Paragangilomas are uncommon catecholamine-secreting neuroendocrine tumors that derived from the autonomic nervous system. Patients with paraganglioma may develop cardiovascular complication such as severe hypertensive crisis during anesthesia or surgery. It can lead to a life threatening condition if undiagnosed preoperatively or not adequately prepared. Paragangiloma and gastrointestinal stromal tumors (GISTs) may have a similar radiographic appearance. If there are no histologic confirmation and clinical manifestation of catecholamine excess, paragangliomas may be mistaken of GISTs. We report the case of a 56-year-old woman who developed hypertensive crisis during anesthesia for GISTs excision.
{"title":"Hypertensive crisis of a patient with undiagnosed paraganglioma","authors":"Kyu Bum Cho, Jeong Seok Lee, Jung Ha Lee, Dae Hun Yun, C. Park","doi":"10.30579/MBSE.2019.2.2.64","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.2.64","url":null,"abstract":"Paragangilomas are uncommon catecholamine-secreting neuroendocrine tumors that derived from the autonomic nervous system. Patients with paraganglioma may develop cardiovascular complication such as severe hypertensive crisis during anesthesia or surgery. It can lead to a life threatening condition if undiagnosed preoperatively or not adequately prepared. Paragangiloma and gastrointestinal stromal tumors (GISTs) may have a similar radiographic appearance. If there are no histologic confirmation and clinical manifestation of catecholamine excess, paragangliomas may be mistaken of GISTs. We report the case of a 56-year-old woman who developed hypertensive crisis during anesthesia for GISTs excision.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"333 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124696078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Corresponding author Jun-Young Park Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-1415 Fax: +82-2-3010-6790 E-mail: anesthesia.pains@gmail.com ORCID: https://orcid.org/0000-0003-4476-4945 Percutaneous nephrolithotomy (PNL) is a relatively safe and effective procedure for the management of nephrolithiasis but is associated with severe complications. We report the case of a 76-year-old woman who underwent PNL for renal calculi removal. Preoperative urinalysis detected a large number of white blood cells and, on culture, Escherichia coli was detected. After an uneventful recovery from general anesthesia, she developed tachycardia, high fever, severe shivering, and hypotension in the post-anesthesia care unit. She was diagnosed with urosepsis associated with PNL and was transferred to the intensive care unit. Urosepsis and refractory hypotension persisted despite meticulous fluid management and vasopressor and inotropic agent administration. On postoperative day 5, she was hemodynamically stable and was transferred to a general ward. On postoperative day 12, she was discharged without any complications. Urosepsis after PNL can be catastrophic; therefore, early detection and optimal treatment are necessary to improve the postoperative outcome.
{"title":"Development of sudden refractory hypotension resulting from urosepsis in the post-anesthesia care unit after percutaneous nephrolithotomy for renal calculi: a case report","authors":"Gi-Ho Koh, Doo-Hwan Kim, Jihion Yu, Seungsoo Ha, Sang-A Lee, Jai-hyun Hwang, Young-Kug Kim, Jun-Young Park","doi":"10.30579/MBSE.2019.2.2.55","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.2.55","url":null,"abstract":"Corresponding author Jun-Young Park Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-1415 Fax: +82-2-3010-6790 E-mail: anesthesia.pains@gmail.com ORCID: https://orcid.org/0000-0003-4476-4945 Percutaneous nephrolithotomy (PNL) is a relatively safe and effective procedure for the management of nephrolithiasis but is associated with severe complications. We report the case of a 76-year-old woman who underwent PNL for renal calculi removal. Preoperative urinalysis detected a large number of white blood cells and, on culture, Escherichia coli was detected. After an uneventful recovery from general anesthesia, she developed tachycardia, high fever, severe shivering, and hypotension in the post-anesthesia care unit. She was diagnosed with urosepsis associated with PNL and was transferred to the intensive care unit. Urosepsis and refractory hypotension persisted despite meticulous fluid management and vasopressor and inotropic agent administration. On postoperative day 5, she was hemodynamically stable and was transferred to a general ward. On postoperative day 12, she was discharged without any complications. Urosepsis after PNL can be catastrophic; therefore, early detection and optimal treatment are necessary to improve the postoperative outcome.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124694994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous intracerebral hemorrhage (sICH) is bleeding that occurs without trauma or known structural abnormality. Hypertension is a main cause of sICH, but liver cirrhosis may be another reason; however, this rarely occurs under anesthesia. We report on a case of sICH in a 75-year-old woman patient with liver cirrhosis during left hemihepatectomy. And the literature on the usefulness of perioperative bispectral index monitoring for early detection of brain damage is reviewed.
