Advertisement

Oral and Maxillofacial Surgery

, Volume 23, Issue 4, pp 507–511 | Cite as

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

  • Takashi HitosugiEmail author
  • Masanori Tsukamoto
  • Takeshi Yokoyama
Case Report
  • 20 Downloads

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 oral-maxillofacial 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) 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The patient reads and signs an informed form.

Informed consent

Written informed consent was obtained from the patient for publication of this case report.

Statement of authors

All authors have viewed and agreed with this present submission.

References

  1. 1.
    Rahn R (1993) Review presentation on povidone-iodine antisepsis in the oral cavity. Postgrad Med J 69:4–9CrossRefGoogle Scholar
  2. 2.
    Durani P, Leaper D (2008) Povidone-iodine: use in hand disinfection, skin preparation and antiseptic irrigation. Int Wound J 5:376–387CrossRefGoogle Scholar
  3. 3.
    Sauerbrei A, Wutzler P (2010) Virucidal efficacy of povidone-iodine-containing disinfectants. Lett Appl Microbiol 51:158–163PubMedGoogle Scholar
  4. 4.
    Howe DJ (1981) Aspiration pneumonia from povidone-iodine (Betadine): report of case. J Oral Surg 39:224–225PubMedGoogle Scholar
  5. 5.
    Numazawa R, Morimoto Y, Yokota S, Yamamura T, Kemmotsu O (1992) Pneumonia due to aspiration of povidone-iodine during anesthesia: a case report. Masui 41:846–849PubMedGoogle Scholar
  6. 6.
    An TH, Ahn BR (2011) Pneumonia due to aspiration of povidine iodine after induction of general anesthesia. Korean J Anesthesiol 61:251–256CrossRefGoogle Scholar
  7. 7.
    Cheong SH, Yang YI, Choi MY, Kim MH, Cho KR, Lim SH, Lee JH, Lee KM, Moon SH (2012) Lung injury induced by the pulmonary instillation of povidone-iodine in rats. J Anesth 26:70–79CrossRefGoogle Scholar
  8. 8.
    Engelhardt T, Webster NR (1999) Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth 83:453–460CrossRefGoogle Scholar
  9. 9.
    Olsson GL, Hallen B, Hambraeus-Jonzon K (1986) Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. Acta Anaesthesiol Scand 30:84–92CrossRefGoogle Scholar
  10. 10.
    Warner MA, Warner ME, Weber JG (1993) Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 78:56–62CrossRefGoogle Scholar
  11. 11.
    Chawla R (2008) Epidemiology, etiology, and diagnosis of hospital acquired pneumonia and ventilator-associated pneumonia in Asian countries. Am J Infect Control 36:93–100CrossRefGoogle Scholar
  12. 12.
    Dave MH, Frotzler A, Spielmann N, Madjdpour C, Weiss M (2010) Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Br J Anaesth 105:538–543CrossRefGoogle Scholar
  13. 13.
    Nagatake T, Ahmed K, Oishi K (2002) Prevention of respiratory infections by povidone-iodine gargle. Dermatology 204:32–36CrossRefGoogle Scholar
  14. 14.
    Wutzler P, Sauerbrei A, Klöcking R, Brögmann B, Reimer K (2002) Virucidal activity and cytotoxicity of the liposomal formulation of povidone-iodine. Antivir Res 54:89–97CrossRefGoogle Scholar
  15. 15.
    Dire DJ, Welsh AP (1990) Comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med 19:704CrossRefGoogle Scholar
  16. 16.
    Johnson JT, Yu VL (1989) Role of aerobic gram-negative rods, anaerobes, and fungi in wound infection after head and neck surgery: implications for antibiotic prophylaxis. Head Neck 11:27–29CrossRefGoogle Scholar
  17. 17.
    Becker GD (1981) Chemoprophylaxis for surgery of the head and neck. Ann Otol Rhinol Laryngol Suppl 90:8–12CrossRefGoogle Scholar
  18. 18.
    Summers AN, Larson DL, Edmiston CE, Gosain AK, Denny AD, Radke L (2000) Efficacy of preoperative decontamination of the oral cavity plast. Reconstr Surg 106:895–900CrossRefGoogle Scholar
  19. 19.
    Grandis JR, Vickers RM, Rihs JD, Yu VL, Johnson JT (1994) Efficacy of topical amoxicillin plus clavulanate/ticarcillin plus clavulanate and clindamycin in contaminated head and neck surgery: effect of antibiotic spectra and duration therapy. J Infect Dis 170:729–732CrossRefGoogle Scholar
  20. 20.
    Redleaf MI, Bauer CA (1994) Topical antiseptic mouthwash in oncological surgery of the oral cavity and oropharynx. J Laryngol Otol 108:973–979CrossRefGoogle Scholar
  21. 21.
    Choi SH, Lee SJ, Yoon KB, Han S, Kim JH (2005) Fiberoptic bronchoscopic treatment of pulmonary aspiration occurring in a child during induction of anesthesia -a case report. Korean J Anesthesiol 49:744–747CrossRefGoogle Scholar
  22. 22.
    Nason KS (2015) Acute intraoperative pulmonary aspiration. Thorac Surg Clin 25:301–307CrossRefGoogle Scholar
  23. 23.
    Paulson TE, Spear RM, Silva PD, Peterson BM (1996) High-frequency pressure-control ventilation with high positive end-expiratory pressure in children with acute respiratory distress syndrome. J Pediatr 129:566–573CrossRefGoogle Scholar
  24. 24.
    Meduri GU, Marik PE, Annane D (2009) Prolonged glucocorticoid treatment in acute respiratory distress syndrome: evidence supporting effectiveness and safety. Crit Care Med 37:1800–1803CrossRefGoogle Scholar
  25. 25.
    Calfee CS, Matthay MA (2007) Nonventilatory treatments for acute lung injury and ARDS. Chest 131:913–920CrossRefGoogle Scholar
  26. 26.
    Takenaka I, Aoyama K, Iwagaki T (2012) Combining head-neck position and head-down tilt to prevent pulmonary aspiration of gastric contents during induction of anaesthesia: a volunteer and manikin study. Eur J Anaesthesiol 29:380–385CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Dental Anesthesiology, Faculty of Dental ScienceKyushu UniversityFukuokaJapan
  2. 2.Department of Dental AnesthesiologyKyushu University HospitalFukuokaJapan

Personalised recommendations