Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report

BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system.At present,surgery is the most important treatment strategy.After esophagectomy and gastric esophagoplasty,the patients are prone to regurgitation.However,these patients currently do not receive much attention,especially from anesthesiologists.CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy.The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior.Although the patient had fasted for>17 h,unexpected aspiration still occurred during induction of general anesthesia.Throughout the operation,oxygen saturation was 98%-100%,but the airway pressure was high(35 cmH2O at double lung ventilation).The patient was sent to the intensive care unit after surgery.Bedside chest radiography was performed,which showed exudative lesions in both lungs compared with the preoperative image.After surgery,antibiotics were given to prevent lung infection.On day 2 in the intensive care unit,the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.CONCLUSION After esophagectomy,patients are prone to regurgitation.We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.

Lipoid Pneumonia Caused by Diesel Aspiration: A Case Report and Literature Review

Diesel poisoning is a rare clinical condition.On September 27,2021,a 55-year-old male who mistakenly inhaled 20 mL of diesel through a siphon was admitted to our hospital.The main symptoms were cough and asthma.Chest computed tomography(CT)showed both lungs scattered with patchy consolidation,ground-glass shadow,exudation,and pleural effusion.After 61 days of lung rehabilitation training and other supportive treatment,including oxygen therapy,postural drainage,ventilator support,bronchoalveolar lavage,hemoperfusion,continuous renal replacement therapy(CRRT),hormones,and antibiotics,the patient’s condition improved,and the patient was discharged.Through literature review,we found that lung consolidation,ground-glass shadow,nodular lesions,and pleural effusion can be observed on chest images of patients with lipoid pneumonia,with severe cases showing diffuse lesions involving both lungs,possibly secondary to respiratory failure.Children with acute critical illness deteriorates rapidly and have poor prognosis,whereas adults or patients with chronic poisoning have better prognosis after active treatment.

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report

BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

Nutritional Evaluation by Nurses and Physical Recovery of Malnourished Patients after Esophagectomy

Following an esophagectomy, nurses’ patient nutrition observations are important for physical recovery and quality of life. The study proposed to identify the factors associated with physical recovery among esophageal cancer patients after surgery based on nurses’ observations and nutritional evaluations. Data were collected from the nursing records of 21 esophagectomy patients. The data included patients’ rate of weight loss, body mass index (BMI), energy intake, and postoperative complications. Patients were divided into two groups according to their weight loss rate: <8% and ≥8%. Patient outcomes were compared between the two groups. There was no difference in average BMI before or after surgery between the two groups. There was no difference in albumin levels during hospitalization;however, after esophagectomy, energy intake at discharge was insufficient in both groups. The ≥8% weight loss may be facilitated, or at least confounded, by the presence of recurrent nerve paralysis and aspiration pneumonia. Thus, the nursing records typically identified the need to check for recurrent laryngeal nerve palsy and aspiration pneumonia in conjunction with nutritional assessment to enhance patients’ physical recovery. When weight loss was significant, nurses provided oral intake support with the NST, and patients maintained oral intake levels similar to the group with weight loss under 8%. In order to better support physical recovery among malnourished, post esophagectomy patients, nurses need to monitor for signs of recurrent nerve palsy and aspiration pneumonia in addition to nutritional intake.