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Whole-lung lavage complicated with pneumothorax -a case report-
안현주,양미경,김지애,허번영,김진경,박소윤 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.4
A patient with pulmonary alveolar proteinosis underwent whole lung lavage of the right lung. Lavage of the left lung was not immediately possible because of severe hypoxemia. Three days later, after correction of hypoxemia, we re-attempted the left lung lavage. However, the patient had severe hypoxemia (SpO2 < 80%) within a few minutes of performing right one lung ventilation (OLV). On bronchoscopic examination, proper tube location was confirmed. Bronchodilator nebulization and steroid injection were attempted with no effect. While searching for the cause of the hypoxemia, we found that the breath sound from the right lung had become very weak and distant compared with that from initial auscultation. Right pneumothorax was diagnosed on chest X-ray and a chest tube was inserted. After confirming pneumothorax resolution, we re-tried right OLV and were able to proceed with the left lung lavage without signs of aggravating air leak, loss of tidal volume, or severe hypoxemia.
펜타닐 정주로 인한 기침반사반응에 대한 클로니딘의 효과
이상민,조현성,정익수,최덕환,이정진,허번영 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.2
Background : The opioid agonist fentanyl has been used at induction of anesthesia to stabilize hemodynamic parameters. But it can induce cough and in some patients, it can be hazardous. We investigated the effect of α2- agonist clonidine premedication on fentanyl induced cough reflex. Methods: 83 patients (ASA class 1) were involved in this study and divided into two groups: Group 1 (no premedication group, n=43) and Group 2 (clonidine 300 g p .o. 1 hour prior to anesthesia, n=40). Before induction of anesthesia, in each group, fentanyl was injected within 1 second through a peripheral venous cannula in dorsum of hand and rapid fluid infusion was followed. We checked cough response, cough emerging time and it's duration. We graded the duration of cough into grade I and II (Grade I: shorter than 5 seconds, Grade II: longer than 5 seconds). Results : There was no significant difference in the incidence of fentanyl induced cough reflex between Group 1 (34.9%) and Group 2 (25.6%). The incidence of Grade II i higher in Group 1 (18.3%) than in Group 2 (2.5%). Conclusions : Clonidine, as a premedication agent, couldn't reduce the incidence of fentanyl induced cough reflex. But it reduced the degree of cough response. (Korean J Anesthesiol 1998; 35: 285∼289)