Pulmonary sequelae of intraparenchymal bismuth subgallate

Abstract

Bismuth subgallate (BSG) is a heavy metal compound which is effective in lowering the incidence of hemorrhage after adenotonsillectomy and has been demonstrated to activate Factor XII. In a minority of children, the paste has been suctioned from the cuffless oral endotracheal tube after adenotonsillectomy. No pulmonary sequelae have been noted in these patients. To assess the effect of BSG aspiration, 75 rats were divided into groups receiving either intratracheal BSG or saline. Early and late parenchymal effects were documented at 5 and 30 days following administration. Although there were no differences in the general well-being, activity level, or weight in these rats, acute pneumonia followed by a histiocytic, foreign-body response was noted in a significant number of rats in the BSG group. Although no clinical pulmonary sequelae of BSG use have been noted in our patients, this information should alert clinicians to the risks of BSG use in the pulmonary-compromised patient, and encourage them to either employ all methods of preventing aspiration in such patients when using BSG, or to use another hemostatic modality for the utmost safety.

Tetracycline Aspiration

“…A miliary granulomatous reaction may be seen with the aspiration of medications like cholestyramine, phenobarbital and phenytoin [16]. A giant cell foreign-body reaction is seen in rats following experimental aspiration of bismuth subgallate [17], peptobismol and kaopectate [18]. Two cases with respiratory failure following activated charcoal aspiration in adults have been reported.…”

Does bismuth subgallate have haemostatic effects in tonsillectomy?

“…However, investigations in animals indicate that aspiration to the lungs results in acute pneumonia followed by a foreign‐body response. 12 The risk of electrocautery‐induced ignition of the swabs by using diathermy is increased if BSG is used. 13 In addition, BSG paste has a tendency to smudge the operation field.…”

Bismuth subgallate – its role in tonsillectomy

“…We X-rayed 30 patients post-operatively and found no evidence of pharyngeal opacities. A recent study by Cozzi et al (1991) where they injected rats intratracheally with bismuth subgallate paste found that it caused pneumonia in a significant number of them. There were no laryngeal or respiratory complications in any of our patients but it still must be kept in mind that there is a theoretical risk of respiratory problems when using this paste.…”