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Alan D. Murray, MD; Scott R. Gibbs, MD; Kathleen R. Billings, MD; Michael J. Biavati, MD

Arch Otolaryngol Head Neck Surg. 2000;126:79-81.

Bismuth subgallate, an agent that initiates clotting via activation of factor XII, has been advocated for use in controlling bleeding during tonsillectomy and adenoidectomy. Direct aspiration of bismuth has produced pulmonary complications in laboratory animals, but no clinical correlation in humans has been previously described. We report 2 cases of bismuth aspiration that resulted in respiratory difficulty after tonsillectomy and adenoidectomy. Neither child's respiratory compromise required airway intubation. This report of pulmonary complications secondary to bismuth aspiration should alert surgeons to the potential for airway problems when using bismuth as a hemostatic agent for tonsillectomy and adenoidectomy.

From the Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas (Drs Murray, Gibbs, Billings, and Biavati). Dr Gibbs is now in private practice in Huntington, WVa.