{"title":"Spontaneous intracerebral hemorrhage during left hemihepatectomy in a cirrhotic patient","authors":"C. Lim, Hui-Young Kim, Hyung-Joo Chung","doi":"10.30579/MBSE.2019.2.2.51","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.2.51","url":null,"abstract":"Spontaneous intracerebral hemorrhage (sICH) is bleeding that occurs without trauma or known structural abnormality. Hypertension is a main cause of sICH, but liver cirrhosis may be another reason; however, this rarely occurs under anesthesia. We report on a case of sICH in a 75-year-old woman patient with liver cirrhosis during left hemihepatectomy. And the literature on the usefulness of perioperative bispectral index monitoring for early detection of brain damage is reviewed.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122772213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Optimizing anesthetic management during cesarean section in parturients with severe pulmonary stenosis is difficult. This report describes the use of extracorporeal membrane oxygenation (ECMO) in a patient with symptomatic severe pulmonary stenosis undergoing cesarean section. A 33-year-old primigravid woman was admitted to the emergency department during the 37 th week of gestation for vaginal leakage and dyspnea on exertion. Transthoracic echocardiography showed severe pulmonary valve stenosis with a maximal gradient of 135 mmHg, combined with right ventricular hypertrophy and moderately decreased right ventricular contractility. She underwent emergency cesarean section under general anesthesia with ECMO as an adjuvant anesthetic method. Hemodynamic variables were well-maintained in the perioperative period, and the baby was delivered without complications. The patient was successfully weaned off of the ECMO device 3 hours after the end of the operation. The mother and baby were discharged in good health on hospital day 6. General anesthesia with ECMO support can be safe and effective in patients with severe pulmonary stenosis undergoing cesarean section.
{"title":"Successful use of extracorporeal membrane oxygenation during cesarean section in parturients with symptomatic severe pulmonary stenosis: a case report","authors":"Doo-Hwan Kim, Gi-Ho Koh, Sang-A Lee, Young-Kug Kim, Dong-Min Jang","doi":"10.30579/MBSE.2019.2.2.46","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.2.46","url":null,"abstract":"Optimizing anesthetic management during cesarean section in parturients with severe pulmonary stenosis is difficult. This report describes the use of extracorporeal membrane oxygenation (ECMO) in a patient with symptomatic severe pulmonary stenosis undergoing cesarean section. A 33-year-old primigravid woman was admitted to the emergency department during the 37 th week of gestation for vaginal leakage and dyspnea on exertion. Transthoracic echocardiography showed severe pulmonary valve stenosis with a maximal gradient of 135 mmHg, combined with right ventricular hypertrophy and moderately decreased right ventricular contractility. She underwent emergency cesarean section under general anesthesia with ECMO as an adjuvant anesthetic method. Hemodynamic variables were well-maintained in the perioperative period, and the baby was delivered without complications. The patient was successfully weaned off of the ECMO device 3 hours after the end of the operation. The mother and baby were discharged in good health on hospital day 6. General anesthesia with ECMO support can be safe and effective in patients with severe pulmonary stenosis undergoing cesarean section.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"145 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124645823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The management of pulmonary hypertension (PH), one of the most important perioperative risk factors, is innately challenging to anesthesiologists owing to its life-threatening consequences. The number of patients with PH has increased because of the development of more effective treatment and advanced hemodynamic monitoring, which consequently result in a longer life-expectancy. By understanding the associated risk factors, utilizing therapies based on PH classification, and performing careful perioperative anesthetic planning and management, we can safely perform elective surgeries or procedures on these patients. In particular, the perioperative management of patients with PH requires a multidisciplinary approach, which is aimed at carefully optimizing hemodynamics, minimizing risk factors, and aggressively treating complications. This review provides an evidence-based overview of the definition and classification of and treatments for PH, while also focusing on the perioperative management and treatment of patients with PH in non-cardiac and non-obstetric settings.
