Difficult airway management in a case with lingual tonsil hypertrophy and temporo-mandibular joint partial ankylosis

권민아,송재격,박기근 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.4

膀胱의 單臟器成 Shwartzman反應에 관한 超微形態學的 硏究

권민아,장세국,서인수,손태중 慶北大學校 醫科大學 1990 慶北醫大誌 Vol.31 No.4

본 연구는 감염성 방광염의 성립의 조건으로 Shwartzman반응의 기전이 참여할 것인가를 검토하고, 방광의 단장기성 Shwartzman반응에서 초기의 형태적 변화를 알아보기 위하여 시도하였다. 실험은 백색 암컷 가토를 실험동물로 하여 방광내에 내독소를 주입하고 24시간후에 정맥내로 같은 내독소를 주사하여 야기조작 15및 30분, 1, 2 및 4시간후에 방광을 적출하여 육안, 광학, 주사전자 및 투과 전자현미경으로 관찰하였던 바 그 성적을 요약하면 다음과 같다. 광학 현미경으로는 반응의 초기부터 표재세포가 호산성 덩어리로의 변성 및 괴사 탈락이 나타나고, 중간세포 및 기저세포는 야기조작 수시간 후부터 공포성 변성을 보이고, 같은 시기에 상피하 미소혈관은 울혈 및 주변 조직의 부종을 보이고, 호중구의 침윤도 관찰되었다. 주사 전자현미경으로는 표재세포 표면의 microridge의 blurring과 표면구조의 편평화 및 세포간 결합장치의 이완등을 초기에서 부터 볼 수 있었고, 수시간이 지난 후에는 군데군데에서 상피의 괴사 탈락이 관찰되었다. 투과 전자현미경으로는 포재세포의 apoptosis를 초기에서부터 볼 수 있었고, 수시간 후에는 상피층 전층의 괴사까지 관찰되었고, 기저세포에는 autophage가 증가된 것이 관찰되었다. 가장 특징적 변화는 상피직하 점막하층 미소혈관계의 변화로 반응의 초기에서부터 내피세포의 종창등의 상해성 변화를 보였고, 수시간후에는 혈소판의 응집과 호중구의 변연화 및 유주등을 관찰할 수 있었다. 이상의 성적으로 보아 방광염의 성립에 Shwartzman반응의 기전이 참여할 수 있는 것으로 생각되며, 방광의 단장기성 Shwartzman반응의 주된 반응을 하는 장소는 상피직하부의 미소혈관계인 것으로 사료된다. This study was carried out to investigate the possible role of Shwartzman reaction in the development of the cystitis and the morphologic changes in early stage of the reaction. Endotoxin extracted from E. coli was injecting same endotoxin via ear vein, 24 hours after first infection. Animals were sacrificed 15 and 30 minutes, and 1, 2 and 4 hours after the last injection. The Urinary bladders were extracted out and examined with the light, transmision electron, and scanning electron microscopes. The results obtained were summarized as follows: Ligth microscopy showed eosinophilic degradation, necrosis and detachment of the superficial cells within 1 hour after provocation treatment. Intermediate and basal cells also showed swelling after few hours. Subepithelial microvasculatures showed congestion with perivascular edema and neutrophilic infiltration from the early stages. Scanning electron microscopy dischlosed blurring of microridge structures on superficial cells with loosening of the intercellular junction from early stage. Necrosis and detachment of epithelial cells were noted in several areas after few hours, only remaining basement membranes. Transmission electron microscopy showed apoptosis of the superficial cells, with partial necrosis through total thickness of the epithelial layer after several hours. Many autophagic vacuoles were found in basal cells. Characteristic vascular change was noted in the microvasculatures on the submucosa, consisting of swelling and archade formation of the endothelial cells with platelet aggregation, and margination and emigration of neutrophils. The results suggest that Shwartzman reaction could be participated on the development of cystitis, and subepithelial small vessels were the main focus of the reaction.

