Pneumonia due to aspiration of povidine iodine after preoperative disinfection of the oral cavity

Abstract

Introduction Povidone-iodine (PI) is thought to be an effective disinfectant and safe for many surgeons. Aspiration pneumonia is usually caused by gastric contents, but if PI solution will be aspirated, pneumonia or other complications may occur. Case report We present a case of pneumonia to aspiration of PI solution in a 91-year-old man patient who underwent oralmaxillofacial surgery. When surgeons used PI solution for disinfection into the oral cavity, the solution seems to be sinking gradually. The patient showed severe respiratory distress and developed hypoxia. There were much frothy fluids into a tracheal tube. We suctioned through the endotracheal tube and performed bronchoscopy, that revealed a redness which appeared associated to a chemical injury on the left trachea and bronchus. His condition was complicated by ARDS and DIC. Periodical bronchial suction and guideline-based treatments of ARDS were carried in ICU. He recovered without severe complication. Conclusion Although PI solution for an oral disinfection is used routinely, all operators need to be aware of the risk for PI aspiration Keywords Aspiration pneumonia. Povidone iodine (PI). Disseminated intravascular coagulation (DIC). Adult respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP)

Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era

“…In 2 of these cases, there was overt concern of lack of integrity of the endotracheal tube balloon. 50,51 One author reports using this solution for antisepsis for over 20 years without any prior complications. 52 The effect of PVP-I on lung tissue was studied in rats, demonstrating atelectasis, edema, alveolar rupture, and leukocyte infiltration, followed by lung parenchyma loss and pulmonary fibrosis at 1% and 5% concentrations with less severe findings in rats exposed to 0.1% concentrations.…”

Clinical and Bacteriological Comparison of Mouthwashes Used in Self-Care During Perioperative Oral Management: A Randomized Clinical Trial

“…In these analyses, there were no signi cant differences between the CPC and PVP-I groups. PVP-I products have previously been reported to inhibit the growth of bacteria in the oral cavity, and CPC products have been shown to be equally effective [11][12][13].…”

“…However, the use of CHX has been reported to cause anaphylactic shock [10] and thus the usable CHX concentrations is limited in Japan. Therefore, we recommend that patients rinse their mouth with a product containing povidone iodine (PVP-I) to maintain cleanliness of the oral cavity after perioperative oral care (POC), which has been reported to inhibit the growth of oral bacteria [11][12][13]. However, the bactericidal capability of PVP-I products is markedly reduced by dilution and is further reduced by the addition of saliva [14].…”

Repurposing povidone-iodine to reduce the risk of SARS-CoV-2 infection and transmission: a narrative review

“…Povidone-iodine is not known to stain the teeth [ 77 ] and has good acceptability in terms of taste, after-taste, and odour [ 78 ]. Rarely, povidone-iodine used to disinfect the oral cavity in preparation for surgery has been reported to cause aspiration pneumonitis following general anaesthesia [ 79–81 ].…”