title: Interstitial pneumonitis after betadine aspiration.
abstract: Disinfection of the face and mucosa lined surfaces of the nose and mouth using a povidone-iodine (PI) or Betadine solution is common practice among head and neck surgeons. Povidone-iodine, which is a highly effective broad-spectrum antibiotic effective against bacteria, viruses, fungi, and protozoa, decreases the risk of postoperative surgical wound infection. We report a case of PI aspiration causing an acute chemical pneumonitis after preoperative disinfection of the oral cavity and nasopharynx in preparation for cleft palate repair. As a result of the inflammatory response, the patient required positive pressure mechanical ventilation and a prolonged stay in the pediatric intensive care unit. The patient was safely extubated on hospital day 7 and discharged on hospital day 10 without any long-term sequelae on follow-up. We also review the 3 other reported cases of PI aspiration pneumonitis. Based on our case report and literature review, we conclude that PI aspiration is associated with a high rate of morbidity; however, this should not preclude the use of PI before surgery, given its effectiveness as an oral disinfectant and the exceedingly low incidence of aspiration.
authors.affiliation: Department of Plastic Surgery. University Hospitals-Case Medical Center, Cleveland, OH 44106, USA.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Chepla
authors.forename: Arun K
authors.initials: AK
authors.lastname: Gosain
mesh_terms: D000891:Anti-Infective Agents, Local / Q000506:poisoning*; D002648:Child; D002972:Cleft Palate / Q000601:surgery; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D010855:Pierre Robin Syndrome / Q000601:surgery; D011015:Pneumonia, Aspiration / Q000139:chemically induced*; D011206:Povidone-Iodine / Q000506:poisoning*
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine