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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pulmonary acid aspiration (Mendelson's) syndrome may present after regurgitation and inhalation of acid gastric content during obstetric anesthesia. The stomach contents of 70 mothers were aspirated at caesarean section after pre-operative gastric 'emptying' and alkaline ingestion. The acidity of the gastric aspirate was analysed and volumes were measured. The patients were divided into 5 groups according to the time when gastric aspiration was carried out. A 'safe' gastric pH (pH greater than 3.5) was found in all patients up to 2 hours after antacid ingestion (groups 1-3). However, 2 1/2 hours after antacid ingestion (group 4y, 50% of patients had gastric volumes in excess of 25 ml and a pH of less than 3.5. We therefore recommend that, if general anaesthesia is to be induced or is in progress 2 hours after antacid therapy, the alkaline regimen should be resumed after repeated gastric aspiration.
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PMID:Gastric volume and acidity at caesarean section. 1 50

Regurgitation, vomiting, and aspiration pneumonia in 4 young male English Bulldogs were attributed to esophageal deviation that was demonstrated by esophageal radiography. A genetic relationship among these dogs was not determined. Exploratory thoractomy, performed in 2 dogs, demonstrated an apparent compression of the esophagus by the left subclavian artery and brachiocephalic artery at the level of the 2nd and 3rd intercostal spaces. This apparent compression correlated with the roentgen location of esophageal deviation. Surgical redirection of the left subclavian artery resulted in immediate and long-lasting remission of clinical signs.
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PMID:Esophageal deviation in four English Bulldogs. 34 61

This paper is concerned with the aetiology, prophylaxis and treatment of the Mendelson-syndrome. It serves as a quick reference to anaesthesists and obstetricians who are faced with this problem and therefore helps them to decrease the maternal mortality resulting from regurgitation and aspiration of gastric juice.
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PMID:[Regurgitation and aspiration of gastric juice during delivery. Aetiology, prophylaxis and treatment (author's transl)]. 52 41

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
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PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Gastric substitution for resectable carcinoma of the esophagus: an analysis of 368 cases. 173 71

A case of aspiration pneumonia is reported after the use of a laryngeal mask airway in a young woman undergoing an elective cholecystectomy. The case illustrates the hazards of regurgitation with the laryngeal mask airway and the need for further evaluation when used with controlled mechanical ventilation.
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PMID:Aspiration pneumonia and the laryngeal mask airway. 1149 27

In a 6.5 year period starting January 1982, 121 patients (74 male, 47 female; 1.6:1) with complicated gastroesophageal reflux referred to Alberta Children's Hospital, University of Calgary, required a Nissen fundoplication at a mean age of 35.5 months (range 3 weeks to 18 years). The median age of onset of symptoms was less than 1 month. Symptoms and indications for surgery included regurgitation (88%), failure to thrive (52%), reflux-associated pulmonary symptoms and aspiration (48%), biopsy evidence of esophagitis (35%) with heartburn (17%), dysphagia (18%), hematemesis (17%), anemia (13%), and hypoproteinemia (22%). Sixty-four percent of the patients had a syndrome or chromosomal abnormality, respiratory disease, or neuromuscular disorder. The barium contrast upper-gastrointestinal radiographic series, performed in all patients, identified structural [gastric outlet obstruction (2%), esophageal stricture (11%), erosive esophagitis (9%)], and functional abnormalities [gastroesophageal reflux (90%), barium aspiration (8%), esophageal hypoperistalsis (30%), delayed gastric emptying (4%)]. Barium contrast upper gastrointestinal radiographic series identified gastroesophageal reflux with a sensitivity of 90% (compared to history), was 50% sensitive and 92% specific for erosive esophagitis (compared to biopsy), was 59% sensitive and 74% specific for esophageal dysmotility (compared to esophageal manometry), and there was a significant (p less than 0.01) association between barium aspiration and prior evidence of aspiration pneumonitis. Esophageal manometry demonstrated a significantly (p less than 0.001) lower esophageal sphincter pressure in patients compared with controls, but no significant correlation with failure to thrive, aspiration pneumonia, biopsy evidence of esophagitis, or parameters of the 24-hour esophageal pH study. Twenty-four hour pH monitoring showed significantly (p less than 0.05) more reflux episodes than in asymptomatic controls and there was significant (p less than 0.05) correlation between the percentage of time pH was less than 4 and the presence of hypoalbuminemia, and biopsy-proven erosive esophagitis or Barrett's esophagus. Endoscopic appearance was 91% sensitive and 60% specific for esophagitis when compared to biopsy. Nissen fundoplication was completely effective at resolving gastroesophageal reflux in 83%, and associated with marked improvement in 15%. No patient died as a result of fundoplication. Major complications included: recurrence of symptoms requiring reoperation (2%), subsequent mechanical bowel obstruction (8%), wound infection or pneumonia (12%).
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PMID:Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. 227 17

In pull-through endoesophageal intubation, the esophageal tube, which traverses the esophagogastric junction, may render the sphincter function incompetent and subsequently induce regurgitation of gastric contents conveyed to the esophagus, reflux esophagitis, and even aspiration pneumonia. An antireflux check-valve was developed and has been applied to the lower end of the inserted esophageal tube in 30 patients with malignant esophageal obstruction since September, 1982. The results have proven satisfactory.
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PMID:A check-valve device for prevention of regurgitation after endoesophageal intubation. 243 May 29

In 210 patients divided in 7 groups depending on surgical disease or pregnancy the authors estimated pH of the gastric content during the preoperative period. It was found that pH was below 2.5, i.e. the acid level of the gastric content was high enough to present a hazard for appearance of Mendelson's syndrome, should eventual regurgitation or aspiration occur during or after general anesthesia. In an effort to prevent aspiration syndrome, apart from the most reliable and well know precaution "empty stomach", the authors suggest premedication with antacid drugs before the operation. They have applied Almagel A or Cimetidin 30 min before the operative intervention. The acid level of the gastric juice was thus reduced for about 1 1/2 hours to pH levels higher than the critical 3.5, so that in the event of eventual regurgitation and aspiration the gastric content would not cause severe respiratory injury. With their suggestion for use of antacid drugs during the preoperative period the authors expand the preoperative preparation of the patient for general anesthesia with set purpose to prevent respiration (Mendelson's) syndrome.
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PMID:[Prevention of aspiration syndrome in general anesthesia]. 258 80

A full-term infant developed dysphagia, vomiting, and regurgitation immediately after birth. On examination at 5 months of age, he was malnourished and had radiographically proven megaesophagus. On direct examination his blood was positive for Trypanosoma cruzi. Additionally an enzyme immunoassay for T. cruzi IgM antibodies was positive. He underwent corrective surgery for the megaesophagus but died post-operatively of aspiration pneumonia. At autopsy, the esophagus was markedly dilated. There was an extreme reduction of neurons in Auerbach's plexus, and inflammation of this plexus and the muscular layer of the esophagus. Nests of parasites were seen in the esophagus and bladder. It is suggested that this patient was not in the chronic phase of Chagas' disease but represents an acute digestive phase of this infection. This is the fourth case in the literature of congenital Chagas' disease with esophageal involvement and clinical signs, and the first in which megaesophagus was seen grossly at post-mortem examination.
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PMID:Esophageal involvement in congenital Chagas' disease. Report of a case with megaesophagus. 642 Nov 81


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