Perioperative surgical home: a new scope for future anesthesiology

권민아 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.3

The health care system is changing from ‘pay for volume’ to ‘pay for value.’ These changes are turning health care delivery into a more cost-effective and coordinated care setup that drives hospitals to lower costs and greater quality gains. The present perioperative care service in Korea has proven to be costly, fragmented, and neither evidence-based nor patient- centered. Recently, a new concept of a perioperative care model termed perioperative surgical home (PSH) has been proposed. The PSH is a patient-centered, team-based, and coordinated perioperative care setup, composed of the head anesthesiologist-perioperativist in tandem with dedicated nurse practitioners and other PSH team doctors. All pre-, intra-, and postoperative patient care functions are performed by a single PSH team, not several different departments. The PSH care extends from the decision to operate till 30 days post-discharge. Several evidence-driven perioperative strategies for reducing postoperative complications and shortening hospital stay can be adapted to each specific hospital situation, rather than strictly applying any given strategies. With the PSH, patients are more satisfied and experience better outcomes. It is also a good hospital business model. The expanded role of anesthesiologists in the PSH has the potential to invigorate the specialty.

유전 자원 활용과 개발을 통한 라오스 토종닭 품종 상업화

권민아,쑥삼란 캄포메,신창호,홍승길,김윤경 한국국제농업개발학회 2020 한국국제농업개발학회 학술대회 Vol.2020 No.12

Life-threatening tension pneumothorax after unsuccessful tracheostomy tube exchange in a trauma patient - A case report -

권민아,조재민,박정헌 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.1

Background: Tracheostomy tube exchange is a common and safe procedure. However, when the tracheocutaneous tract is not completely mature, cannula exchange or endotracheal tube insertion via the tracheostomy site can rarely induce life-threatening complications, including subcutaneous emphysema, loss of airway, tension pneumothorax, and pneumoperitoneum. Case: We report a case of life-threatening tension pneumothorax developed during tracheostomy tube exchange with a reinforced endotracheal tube for a planned facial surgery after recent tracheostomy in a trauma patient. Conclusions: Understanding of the pathogenesis and the use of preventive strategies based on it are expected to provide safer and more effective anesthetic management to patients with tracheostomy.

The effect of a pediatric heat and moisture exchanger on dead space in healthy pediatric anesthesia

권민아 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.5

Background: Heat and moisture exchangers (HME) are often used to maintain humidity of breathing circuits during anesthesia. It is also known to increase dead space ventilation in respiratory distress syndromes. However, the effect of a pediatric HME in healthy pediatric patients has not yet been clarified. The purpose of this study was to evaluate the effect of a pediatric HME on dead space in healthy pediatric patients during anesthesia. Methods: 20 ASA physical class I pediatric patients, without respiratory impairment, who underwent elective surgery for inguinal hernia or hydrocele with general anesthesia were enrolled. Fifteen minutes after ventilation with and without pediatric HME (internal volume of 22 ml), hemodynamic variables, end tidal CO2, minute volume and airway pressure were measured, and arterial blood sampling was conducted simultaneously. Results: The removal of pediatric HME decreased PaCO2 significantly from 46.1 ± 6.9 mmHg to 37.9 ± 4.3 mmHg (P < 0.001) and increased the pH from 7.32 to 7.37 (P < 0.001). The differences between PaCO2 with and without HME (Δ PaCO2) were significantly correlated with weight (P < 0.001, β1 = -0.749) and age (P = 0.002, β1 = -0.623). Conclusions: The use of a pediatric HME significantly increased PaCO2 in healthy pediatric patients that was inversely proportional to weight and age. The use of pediatric HME should be carefully considered in small pediatric patients. Background: Heat and moisture exchangers (HME) are often used to maintain humidity of breathing circuits during anesthesia. It is also known to increase dead space ventilation in respiratory distress syndromes. However, the effect of a pediatric HME in healthy pediatric patients has not yet been clarified. The purpose of this study was to evaluate the effect of a pediatric HME on dead space in healthy pediatric patients during anesthesia. Methods: 20 ASA physical class I pediatric patients, without respiratory impairment, who underwent elective surgery for inguinal hernia or hydrocele with general anesthesia were enrolled. Fifteen minutes after ventilation with and without pediatric HME (internal volume of 22 ml), hemodynamic variables, end tidal CO2, minute volume and airway pressure were measured, and arterial blood sampling was conducted simultaneously. Results: The removal of pediatric HME decreased PaCO2 significantly from 46.1 ± 6.9 mmHg to 37.9 ± 4.3 mmHg (P < 0.001) and increased the pH from 7.32 to 7.37 (P < 0.001). The differences between PaCO2 with and without HME (Δ PaCO2) were significantly correlated with weight (P < 0.001, β1 = -0.749) and age (P = 0.002, β1 = -0.623). Conclusions: The use of a pediatric HME significantly increased PaCO2 in healthy pediatric patients that was inversely proportional to weight and age. The use of pediatric HME should be carefully considered in small pediatric patients.

