비출혈 환자에서 굴곡성 기관지를 이용한 맹목적 기관내 삽관

Blind Intubation Using Fiberoptic Bronchoscope in Epistaxis

  • 이승현 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 윤지영 (부산대학교 치의학전문대학원 치과마취통증학교실) ;
  • 김철홍 (부산대학교 치의학전문대학원 치과마취통증학교실)
  • Lee, Seung-Hyun (Department of Oral and Maxillofacial Surgery, Busan National University) ;
  • Yoon, Ji-Young (Department of Dental Anesthesia and Pain Medicine Busan National University) ;
  • Kim, Cheul-Hong (Department of Dental Anesthesia and Pain Medicine Busan National University)
  • 투고 : 2012.06.28
  • 심사 : 2012.07.02
  • 발행 : 2012.06.30

초록

Nasotracheal intubation is an essential procedure during general anesthesia for dental treatment. Fiberoptic intubation is best accomplished by those who perform it as part of their daily practice. But nasal approach of fiberoptic intubation has some complications such as epistaxis and laryngeal injury. Especially, epistaxis is common and it make fiberoptic intubation because of limited view. When the epistaxis obstruct the field of vision we have to withdraw the fiberoptic bronchoscope and consider the other method for securing the airway. We succeeded in securing the airway of patient who had epistaxis during the fiberoptic nasotracheal intubation without withdrawing the fiberoptic bronchoscope. We used blind intubation guided by light source placed the tip of fiberoptic bronchscope applied to lightwand intubation.

키워드

참고문헌

  1. Heidegger T, Gerig HJ, Henderson JJ: Strategies and algorithms for management of the difficult airway. Best Pract Res Clin Anaesthesiol 2005; 19: 661-74. https://doi.org/10.1016/j.bpa.2005.07.001
  2. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269-77. [Erratum, Anesthesiology 2004; 101: 565.] https://doi.org/10.1097/00000542-200305000-00032
  3. Drolet P: Management of the anticipated difficult airway - a systematic approach: continuing professional development. Can J Anaesth 2009; 56: 683-701. https://doi.org/10.1007/s12630-009-9144-4
  4. Hall CE, Shutt LE: Nasotracheal intubation for head and neck surgery. Anaesthesia 2003; 58: 249-56. https://doi.org/10.1046/j.1365-2044.2003.03034.x
  5. Tintinalli JE, Claffey J: Complications of nasotracheal intubation. Ann Emerg Med 1981; 10: 142-4. https://doi.org/10.1016/S0196-0644(81)80379-4
  6. Morinoto Y, Sugimura M, Hirose Y, Taki K, Niwa H: Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anesth 2006; 53: 295-8. https://doi.org/10.1007/BF03022218
  7. Williamson R: Nasal intubation and epistaxis. Anaesthesia 2002; 57: 1033-4. https://doi.org/10.1046/j.1365-2044.2002.00017.x
  8. Viehweg TL, Roberson JB, Hudson JW: Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg 2006; 64: 511-8. https://doi.org/10.1016/j.joms.2005.11.031
  9. Agro F, Hung OR, Cataldo R, Carassiti M, Gherardi S: Lightwand intubation using the Trachlight: a brief review of current knowledge. Can J Anaesth 2001; 48: 592-9. https://doi.org/10.1007/BF03016838
  10. Heidegger T: Fiberoptic intubation. N Engl J Med 2011; 364: e42. https://doi.org/10.1056/NEJMvcm0906443