development of acute respiratory failure. In the second case, very acidic gastric juice, if it enters the respiratory tract, can cause a chemical burn of the mucous membrane of the bronchi and trachea. Further, mucosal edema provokes the developmentbronchial obstruction.
Mendelssohn syndrome: symptoms
The clinical picture of the disease almost coincides with the symptoms of severe respiratory failure. The patient's condition is characterized by pulmonary edema, tachycardia, dyspnea, cyanosis, bronchospasm. Against the background of strongly pronounced initial changes, cardiac arrest may occur. In the patient's body, the general and pulmonary blood flow is disturbed, arterial hypertension progresses. Together with severe hypoxemia, 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 impaired tissue perfusion.
Clinical changes and pathophysiological disorders are 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 after the onset of Mendelssohn's syndrome, the symptoms of respiratory failure begin to progress. A person can be saved only if he is provided with urgent medical care.
Mendelssohn's syndrome in obstetrics
Women during obstetric operations or during general anesthesia of childbirth most often develop this disease. For aspiration into the airway, two conditions must be met. 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, vomiting. ATIn most cases, the patient will die if he has Mendelssohn's syndrome. That this gives the right to put the disease on a par with the most dangerous, deadly complications of anesthesia, there is no doubt.
Food in the stomach of parturient women tends to linger due to a slowdown in its passage during pregnancy due to a decrease in gastrin levels and an increase in intra-abdominal pressure. It is gastrin that regulates gastric motility, and an insufficient amount of it leads to the development of acid aspiration syndrome during anesthesia.
Emergency
The first thing a patient with Mendelssohn's syndrome should do is remove the aspirated contents of the stomach from the respiratory tract. The oral cavity is cleaned with suction or a gauze swab. Tracheal intubation should be performed at the prehospital stage. Next, you need to do an urgent bronchoscopy under anesthesia in combination with injection artificial ventilation of the lungs. To wash the bronchi, use a solution of sodium bicarbonate (2%) with the drug "Hydrocortisone" or a warm isotonic solution of sodium chloride. After tracheal intubation, the stomach is thoroughly washed with an alkaline solution through a probe. Solutions "Atropine" and "Eufillin" are administered intravenously.
In the case when the patient's condition is moderate, mechanical ventilation can be replaced by spontaneous breathing with exhalation resistance. For this procedure, you will need a special mask, if it is not available, you need to teach the patient to exhale through a rubber tube lowered by the end into the water.
Mendelssohn's syndrome (the photo above shows which part of the system suffers in the first place) can lead to the death of the patient if he is not helped in time. Even with rapid relief of laryngo- and bronchospasm, the patient must be hospitalized in order to prevent the development of severe complications.
Treatment
If a patient is diagnosed with Mendelssohn's syndrome, treatment should include those measures that will help stop acute respiratory failure and prevent the development of infectious complications. Artificial ventilation of the lungs is carried out when arterial hypoxia cannot be eliminated under conditions of spontaneous breathing. 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 oxygen therapy is used, which in some cases gives positive results. Medical treatment consists of the use of symptomatic agents, antibiotics and high doses of corticosteroids.
Mendelssohn's syndrome in 30-60% of cases leads to the death of the patient. Those who have had it may develop severe restrictive or obstructive disorders to varying degrees.
Prevention
There are a number of actions that can prevent the development of such a severe complication as Mendelssohn's syndrome. Prevention consists of several steps. The first is the use of drugs whose action is aimed at lowering the secretionstomach ("Ranitidine", "Cimetidine"). Clear and correct actions of the anesthesiologist can prevent the occurrence of complications. The drug "Atropine" should be replaced by the drug "Metacin", the patient should be introduced into the state of anesthesia smoothly and quickly. The physician must be proficient in the technique of intubation and laryngoscopy of the trachea and use the Celica maneuver.
Sometimes a gastric tube is inserted, leaving it throughout the operation to prevent gastric contents from entering 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.