Tracheal intubation with rocuronium using a “modified timing principle”

권민아,송재격,김주리 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.3

Background: Rapid sequence induction (RSI) is indicated in various situations. Succinylcholine has been the muscle relaxant of choice for RSI, and rocuronium has become an alternative medicine for patients who cannot be administered succinylcholine for various reasons. Although rocuronium has the most rapid onset time among non-depolarizing muscle relaxants, the standard dose of rocuronium (0.6 mg/kg) takes 60 seconds to achieve appropriate muscle relaxation. We evaluated intubating conditions using the “modified timing principle” with rocuronium and succinylcholine. Methods: In this prospective controlled blinded study, all patients received 1.5 μg/kg fentanyl intravenously with preoxygenation for 2 minutes and were randomized to receive 0.6 mg/kg rocuronium followed by 1.5 mg/kg propofol or 1.5 mg/kg propofol and 1.5 mg/kg succinylcholine. The rocuronium group was intubated just after confirming loss of consciousness, and the succinylcholine group was intubated 1 minute after injecting succinylcholine. Intubation condition, timing of events, and complications were recorded. Results: All patients were successfully intubated in both groups. Apnea time of the rocuronium group (38.5 seconds) was significantly shorter than that in the succinylcholine group (100.7 seconds). No significant differences were observed in loss of consciousness time or intubation time. The succinylcholine group tended to show better intubation conditions, but no significant difference was observed. None of the patients complained awareness of the intubation procedure or had respiratory difficulty during a postoperative interview. Conclusions: The modified RSI with rocuronium showed shorter intubation sequence, acceptable intubation conditions, and a similar level of complications compared to those of conventional RSI with succinylcholine.

기후변화에 따른 기후재난 예방 시스템

권민아 한국품질경영학회 2023 한국품질경영학회 학술대회 Vol.2023 No.0

오늘날 기후변화에 따른 영향으로 전 세계에서 기후재난을 경험하고 있다. 여름철 폭우 침수사고, 겨울철 폭설로 인한 고립 사고, 빙판길 차 사고 등 큰 피해를 보고 있다. 매년 사고가 발생하지만, 피해를 보는 주민들에게 특별한 예방대책이 없는 게 현실이다. 폭우로 인한 하수도 침수로 인해 주민들의 주거환경에 악영향 주고 있으며, 폭설로 인한 빙판길 사고로 보행자 사고와 차 사고, 고립 사고도 빈번하게 일어나고 있다. 재난 문자가 발송되어 오지만 문자를 자세히 읽지 않고 넘기는 일도 있고, 확인이 늦어지는 경우가 있다. 사고가 빈번하게 일어나는 지역에선 매년 같은 사고가 반복해서 발생하고 있고, 폭설로 인해 제설함이 곳곳에 설치되어 있지만 막상 사용하려면 정확한 위치를 몰라 늦어지는 경우가 많다고 한다. 빅데이터로 사고가 빈번하게 일어나는 지역을 수집하고, 분석을 통해 침수가 많이 일어나는 하수구 배수로에 센서 부착을 통해 핸드폰으로 침수되기 전 미리 위험지역을 알려주며 피해를 막아주도록 한다. 그리고 사고가 발생하면 어느 동네가 침수되었는지 빠르게 알아내 피해 복구를 도와준다. 대설로 인해 주민들이 사용하는 제설함 마다 센서 부착하여 위치를 핸드폰으로 쉽게 확인하도록 해준다. 본 연구를 통해 빅데이터를 활용하여 기후변화로 인한 피해에 사회적 도움이 되었으면 좋겠다.

秦의 博士官 설치와 그 의미

권민균(權珉均) 중국고중세사학회 2015 중국고중세사연구 Vol.38 No.-

요로감염증에서 Cefadroxil Monohydrate (Duricef(r))의 임상효과

권민아,장세국 大韓泌尿器科學會 1982 Korean Journal of Urology Vol.23 No.8