Risk from the Aspiration of Vomit During Obstetric Anaesthesia

Parker, Rachel

doi:10.1136/bmj.2.4879.65

Cited by 35 publications

(9 citation statements)

References 8 publications

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“…Further, the use of cortisone may be expected to reduce the bronchospasm, which was stated by Mendelson (1946) and by Parker (1954) to be a feature of these cases. Several authors, notably Hall (1940) and Parker (1954), have described the pathological changes in the lungs in severe cases of Mendelson's syndrome. In their papers one reads of " diffuse wet consolidation with air present only at the extreme apices " and " massive oedema of all lobes of the lungs."…”

Section: Discussionmentioning

confidence: 99%

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Mendelson's Syndrome: its treatment by tracheostomy and hydrocortisone.

Nicholl¹,

Holland²,

Brown³

1967

BMJ

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Medical MemorandaBansH 745Three weeks after discontinuation the eye-grounds were normal and x-ray examination of the skull showed normal sutures. There were no sequelae and the boy was doing very well. DISCUSSIONThe first two episodes of increased intracranial pressure occurred in close connexion with nalidixic acid medication. No other drugs were involved. It was necessary to obtain final proof of a cause-and-effect relation in this case because it was important to explain the reaction before surgery for the ureter stenosis was undertaken. Thus an attempt was made (episode 3) to provoke the symptom by a third administration of the drug with the patient under close surveillance.The earlier symptoms of intracranial hypertension now promptly reappeared, and, as before, they were rapidly reversible. The plasma levels of nalidixic acid paralleled these clinical observations very closely. There was a sharp rise in concentration and a rapid decrease after discontinuation. As the drug had to be withdrawn on the second day of medication, data about its possible cumulation could not be obtained. However, according to data available in the literature (McChesney et al., 1964;Walker et al., 1966) the levels in this patient do not seem to be particularly high. The rate of disappearance of the drug from the blood also seems to be in the same order as that described by the authors mentioned above.Benign intracranial hypertension has been reported after treatment with tetracycline (Millichap, 1959; Fields, 1961;Opfer, 1963;O'Doherty, 1965), with corticosteroids (Dees and McKay, 1959;Valentine, 1959; Laurence et al., 1960;Greer, 1963;Walker and Adamkiewicz, 1964), and with toxic doses of vitamin A (Josephs, 1944; Oliver, 1958 ;Marie et al., 1963; Persson et al., 1965). A bulging fontanelle as a side-effect of nalidixic acid, however, has not previously been described in the literature, though Walker et al. (1966) reported that one of their patients, a 9-year-old girl admitted to hospital after a car injury, developed a slight papilloedema while receiving nalidixic acid for a urinary tract infection. Details were not given, but this suggests a drug effect, since the papilloedema disappeared when the drug was discontinued. Furthermore, the manufacturer (Winthrop Company) have informed us that in their files they have four recent reports on intracranial hypertension during nalidixic acid therapy in children. However, in none of these cases was a connexion with the medication proved and none of them has been published. Hall (1940) described the cases of 15 patients who had inhaled vomitus during or after anaesthesia for childbirth. He described two types of case: (1) those patients in whom the inhaled vomitus consisted of solid material; this caused mechanical obstruction of the airway; and (2) those in whom the inhaled vomitus was entirely liquid; these latter patients developed marked cyanosis, tachycardia, and tachypnoea several hours later. Mendelson (1946) also noted the two types of reaction, depending on the quality of the...

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Section: Discussionmentioning

confidence: 99%

“…Others have confirmed that pulmonary oedema may develop after the inhalation of acid gastric contents (Hartzell and Mininger, 1946;Parker, 1954;Hausmann and Lunt, 1955).…”

Section: Mendelson's Syndrome: Its Treatment Bymentioning

confidence: 93%

Mendelson's Syndrome: its treatment by tracheostomy and hydrocortisone.

Nicholl¹,

Holland²,

Brown³

1967

BMJ

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“…The cases described by Mendelson (1946) and Parker (1956) were confined to obstetrical anaesthesia, but there have been other cases reported associated with patients anaesthetized for other surgical procedures, and also in patients in coma.…”

Section: B Mendelson's Syndromementioning

confidence: 99%

The Effects of the Inhalation of Vomitus on the Lungs: Clinical Considerations

Mucklow¹,

Larard²

1963

British Journal of Anaesthesia

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The problem of the incidence and dangers of inhalation of gastric contents are considered not only as an accompaniment of general anaesthesia but also as a complication in comatose and debilitated states. The values of some of the methods which may be used for the prevention of such inhalation during anaesthesia are discussed. The immediate and late effects of aspiration on the patient are described. Special reference is made to Mendelson's syndrome. A method of treatment of inhalation is given and the value of the use of bronchial lavage and hydrocortisone is noted.

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“…In the past few years the increased awareness, largely due to the activities of the Committee of the Association of Anaesthetists on deaths under anaesthesia (Morton and Wylie, 1951) and the writings of Parker (1954), of the danger of vomiting during obstetrical anaesthesia has apparently reduced the maternal mortality from this cause, though fatalities still occur (Walker et al, 1960).…”

Section: Vomitingmentioning

confidence: 99%

A Method of Anaesthesia for Caesarean Section

Armstrong¹

1961

British Journal of Anaesthesia

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Risk from the Aspiration of Vomit During Obstetric Anaesthesia

Cited by 35 publications

References 8 publications

Mendelson's Syndrome: its treatment by tracheostomy and hydrocortisone.

Mendelson's Syndrome: its treatment by tracheostomy and hydrocortisone.

The Effects of the Inhalation of Vomitus on the Lungs: Clinical Considerations

A Method of Anaesthesia for Caesarean Section

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