Avoidance of saliva aspiration in a patient with acute stroke by application of scopolamine ointment

Abstract

A 62-year-old man was urgently admitted to the hospital because of left incomplete paralysis, left upper limb paresthesia, and decreased level of consciousness. Head computed tomography revealed right thalamic hemorrhage with ventricular perforation, and another computed tomography scan 1 hour later showed acute hydrocephalus. The patient was diagnosed with stroke and underwent surgery to alleviate the hemorrhage. He was extubated the day after surgery, but reintubation was considered because of the high risk of saliva aspiration due to drooling. An in-hospital preparation of scopolamine ointment was applied to the mastoid process of the posterior auricle, which decreased the patient’s drooling and number of daily aspiration events. Although xerostomia was observed as a side effect, the patient continued oral care without oral contamination. No skin symptoms were observed at the site of the ointment application. The use of scopolamine ointment reduced the risk of choking and aspiration due to saliva, suggesting the possibility of respiratory management without the need for intubation, tracheotomy, or other invasive procedures.