{"title":"Perioperative anesthetic considerations in patients with pulmonary hypertension undergoing non-cardiac and non-obstetric surgeries","authors":"J. Seo, K. So, Sang Hun Kim","doi":"10.30579/MBSE.2019.2.2.31","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.2.31","url":null,"abstract":"The management of pulmonary hypertension (PH), one of the most important perioperative risk factors, is innately challenging to anesthesiologists owing to its life-threatening consequences. The number of patients with PH has increased because of the development of more effective treatment and advanced hemodynamic monitoring, which consequently result in a longer life-expectancy. By understanding the associated risk factors, utilizing therapies based on PH classification, and performing careful perioperative anesthetic planning and management, we can safely perform elective surgeries or procedures on these patients. In particular, the perioperative management of patients with PH requires a multidisciplinary approach, which is aimed at carefully optimizing hemodynamics, minimizing risk factors, and aggressively treating complications. This review provides an evidence-based overview of the definition and classification of and treatments for PH, while also focusing on the perioperative management and treatment of patients with PH in non-cardiac and non-obstetric settings.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126691659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Corresponding author Seongheon Lee Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Gwangju 61469, Korea Tel: +82-62-220-6895 Fax: +82-62-232-6294 E-mail: aneshead@gmail.com ORCID: http://orcid.org/0000-0002-2675-2521 Continuing angiotensin receptor blockers (ARBs) until the day of surgery remains controversial because of the risk of intraoperative hypotension. This study was aimed at evaluating the perioperative hemodynamic changes and postoperative complications associated with continuation or discontinuation of ARBs in patients undergoing laparoscopic cholecystectomy. A total of 283 patients with antihypertensive medication, including ARBs, were enrolled in this retrospective study. On the day of surgery, ARBs were continued in some patients (continuation group, n=111) and discontinued in other patients (discontinuation group, n=172). On the basis of the patients’ electronic medical records, hemodynamic values (systolic blood pressure, mean arterial pressure, and heart rate) were compared before anesthesia (baseline), at 10 min after induction (post-induction), and on arrival at the post-anesthesia care unit (postanesthesia). Vasoactive drug use, postoperative complications, and length of hospital stay were compared. The blood pressures and heart rates at baseline and post-induction were not significantly different between the groups. The number of patients who required ephedrine to correct intraoperative hypotension was significantly higher in the continuation group than in the discontinuation group (27.9% vs. 14.5%, p=0.009). The systolic blood pressure at postanesthesia was significantly higher in the discontinuation group (159.9±21.7 vs. 146.4±20.9, p<0.001). The postoperative complications and length of hospital stay were similar. Discontinuing ARBs may reduce the incidence of intraoperative hypotension requiring pharmacological intervention in patients undergoing laparoscopic cholecystectomy; however, possible occurrence of postoperative hypertension should be considered.
通讯作者Seongheon Lee全南大学医学院麻醉学和疼痛医学系，韩国光州61469白西路160号，电话:+82-62-220-6895传真:+82-62-232-6294 E-mail: aneshead@gmail.com ORCID: http://orcid.org/0000-0002-2675-2521持续使用血管紧张素受体阻滞剂(ARBs)直到手术当天仍然存在争议，因为存在术中低血压的风险。本研究旨在评估腹腔镜胆囊切除术患者继续或停止ARBs的围手术期血流动力学变化和术后并发症。本回顾性研究共纳入283例接受抗高血压药物治疗的患者，包括arb。手术当日，部分患者(继续组，n=111)继续使用arb，其余患者(停止组，n=172)停止使用arb。根据患者的电子病历，比较麻醉前(基线)、诱导后10分钟(诱导后)和到达麻醉后护理单位(麻醉后)的血流动力学值(收缩压、平均动脉压和心率)。比较血管活性药物的使用、术后并发症和住院时间。两组之间的血压和心率基线和诱导后无显著差异。继续组中需要麻黄碱纠正术中低血压的患者数量明显高于停药组(27.9% vs. 14.5%， p=0.009)。停药组麻醉后收缩压明显高于停药组(159.9±21.7 vs 146.4±20.9,p<0.001)。术后并发症及住院时间相似。停止ARBs可能会降低腹腔镜胆囊切除术患者术中低血压需要药物干预的发生率;但应考虑术后可能发生的高血压。
{"title":"Effects of discontinuing angiotensin receptor blockers on perioperative hypotension in patients undergoing laparoscopic cholecystectomy","authors":"D. Han, Jia Song, M. Yoon, Seongheon Lee","doi":"10.30579/MBSE.2019.2.1.6","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.1.6","url":null,"abstract":"Corresponding author Seongheon Lee Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Gwangju 61469, Korea Tel: +82-62-220-6895 Fax: +82-62-232-6294 E-mail: aneshead@gmail.com ORCID: http://orcid.org/0000-0002-2675-2521 Continuing angiotensin receptor blockers (ARBs) until the day of surgery remains controversial because of the risk of intraoperative hypotension. This study was aimed at evaluating the perioperative hemodynamic changes and