Interstitial pneumonitis after betadine aspiration

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.