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증례보고 : 과열된 혈액의 수혈로 인한 급성 용혈 -증례보고-
김미경 ( Mi Kyeong Kim ),구본녀 ( Bon Nyeo Koo ),길혜금 ( Hae Keum Kil ),김기범 ( Ki Beom Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
The physiologic changes produced by hypothermia include impairments in the stress response and immune system, and drug clearance, exacerbation of lactic acidosis, cardiac arrhythmias, and coagulopathies. Transfusion with cold blood is known to produce profound changes in body temperature and other metabolic responses with significant morbidity especially in infants and children. Warming blood for transfusion has been a common practice to avoid the dangers of hypothermia following cold blood transfusion. However, overheating of packed red blood cells results in hemolysis and transfusion of hemolyzed blood may cause hypotension, shock, and renal dysfunction. This case report describes an acute hemolysis due to transfusion of overheated blood. (Korean J Anesthesiol 2006; 50: 463~5)
Desflurane의 세로토닌3A형 수용체 항진작용에 대한 인삼사포닌의 효과
최승호 ( Seung Ho Choi ),김미경 ( Mi Kyeong Kim ),구본녀 ( Bon Nyeo Koo ),민경태 ( Kyeong Tae Min ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: Postoperative nausea and vomiting (PONV) is the most frequent and discomforting side effect following general anesthesia. Most volatile anesthetics have a potent effect on serotonin (5-hydroxydtryptamine, 5-HT) type 3 receptor mediating PONV, and their antagonists have been currently used effectively to prevent and/or reduce the incidence and severity of PONV. The authors reported previously that ginsenosides have inhibitory effect on 5-HT(3A) receptor. In this study we intended to elucidate the inhibitory effect of ginsenosides on the potentiated 5-HT(3A) receptor by desflurane. Methods: After in vitro transcription of the recombinant mouse 5-HT(3A) receptor in the Xenopus laevis oocyte, we examined the effects of ginsenosides (g-Rb1, g-Rg1, g-Rd, g-Rg2) as well as ginsenoside metabolite, compound K on the modulation of desflurane by measuring currents flowing through 5-HT(3A) receptor using two-electrode voltage clamp technique. Results: Although normalized inhibitory responses of ginsenosides were same regardless of desflurane, some ginsenosides such as g-Rd, g-Rg2, and g-Rg1 showed potential inhibition to the enhanced 5-HT induced current of 5-HT(3A) receptor by desflurane. Conclusions: Although ginsenosides have substantial inhibitory effect on 5-HT(3A) receptor, the effects of ginsenoside on potentiation by desflurane of 5-HT induced current via recombinant 5HT(3A) receptor may depend on the types of ginsenoside, which suggesting that ginsenoside might have an antagonistic action to nausea and vomiting associated with volatile anesthetics. (Korean J Anesthesiol 2009; 56: 681~6)
개구가 어려운 소아에서 성인 및 소아용 굴곡성 기관지경 두가지를 이용한 경비 기관내 삽관 : 증례 보고 A case report
이우창,구본녀,김기준,민경태,박윤곤,박형식,유대현 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.6
We present two pediatric patients, one with Pierre Robin syndrome and one with temporomandibular joint ankylosis with limited mouth opening. They had historical and physical evidence of airway obstruction, difficult feeding, and sleep disturbance. They were scheduled for oromaxillofacial surgery. In each case, two different-sized fiberotic bonchoscopes were used for nasotracheal intubation. After loss of consciousness following an IV injection of ketamine or inhalation of sevoflurane while maintaining spontaneous respiration, 10% lidocaine was sprayed into one nostril. Following insertion of a 60 cm Olympus LF-2 fiberoptic bronchoscope (OD: 3.8 mm) through the same nostril without tube placement, the vocal cords were visualized and topical anesthesia of the larynx was achieved by spraying 2% lidocaine through the biopsy channel. Thirty seconds later, the bronchoscope was passed into the trachea and 2% lidocaine was sprayed intratracheally. Then, the bronchoscope was withdrawn. An endotracheal tube was advanced through the same nostril and positioned in the nasopharunx and the ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded through the tube. There was neither a cough nor laryngeal spasm during advancement of the tube into the trachea. Extubation was performed without compromise in the operating room. The patients were discharged uneventfully. (Korean J Anesthesiol 2002; 43: 759~799)
강화튜브 사용중 튜브내막의 융기로 인한 최고 흡기압의 증가
김미경,길혜금,구본녀 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.2
Increased Peak Inspiratory Pressure Due to Intraluminal Bulging of the Inner Layer of the Reinforced Wire Tube during Anesthesia - A case report - Hae Keum Kil, M.D., Bon Nyeo Koo, M.D., and Mee Kyung Kim, M.D. Depratment of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea Excessive peak airway pressure during general endotracheal anesthesia may result from bronchospasm due to light anesthesia or surgical stimulation, bronchial intubation, tension pneumothoras, pulmonary edema, or mechanical obstruction of tube, whether from kinking, inspissated secretions, or overinflation of the cuff. Usually these problems are differentiated with auscultation and drug administration. How-ever, mechanical problems associated with the endotracheal tube may be a cause of increased airway pressure. Reinforced, anode, or armored tubes consist of two coating of latex or PVC that enclose spiral metal windings. Because of that, the inner layer may peel away, and intraluminally bulge due to nitrous oxide and cause airway obstruction during the course of an anesthetic process. We report a case of intraluminal bulging of the inner layer in a reinforced tube using fiberoptic bronchoscopy during anesthesia. (Korean J Anesthesiol 2001; 41: 239~243)