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복부 가스괴저 환자의 마취 유도 과정에서 발생한 심정지 -증례보고
김덕경 ( Duk Kyung Kim ),김성협 ( Seong Hyop Kim ),윤태균 ( Tae Gyoon Yoon ),장성환 ( Sung Whwan Jang ),이준희 ( Jun Hee Yi ),주영 ( Young Joo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
We report here on a fatal case of abdominal gas gangrene. Two days after gastrectomy, a 56-year-old man presented with intractable abdominal pain and fever of a sudden onset, which quickly progressed over several hours to septic shock. Despite of the unexplained gas collections in the abdominal muscle, fascia, and subcutaneous layers on computed tomography scan, its clinical significance was overlooked. Emergency laparotomy was initially scheduled because of concern that there may have been a perforated viscus. At the time of monitoring for the anesthesia, we noticed marbled skin discoloration and the subcutaneous emphysema had spread on his flank. Shortly after the initial suspicion of gas gangrene, cardiac arrest developed during the arterial line cannulation. Despite prompt resuscitation measures, including the administration of catecholamines and the application of extracoporeal membrane oxygenation, he eventually died. Anesthesiologists need to understand this fulminant disease because extensive debridement under general anesthesia is essential for the treatment of abdominal gas gangrene. (Korean J Anesthesiol 2009; 57: 127~31)
돼지 폐동맥수툭에 관여하는 Protein Kinase C 동위효소와 RhoA GTPase 의 역할
김민정,조성일,김보경,최윤정,이예철,임정애,김중완,김성협,김윤수,우남식 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.2
Background: It is well established that vascular contraction is caused by not only an increase in cytosolic Ca2+ level but also activations of Ca2- sensitizing mechanisms including protein kinase C (PKC) and low molecular GTP binding protein. However, the rolls of PKC and RhoA, a low molecular GTP-binding protein, on the receptor agonist-mediated contraction in swine pulmonary artery has not been clarified. In the present study, we examined the contribution of PKC isoform and RhoA to the arterial stimulants-induced contraction in swine pulmonary artery. Method: The large (> 5 mm), medium (1-3 mm) and small (< 1 mm in outer diameter) sized pulmonary arteries were excised and the contractions were recorded isometrically. The contents and subcellular distribution of PKC isoforms and RhoA were detected using immunoblotting. Results: In medium pulmonary artery, norepinephrine (NE, 10 nM -30μM) led contraction in a dose-dependent manner. In large and small pulmonary arteries, however, NE failed to induce a contrac-tion. Adding of 12-deoxyphorbol 13-isobutyrate (DPB, 1 μM), a PKC activator, developed muscle force in 1 mM BGTA-contained Ca+2 -free physiological salt solution. The expressions of PKC α, ε, were significantly increased in medium pulmonary artery. NE (10 μM) evoked the translocation of RhoA from cytosol to the membrane but not those of PKC isoforms, In Ca2+-free physiological salt solution, DPB (1 μM) caused a translocation of PKC isoforms. Conclusions: These results support that NE induces contraction via RhoA pathway but not PKC pathway in swine pulmonary artery. (Korean J Anesthesiol 2001; 40: 229 ~237)