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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)