postoperative complications associated with continuation or discontinuation of ARBs in patients undergoing laparoscopic cholecystectomy. A total of 283 patients with antihypertensive medication, including ARBs, were enrolled in this retrospective study. On the day of surgery, ARBs were continued in some patients (continuation group, n=111) and discontinued in other patients (discontinuation group, n=172). On the basis of the patients’ electronic medical records, hemodynamic values (systolic blood pressure, mean arterial pressure, and heart rate) were compared before anesthesia (baseline), at 10 min after induction (post-induction), and on arrival at the post-anesthesia care unit (postanesthesia). Vasoactive drug use, postoperative complications, and length of hospital stay were compared. The blood pressures and heart rates at baseline and post-induction were not significantly different between the groups. The number of patients who required ephedrine to correct intraoperative hypotension was significantly higher in the continuation group than in the discontinuation group (27.9% vs. 14.5%, p=0.009). The systolic blood pressure at postanesthesia was significantly higher in the discontinuation group (159.9±21.7 vs. 146.4±20.9, p<0.001). The postoperative complications and length of hospital stay were similar. Discontinuing ARBs may reduce the incidence of intraoperative hypotension requiring pharmacological intervention in patients undergoing laparoscopic cholecystectomy; however, possible occurrence of postoperative hypertension should be considered.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127170684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Most common and featured complication in anesthetized patient with mediastinal mass is tracheobronchial compression distal to endotracheal tube. Because of reduced lung volume, relaxation of bronchial smooth muscle and eliminated diaphragm movement, general anesthesia exacerbate extrinsic intrathoracic airway compression. Once trachea or bronchus is collapsed, it is usually known to impossible to pass an endotracheal tube through compressed airway forcibly. However, if ventilation proves difficult, an attempt should be made to pass the endotracheal tube down the least obstructed portion and some cases reporting successful ventilation through placing endotracheal tube passed further down beyond the obstruction even after neuromuscular blockade. We describe the anesthesia experience that placing the endotracheal tube passed beyond the obstruction using fiberoptic bronchoscope in child with total tracheal obstruction after induction of general anesthesia.
{"title":"Ventilation through placing the endotracheal tube passed down beyond the obstruction during general anesthesia in patient with mediastinal mass","authors":"D. Han, Sue Youn Park, Young-Mo You, Jeeyun Rhee, Daehoon Kim, Seongtae Jeong","doi":"10.30579/MBSE.2019.2.1.17","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.1.17","url":null,"abstract":"Most common and featured complication in anesthetized patient with mediastinal mass is tracheobronchial compression distal to endotracheal tube. Because of reduced lung volume, relaxation of bronchial smooth muscle and eliminated diaphragm movement, general anesthesia exacerbate extrinsic intrathoracic airway compression. Once trachea or bronchus is collapsed, it is usually known to impossible to pass an endotracheal tube through compressed airway forcibly. However, if ventilation proves difficult, an attempt should be made to pass the endotracheal tube down the least obstructed portion and some cases reporting successful ventilation through placing endotracheal tube passed further down beyond the obstruction even after neuromuscular blockade. We describe the anesthesia experience that placing the endotracheal tube passed beyond the obstruction using fiberoptic bronchoscope in child with total tracheal obstruction after induction of general anesthesia.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122365513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
*These authors contributed equally to this work. Sciatic nerve palsy is a rare complication that occur after total hip arthroplasty but clinically this can result in significant functional deficit. The previous literature suggests most of the sciatic nerve palsy symptom to improve after a few weeks to a few months but in the real clinical setting, the result may vary and the symptom maybe significantly prolonged and some may not fully recover to the original state. Therefore, the current study aims assessed the fate of the patients who developed sciatic nerve palsy from hip arthroplasty operation. The authors have also looked at potential risk factors for poor outcome. This is the first case series in the Korean literature and we are reporting the result with the literature review.
