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전신마취 후 발생한 상부기도폐쇄로 인한 급성 폐부종 - 증례보고 -
김소연 ( Soyeon Kim ),김건식 ( Keon Sik Kim ),김영순 ( Youngsoon Kim ) 경희대학교 경희의료원 2019 慶熙醫學 Vol.34 No.1
Upper airway obstruction is one of the serious complications that can occur after general anesthesia, and can also cause acute pulmonary edema if excessive negative pressure develops in the lungs. We report a case of postobstructive pulmonary edema after laryngospasm that occurred during the emergence from general anesthesia. When the laryngospasm occurs, positive pressure ventilation with 100% oxygen is the most important management. Intravenous administration of propofol or succinylcholine may help to treat laryngospasm. Most cases of postobstructive pulmonary edema are alleviated without sequelae within 24 hours, but acute lung injury or death is also reported and requires careful observation.
기관내튜브 발관 후에 발생한 성대문연축에 의한 음압성 폐부종
이인구 외 중앙대학교 의과대학 의학연구소 2004 中央醫大誌 Vol.29 No.1·2
Negative pressure pulmonary edema is a potential complication secondary to acute upper airway obstruction in the early postoperative period. Two young and previously healthy males developed pulmonary edema following an episode of post-extubation laryngospasm. Pink frothy sputum, expiratory wheezing, hypoxemia, and hypercapnia were presented. So both patients were reintubated, ventilated and admitted to the intensive care unit for mechanical ventilation with PEEP. Both cases were resolved fully within 24 hours. The main mechanism of postobstructive negative pressure pulmonary edema is the multifactorial effects of large intrapleural negative pressure created by attempted inspiration against a closed glottis (Müller maneuver). Treatment of negative pressure pulmonary edema is dependent on its severity. In most cases, it is self-limiting requires supportive therapy only. But mechanical ventilation may be required and can usually be withdrawn within 24 hours.
최서희,박경배,박준수,김영창 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Laryngospasm can occur during induction of anesthesia, especially with inhalational anesthetics, up to 2% of all anesthetic inductions in children younger than age 9yr and is half as common in older patients. When laryngospasm occurs, it can be relieved during induction of anesthesia by deepening the anesthetic, muscle relaxation with succinylcholine, or constant positive airway pressure. A prior history of stridor increases the likelihood of postoperative complications. Stridor may be severe enough post laryngoscopy to require intubation. In this case, racemic epinephrine aerosols would be a effective therapy. We experienced a case of laryngospasm which is treated by racemic epinephrine aerosol. The patient's mother had smoking history, laryngomalacia was revealed on larnygoscopy. By the way, unfortunally, laryngospasm was developed on the diagnostic laryngoscopy. It was reluctant to treatments of epinephrine intramuscular injection or dexamethasone. We decided to use the racemic epinephrine aerosols including beta-agonist or budesonide alternatively, and his respiratory distress was resolved.
장철원,지기환,김준엽 대한수면연구학회 2016 Journal of sleep medicine Vol.13 No.1
Sleep-related laryngospasm is a rare cause of sleep-related breathing disturbance which produce stridor or interruption of airflow associated with a distinct polysomnography arousal pattern. We report a case of a sixty-five-year-old woman who was referred for awakenings with abrupt respiratory distress and fear of suffocation. A polysomnography showed a total or near-total cessation of airflow, followed by choking and stridor for several minutes with a rapid increase in heart rate. Temporary hoarseness was seen. The esophageal pH monitoring indicated acid reflux, which confirmed gastroesophageal reflux disease. The protonpump inhibitor eliminated the sleep-related laryngospasm
행동조절이 어려운 소아환자의 Deep sedation을 이용한 치과치료
엄혜숙,윤형배 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.4
It is one of difficulties to control children who show defintely negative behavior in dental clinic. In such a case, the pharmacologic management has been used to provide quality care, minimize the extremes of disruptive behavior, promote a positive psychologic response to treatment and patient welfare and safety. Deep sedation can be defined as a controlled, pharmacologically-induced state of depressed consciousness from which the patient is not easily aroused which may be accompanied by a partial loss of protective reflexes. In this retrospective report, the sedation records of 200 pediatric dental patients of ASA Class Ⅰ&Ⅱ Who were not successfully treated under conscious sedation were used for analysis. Most frequently used regimen of deep sedation was the co-medication of midazolam(0.3mg/kg), enflurane(1.0-2.0 vol%) and 50-70% N₂O-O₂. The average age and weight of the patients was 4.6 yr (S,D:2.72) and 18.7kg(S.D:6.35)respectively. The average operative time was 52 minutes and midazolam (0.1-0.2㏄) was additionally administered intranasally to prolong the operative time as needed. The episodes of untoward side effects were reported during and/or after the procedure in 58 patients. Serious adverse reactions such as cyanisis or laryngospasm were even reported in 7 patients but without mortality. deep sedation is a very effective way of completing the dental treatments for those who failed to respond well to the conscious sedation. This technique has many practical advantages over general anesthesia case but the demands for the rigid monitoring criteria limit its use in general practice setting. The continuous efforts to improve the safety of the medication and the technique are required for the benefits of the patients and parent.
급성 상기도 폐쇄 후 발생한 음압성 폐부종 : 증례보고
장미순,손용,정용관 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.1
Pulmonary edema following the relief of an upper airway obstruction is a rare and unpredictable clinical entity. Post-obstructive pulmonary edema develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis(type Ⅰ) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy(type Ⅱ). We report a case of negative pressure pulmonary edema developed immediately after extubation in 53-year-old male patient undergoing laparoscopic cholecystectomy under general anesthesia.
한정욱,정태영,박태정,김보영 대한이비인후과학회 부산,울산,경남 지부회 2010 임상이비인후과 Vol.21 No.1
Post-obstructive pulmonary edema (POPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction or after the relief of chronic upper airway obstruction. Otolaryngologist frequently handles the upper airway, so the full knowledge about the mechanism and treatment of POPE for them is very important. We encountered a 33-years-old man with POPE after operation for obstructive sleep apnea and report this case with a review of the related literatures.