Mendelssohn syndrome: symptoms, treatment, prevention

There is a list of diseases that do not give patients a chance to continue their lives normally. Emerging all at once, they completely change a person, and he has very little chance of continuing his normal life. One such pathological condition is the acid-aspiration syndrome, which is still known as Mendelssohn's syndrome.

Description

The occurrence of the disease is associated with the ingress of acidic gastric juice into the respiratory tract, resulting in a person developing acute inflammation. Most cases of the appearance of a pathological condition are known in obstetric anesthesiology. In patients with different diagnoses, who are under general anesthesia or without, the acidic contents of the stomach can get into the lower respiratory organs.

Mendelssohn syndrome is a deadly complication of anesthesia. In general medical practice, almost 60% of cases are lethal. In obstetrical anesthesia, this figure reaches 70%.

Causes

The main factor that provokes the emergence of an acidic aspiration symptom is regurgitation or vomiting that occurred during anesthesia, when the functionality of the protective reflexes of the larynx is lowered. Mendelssohn syndrome is predominantly caused by regurgitation, with passive expiration of the gastric contents into the oropharynx.

An increased risk of complications appears with a full stomach, drug depression, alcohol intoxication, and inhibition. Regurgitation can occur during pregnancy (from 22-23 weeks), when due to hormonal adjustment the production of gastrin decreases, which leads to the development of hypertension of the stomach. 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 operative delivery in obstetrics or in the practice of emergency surgery.

Pathogenesis

Mendelssohn syndrome has a peculiar mechanism of development. The first option is when the particles of undigested food enter the respiratory tract along with the gastric juice. At the level of secondary bronchi, mechanical blockage leads to the development of acute respiratory failure. In the second case, very acidic gastric juice, if inhaled, can cause a chemical burn of the mucous membrane of the bronchi and trachea. Further, the 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, dyspnoea, 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 disrupted, arterial hypertension progresses. Together with pronounced hypoxemia, pressure in the pulmonary artery increases with simultaneous increase in pulmonary vascular resistance. Metabolic acidosis and respiratory alkalosis develop as a result of disorders of tissue perfusion.

Clinical changes and pathophysiological disorders are associated with lesion of the lung tissue. Sometimes the symptomatology is less pronounced. Morphological changes in the respiratory organs manifest themselves distinctly one day after aspiration. Only a day or two from the moment when Mendelssohn's syndrome arose, the symptoms of respiratory failure begin to progress. A person can be saved only if he is provided with urgent medical assistance.

Mendelssohn's syndrome in obstetrics

In women with obstetrical operations or with general anesthesia of childbirth, this disease most often arises. There must be two conditions for aspiration in the airway. The first is general anesthesia (for obstetrical operations, childbirth, surgical abdominal pathology), the second is a disorder of the bulbar mechanism in comatose states, regurgitation, vomiting. In most cases, the patient is expected to die if he has Mendelssohn syndrome. That this gives the right to put the disease on a par with the most dangerous, fatal complications of anesthesia, there is no doubt.

The food in the stomach in parturient women is peculiar to linger because of the slowing of its passage during pregnancy due to a decrease in the level of gastrin and an increase in intra-abdominal pressure. It is gastrin that regulates gastric motility, and its insufficient amount leads to the development of an acid-aspiration syndrome in anesthesia.

Urgent care

The first thing that a patient with Mendelssohn syndrome should do is remove the aspirated contents of the stomach from the respiratory tract. The oral cavity is then cleaned with a suction or gauze swab. Intubation of the trachea should be performed at the pre-hospital stage. Next, you need to do an emergency bronchoscopy under anesthesia in combination with injection artificial ventilation. For washing the bronchi, a solution of sodium hydrogencarbonate (2%) is used with the preparation "Hydrocortisone" or a warm isotonic solution of sodium chloride. After intubation, the trachea is thoroughly washed with an alkaline solution through a probe. Intravenously injected solutions of "Atropine" and "Eufillin."

In the case when the patient's condition is moderate, artificial ventilation can be replaced by spontaneous breathing with expiratory resistance. For this procedure, you need a special mask, if it is not, you need to teach the patient to exhale through the rubber tube, which is lowered to the water.

Mendelssohn 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 needs to 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 to stop acute respiratory failure and prevent the development of infectious complications. Artificial ventilation is carried out when arterial hypoxia can not be eliminated in conditions of spontaneous breathing. In the extremely serious condition of the patient, the procedure is carried out for several days until the parameters of pulmonary gas exchange improve. Sometimes hyperbaric oxygenation is used, which in a number of cases gives positive results. Medicamentous treatment consists in the use of symptomatic drugs, antibiotics and corticosteroids in large doses.

The syndrome of Mendelssohn in 30-60% of cases leads to the death of the patient. Those who have suffered it can 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 - the use of drugs, whose effect is directed to lowering the secretion of the stomach ("Ranitidine", "Cimetidine"). To prevent the occurrence of complications, clear and correct actions of the anesthetist can be made. The drug "Atropin" needs to be replaced with "Metacin", the patient should be injected into the state of anesthesia smoothly and quickly. The doctor should have a good knowledge of intubation technique and laryngoscopy of the trachea and use Selik's technique.

Sometimes enter the stomach probe, leaving it throughout the operation to prevent ingress of gastric contents into the respiratory tract. Some experts are against such a technique, because the probe can play the role of a wick and aggravate the condition. In obstetrics, prevention should be in the correct position of the parturient woman on the operating table, whose head end should be slightly raised.