There is a list of diseases that do not give patients a chance to continue their lives normally. Arising quite suddenly, they completely change a person, and he has very few chances to continue normal life activities. One of these pathological conditions is acid-aspiration syndrome, which is also known as Mendelssohn syndrome.
Description
The onset of the disease is associated with the ingestion of acidic gastric juice into the respiratory tract, as a result of which acute inflammation develops in a person. Most cases of the appearance of a pathological condition are known in obstetric anesthesiology. In patients with different diagnoses who are under or without anesthesia, acidic stomach contents 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. In obstetric anesthesia, this figure reaches 70%.
Causes
The main factor that provokes the occurrence of an acid-aspiration symptom is regurgitation or vomiting, which occurred during anesthesia, when the functionality of the protective reflexes of the larynx is reduced. Mendelssohn’s syndrome is mainly caused by regurgitation, with passive expiration of gastric contents into the oropharynx.
An 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 due to hormonal changes, gastrin production decreases, 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 with surgical 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, a very acidic gastric juice when it enters the respiratory tract can cause a chemical burn of the mucous membrane of the bronchi and trachea. Further, swelling of the mucosa provokes the development of bronchial 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 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 tissue perfusion disorders.
Clinical changes and pathophysiological disorders are associated with damage to the lung tissue. Sometimes the symptoms are less pronounced. Morphological changes in the respiratory system are clearly manifested a day after aspiration. Only a day or two from the moment when Mendelssohn syndrome arose, 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 general anesthesia for childbirth, this disease 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 be fatal 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.
Food in the stomach of women in labor tends to linger due to the slowdown of its 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
The first thing a patient with Mendelssohn syndrome should do 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, use a solution of sodium bicarbonate (2%) with the drug "Hydrocortisone" or a warm isotonic solution of sodium chloride. After intubation, the trachea 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, artificial lung 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 (the photo above shows which part of the system suffers in the first place) can lead to the death of the patient if help 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 will 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 the 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 can prevent 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.
A gastric tube is sometimes administered , leaving it throughout the operation to prevent gastric contents from entering the airways. 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.