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( Jae Wan Jung ),( Hyunho Lee ),( Jimi Oh ) 영남대학교 의과대학 2021 Yeungnam University Journal of Medicine Vol.38 No.4
Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by progressive accumulation of lipoprotein material in the lungs due to impaired surfactant clearance. Whole-lung lavage (WLL) is the current standard treatment and consists of sequential lavage of each lung to mechanically remove the residual material from the alveoli. Although WLL is considered safe, unexpected complications can occur. Moreover, due to the rarity of the disease itself, this procedure is unknown to many physicians, and management of intraoperative complications can be challenging for anesthesiologists. Lung ultrasound (LUS) provides reliable and valuable information for detecting perioperative pulmonary complications and, in particular, quantitation of lung water content. There have been reports on monitoring the different stages of controlled deaeration of the non-ventilated lung during WLL using LUS. However, it has been limited to non-ventilated lungs. Therefore, we report the use of LUS in WLL to proactively detect pulmonary edema in the ventilated lung and implement a safe and effective anesthesia strategy. Given the limited diagnostic tools available to anesthesiologists in the operating room, LUS is a reliable, fast, and noninvasive method for identifying perioperative pulmonary complications in patients with PAP undergoing WLL.
일측폐환기 시 Propofol, Ketamine 및 Enflurane이 동맥혈 산소 분압과 이산화탄소 분압에 미치는 영향의 비교
우남식,이규창,김민정,김윤수 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-
The mechanism which normally affects distribution of blood flow through unventilated areas of the lung is hypoxic pulmonary vasoconstriction, this acts to divert the blood to well ventilated alveoli, resulting in a better retio of ventilation to perfusion. Several reports have focused attention to the reduction or abolition of this reflex in the unventilated lung by most volatile anesthetic agents used in clinical practice. This response was not abolished by the intravenous anesthetic agents. 30 patients undergoing elective thoracic surgery were stuided to evaluate the effect of a propofol(n=10), ketamine(n=10) and enflurane(m=10) on the changes in PaO₂ and in PaCO₂ as reflections of shunt and ventilation respectively during one lung anesthesia. We have demonstrated that in all cases a PaO₂ in excess of 105.3mmHg, 79.5mmHg, and 177mmHg were achived with propofol, ketamine and enflurane. In all cases a PaCO₂ was under the 36.8mmHg. We concluded that both propofol and enflurane were satisfactory anesthetics for one-lung anesthesia. and ketanine was not ideal for one-lung anesthesia in adult patients.
임상연구 : 측와위에서 수술 전 일측폐환기가 향후 수술 중 일측폐환기 시 동맥혈 산소화에 미치는 영향
박희평 ( Hee Pyoung Park ),전영태 ( Young Tae Jeon ),박상헌 ( Sang Hyun Park ),이석면 ( Seok Myeon Rhee ),오용석 ( Yong Seok Oh ),황정원 ( Jung Won Hwang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: There are a few reports with conflicting results regarding the potentiation of hypoxic pulmonary vasoconstriction (HPV) by repeated hypoxic challenges. The aim of this study was to determine if preoperative one lung ventilation (OLV) in the lateral position (LP) for a short time decreases the development of arterial hypoxemia and improves the level of arterial oxygenation via the potentiation of HPV in patients undergoing thoracic surgery with OLV. Methods: Forty patients were randomly divided into two groups according to presence or absence of preoperative OLV. Preoperative OLV in LP was achieved for 10 minutes with 100% O2 in group P (n = 20). Thereafter, the two lungs were again ventilated with 50% O2 until OLV with 100% O2 had been achieved. In group C (n = 20), the two lungs were continuously ventilated with 50% O2 until OLV with 100% O2 was achieved. The arterial blood samples were obtained 15 minutes after the two lung ventilation in the supine position (baseline) during preoperative OLV in LP, before pulmonary vein ligation, as well as before and after pulmonary artery ligation. The development of arterial hypoxemia (peripheral blood oxygen saturation in pulse oximetry < 95%) in patients undergoing thoracic surgery with OLV was also recorded. Results: Arterial hypoxemia during OLV was observed in 2 cases in group C and 3 cases in group P. There was a similar level of arterial oxygen tension during OLV between the two groups. Conclusions: This study showed that the preoperative OLV in LP for 10 minutes neither potentiated the HPV response during OLV nor decreased the frequency of arterial hypoxemia during OLV. (Korean J Anesthesiol 2006; 51: 568~72)