{"title":"Fate of sciatic nerve palsy following hip arthroplasty","authors":"W. Na, J. Kang, Jung Woo Lee, S. Jo","doi":"10.30579/MBSE.2019.2.1.12","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.1.12","url":null,"abstract":"*These authors contributed equally to this work. Sciatic nerve palsy is a rare complication that occur after total hip arthroplasty but clinically this can result in significant functional deficit. The previous literature suggests most of the sciatic nerve palsy symptom to improve after a few weeks to a few months but in the real clinical setting, the result may vary and the symptom maybe significantly prolonged and some may not fully recover to the original state. Therefore, the current study aims assessed the fate of the patients who developed sciatic nerve palsy from hip arthroplasty operation. The authors have also looked at potential risk factors for poor outcome. This is the first case series in the Korean literature and we are reporting the result with the literature review.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127210580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Humidification of inhaled gases has been standard of care in mechanical ventilation recently. Heat and moisture exchange is one of the most important functions of the upper respiratory system. The warming and humidification function through the upper airway disappears when mechanical ventilation with endotracheal intubation. An active humidification system is often used to preserve of warming and humidification function. But, we experienced of unexpected high inspiratory pressure and auto-positive end-expiratory pressure (PEEP) during mechanical ventilation with heated wire humidifier that one of active humidification system. We did not find any factor to raise airway pressure other than the water in the inspiratory limb of circuit. After some of sterile water in the circuit removed, high inspiratory pressure and auto-PEEP reduced. So we think that inspiratory limb water is a rare cause of airway pressure rise. Therefore, if sudden high peak airway pressure and auto-PEEP is encountered upon ventilation, the ventilator circuit status should be checked for the safety of patients.
{"title":"Could the unexpected excessive airway pressure be caused by water in the ventilator circuit?: a case report","authors":"Taehee Pyeon, J. Hwang, Sungmin Kim, H. Bae, Joungmin Kim","doi":"10.30579/MBSE.2019.2.1.22","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.1.22","url":null,"abstract":"Humidification of inhaled gases has been standard of care in mechanical ventilation recently. Heat and moisture exchange is one of the most important functions of the upper respiratory system. The warming and humidification function through the upper airway disappears when mechanical ventilation with endotracheal intubation. An active humidification system is often used to preserve of warming and humidification function. But, we experienced of unexpected high inspiratory pressure and auto-positive end-expiratory pressure (PEEP) during mechanical ventilation with heated wire humidifier that one of active humidification system. We did not find any factor to raise airway pressure other than the water in the inspiratory limb of circuit. After some of sterile water in the circuit removed, high inspiratory pressure and auto-PEEP reduced. So we think that inspiratory limb water is a rare cause of airway pressure rise. Therefore, if sudden high peak airway pressure and auto-PEEP is encountered upon ventilation, the ventilator circuit status should be checked for the safety of patients.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"8 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123427586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The tissue microenvironment regulates differentiation of precursor monocytes into macrophages. In response to the presence of microbial products, stimulated lymphocytes, or damaged cells in the microenvironment, macrophages differentiate into distinct functional populations. The M1 macrophages are characterized by the generation of high levels of pro-inflammatory cytokines, antimicrobial properties, increased production of reactive nitrogen and oxygen intermediates, and induction of Th1 response. In contrast, M2 macrophages are characterized by their involvement in tissue remodeling, immune regulation, tumor promotion, and efficient phagocytosis. In this minireview, we discuss the stimulation, markers, cytokines, and signaling molecules involved in macrophage polarization.
{"title":"M1 and M2 polarization of macrophages: a mini-review","authors":"Kun Yeong Lee","doi":"10.30579/MBSE.2019.2.1.1","DOIUrl":"https://doi.org/10.30579/MBSE.2019.2.1.1","url":null,"abstract":"The tissue microenvironment regulates differentiation of precursor monocytes into macrophages. In response to the presence of microbial products, stimulated lymphocytes, or damaged cells in the microenvironment, macrophages differentiate into distinct functional populations. The M1 macrophages are characterized by the generation of high levels of pro-inflammatory cytokines, antimicrobial properties, increased production of reactive nitrogen and oxygen intermediates, and induction of Th1 response. In contrast, M2 macrophages are characterized by their involvement in tissue remodeling, immune regulation, tumor promotion, and efficient phagocytosis. In this minireview, we discuss the stimulation, markers, cytokines, and signaling molecules involved in macrophage polarization.","PeriodicalId":259565,"journal":{"name":"Medical Biological Science and Engineering","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122035263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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