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Bon Nyeo Koo,Shin Ok Koh,Sung Yong Park,Jae Kwang Shim,Sung Sik Chon Korean Society of Critical Care Medicine 2000 Acute and Critical Care Vol.15 No.2
Ketamine is well known for its analgesic, bronchodilating and sympathetic stimulating effect. Hence, it has been widely used for induction of patients with hypotension or asthma and also for analgesic and sedating purposes in the ICU. We presented a 62 year old female patient with ventilator support in septic shock with refractory asthma whom we managed successfully with continuous intravenous infusion of ketamine postoperatively in the ICU. The patient had a history of asthma but had been asymptomatic recently and was scheduled for an emergent explo-laparotomy under the diagnosis of acute panperitonitis. Before the induction of anesthesia, the patient was in septic shock but no wheezing could be auscultated. After the induction of general anesthesia and endotracheal intubation, wheezing was apparent in both lung fields with a high peak inspiratory pressure. Inotropics, vasopressors and bronchodilators were promptly instituted without any improvement of asthma and the patient had to be transferred to the ICU with intubated after the operation. Clinical symptoms of asthma continued throughout the first day despite using bronchodilators under mechanical ventilation but, after starting the IV infusion of ketamine, there were decrease in the peak inspiratory pressure and wheezing with a subsequent improvement in the arterial blood gas analysis findings. We could also achieve considerable analgesic and sedating effect without any decrease in the blood pressure. The patient's general physical status improved and weaning with extubation was successfully done on the 21st day and was transferred to the general ward on the 28th day.
Bon Nyeo Koo,Shin Ok Koh,Tae Dong Kwon Korean Society of Critical Care Medicine 2003 Acute and Critical Care Vol.18 No.1
BACKGROUND: Unplanned endotracheal extubation is a potentially serious complication, as some patients may need reintubation while in very critical conditions that may increase the morbidity and mortality rates. We conducted a study to evaluate the predictors for reintubation after unplanned extubation. METHODS: Patients who presented unplanned extubation over a 35-month period in two multidisciplinary intensive care units of university affiliated hospital were included. Any replacement of an endotracheal tube within 48 hours after unplanned extubation was considered as reintubation. RESULTS: There were 62 episodes of unplanned endotracheal extubation in 56 patients (incidence rate 2.8%). Fifty seven episodes (91.9%) were deliberate self-extubation, while 5 episodes (8.1%) were accidental extubation. Reintubation was required in 42 episodes (67.7%). Only 44.4% (12/27) of the patients who presented unplanned extubation required reintubation during weaning period, while reintubation was mandatory in 85.7% (30/35) of the patients who presented unplanned extubation during full ventilatory support (P
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)
Eggshell apex abnormalities associated with Mycoplasma synoviae infection in layers
전은옥,Jong-Nyeo Kim,Hae-Rim Lee,Bon-Sang Koo,Kyeong-Cheol Min,Moo-Sung Han,Seung-Baek Lee,Yeon-Ji Bae,Jong-Suk Mo,Sun-Hyung Cho,Chang-Hee Lee,모인필 대한수의학회 2014 Journal of Veterinary Science Vol.15 No.4
Eggs exhibiting eggshell apex abnormalities (EAA) wereevaluated for changes in shell characteristics such asstrength, thickness, and ultrastructure. Mycoplasmasynoviae (MS) infection was confirmed by serological assayalong with isolation of MS from the trachea and oviduct. Changes in eggshell quality were shown to be statisticallysignificant (p < 0.01). We also identified ultrastructuralchanges in the mammillary knob layer by Scanning ElectronMicroscopy. While eggs may seem to be structurally sound,ultrastructural evaluation showed that affected eggs do notregain their former quality. In our knowledge, this is the first report describing the occurrence of EAA in Korea.
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)
Acute Respiratory Distress Syndrome after Severe Hypothermia and Hypotension Due to Near Drowning
Ho Dong Park,Bon Nyeo Koo,Dong Woo Han,Seung Tak Han,Shin Ok Koh Korean Society of Critical Care Medicine 2001 Acute and Critical Care Vol.16 No.2
The increase in short-term survival of near-drowning victims after an acute submersion episode has resulted in an increase of major complications. Two major complications are the development of acute respiratory distress syndrome and persistent hypoxic-ischemic central nervous system injury. A 43-year-old male patient was presented with acute respiratory distress syndrome after near drowning. He was severely hypothermic and hypotensive when he arrived to emergency department. His body temperature was 24oC. There was no pulse and no spontaneous respiration. He was treated with advanced life support measure. He was intubated and vasoactive drugs such as epinephrine and norepinephrine were used. On ICU admission, his blood pressure and pulse rate were 80/40 mmHg, 170 beats/min respectively. His oxygen saturation was 40~60% with 100% oxygen. We applied 16~30 cmH2O of PEEP with low tidal volume for recruitment. Patient was flipped over to prone position. Solu-medrol 1.0 g was infused. The blood pressure restored to 140/50 mmHg, and the pulse rate was normalized to 100 beats/min. The dose of vasopressors and inotropes were reduced and stopped 5 hour after the arrival. When the oxygenation has improved, the position was changed to supine and PEEP was lowered. Eventually weaning was successful. Brain MRI and EEG showed global atrophy of cerebral cortex and moderate diffuse brain dysfunction respectively. He received tracheostomy since he was semi-comatose. He was transferred to general ward on 39th ICU day.