Should Mendelson's syndrome be renamed?

Abstract

Dr Ravalia (Ravalia. Anaesthesia 2000; 55: 1040) suggests renaming Mendelson's syndrome by pointing out that Hall identified 15 deaths in parturient women caused by pulmonary aspiration during anaesthesia [1], and reported it 6 years before (1940) Mendelson's report in 1946 [2]. There were already reports in the mid 19th century of death due to pulmonary aspiration during anaesthesia [3, 4]. However, it was late in the 1930s when the danger of pulmonary aspiration during anaesthesia was recognised: a report in 1937 stated that ‘… under the influence of general anaesthesia, flooding of the respiratory tract with vomitus leads to acute alterations that have not been described and recognised anatomically and clinically to a degree proportional to the frequency of occurrence … Clinically, dilatation of the heart, pulmonary embolism, coronary thrombosis and acute pulmonary oedema are the usual interpretations’[5]. Since then, several committees on maternal death have pointed out the danger of aspiration during obstetric anaesthesia before Hall's [6, 7] or Mendelson's [8–10] report. Hall claimed that ‘a careful search of all the medical literature failed to yield a single detailed report of a similar case.’[1]. In fact, Kaye made a detailed report of such a case (although non-obstetric) [11] well before 1936 when Hall made his claim. Hall reported cases, but did not elucidate the mechanisms [1]. It is generally considered that Mendelson [2] was the first to show pathological changes caused by aspiration – but it is not so. Winternitz and colleagues reported in 1920 the effect of hydrochloric acid infused into the bronchi of rabbits [12], although they were not thinking of aspiration of gastric acid but of war gases liberating free chlorine. Apfelbach and Christianson [5] were probably the first to report (as a proceeding in 1937) pathological changes caused by aspiration through animal research. In a subsequent article, they stated that animal gastric fluid containing normal amounts of hydrochloric acid did not usually produce death, but a temporary hyperaemia of the lungs [13]. Mendelson's contribution was that he established the aetiology of pulmonary aspiration of gastric acid and solids through extensive clinical observations and comprehensive animal research, but there had been a general awareness of the danger of intra-operative pulmonary aspiration since which his name has been attached to the syndrome. We agree with Dr Ravalia that Hall's report has been forgotten and his work should be acknowledged as late 1930s. There is also no need to rename Mendelson's syndrome as this term is now used less frequently and is increasingly replaced by ‘aspiration pneumonia’.