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예상하지 못한 어려운 기관내 삽관 조작후 발생한 경부 피하기종
이상화,김봉일,노운석,조성경,박태숙,백승희 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.1
Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day. (Korean J Anesthesiol 1997; 33: 178∼181)
임신 2기 계류유산환자에서 경관확장 자궁소파수술시 발생한 양수색전증
이상화,김봉일,노운석,조성경,백승희,이상평 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.4
Amniotic fluid embolism(AFE) is a rare but devasting obstetric emergency. We experienced a case of AFE during dilatation and curettage(D&C) in a 15 2/7 weeks pregnant woman, age 30, who was diagnosed as having a missed abortion. Sudden rapid hypoxemia, low SpO2, hypotension, low PETCO2, high CVP, and tachycardia, right axis deviation and right bundle branch block in 12 leads ECG were developed during D&C under general anesthesia, and signs of disseminated intravascular coagulation(DIC) followed after the operation, which are consistent with the findings of AFE. Even though there was no definite pathologic and radiologic confirmation of AFE, laboratory findings showed 100 times higher level of α-fetoprotein in her central venous blood than same weeks of missed abortion woman's blood. Though it is rare, the anesthesiologist should always suspect the possibility of AFE, when the patient shows an unexplained collapse, cyanosis, low PETCO2, high CVP, low SpO2, ECG change and DIC during any kind of obstetric proceure. (Korean J Anesthesiol 1997; 33: 778∼783)