• 대한치과마취과학회지
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• 제10권2호
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• pp.190-196
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• 2010

Difficult airway management including difficult intubation, difficult ventilation and difficult mask ventilation is a life threatening issue during anesthesia care. A 23-year-old woman with Treacher Collins syndrome was scheduled for distraction osteogenesis. She had hypoplasia of mandible and malar bone, bilateral deformities of auricles with partial deafness and antimongoloid slant of the palpebral fissures. A 56-year-old woman with mandibular hypoplasia due to childhood trauma was scheduled for distraction osteogenesis. She had a history of difficult intubation. We anticipated a difficult intubation and ventilation. Fiberoptic bronchoscopic guided awake intubation was selected for anesthesia induction. After intravenous injection of midazolam and remifentanil, 10% lidocaine pump spray on the pharyngolarynx with a direct laryngoscope and on the nasal canal. However fiberoptic bronchoscopic guided awake intubation was failed due to severe gag reflex. After intravenous injection of propofol and remifentanil using the target controlled infusion (TCI), mask ventilation was easily performed and, after intravenous injection of vecuronium, fiberoptic bronchoscopic guided intubation was easily performed using a wire reinforced endotracheal tube. The operation was completed successfully without any adverse events.

• 한국응급구조학회지
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• 제24권2호
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• pp.123-131
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• 2020

Purpose: This study aimed to find out the effectiveness of gum elastic bougies for intubation in comparison to stylet according to airway type using a manikin. Methods: The study subjects were 52 paramedic students who intubated using a Macintosh laryngoscope and compared stylet and gum elastic bougie use in a 7.5 mmID endotracheal tube, on a manikin with either normal or difficult airway. Difficult airway was made Philadelphia neck collar. Collected data included intubation time, accuracy and ease of intubation, later analyzed by frequency analysis, descriptive analysis, independent t-test, chi square test, paired t-test, and McNemar test using SPSS Statistics 18.0. Results: There was a significant difference in intubation time according to intubation device and airway type (p=.000). There was no significant difference in accuracy of intubation according to intubation device or airway type (normal airway p=1.000, difficult airway p=.052). There was a significant difference in ease of intubation scale according to intubation device and airway type (p=.000, p=.000). Conclusion: Based on the speed and ease of intubation, gum elastic bougie is recommended for intubation in patients with difficult airways such as those with cervical injury.

• 대한치과마취과학회지
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• 제9권2호
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• pp.91-97
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• 2009

Background: Nasotracheal intubation for general anesthesia is preferred for oral and maxillofacial procedures because it provides improved access to the operative site. Fiberopic nasotracheal intubation is a useful technique when airway management seems difficult. But, intaoral bleeding is considered as the important factor that makes fiberopic nasotracheal intubation difficult. The purpose of our study was to elucidate the effect of laryngeal view and bleeding on intubation difficulty during fiberopic intubation. Methods: We studied 461 patients undergoing nasotracheal intubation with permission. Laryngeal view grades were examined with laryngoscope and were recorded. Then, intubation time and the amounts of bleeding were measured during fibroptic nasotracheal intubation under general anesthesia. Results: There was no significant difference between laryngeal view grade and intubation difficulty (P > 0.05). But severity of bleeding increased intubation difficulty (P < 0.05). Conclusions: In this study, the significant amounts of bleeding had an effect on intubation difficulty.

• The Korean Journal of Pain
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• 제10권1호
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• pp.58-63
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• 1997

Background : Endotracheal intubation is one of the methods most securely establishing airway. But accompanying hemodynamic responses are harmful to coronary or cerebral vascular disease patients. These hemodynamic responses are regarded as the results of sympathetic stimulation due to pharyngolaryngeal stimulation, and sympathetic blocking method-stellate ganglion block- may be obtundate these hemodynamic responses. Methods : 75 patients of ASA physical status I-II were selected. There were 40 patients normotensive (Group I), 35 patients hypertensive (Group II) Group I, steliate ganglion block was performed on 20 patients (Group I-S) the remainder had no procedure (Group I-O). Group II, 18 patients received SG3 (Group II-S), 17 patients had no procedure (Group II-O). SGB was performed with 1% lidocaine 8 ml on right stellate genglion after patient's consent. Blood pressure (IIP) and pulse rate(PR) were first measured in the pre-anesthesia room. Follow up BP and PR are checked immediately following SGB and every 5 minutes for subsequent 20 minutes, then after arrival at operatig room, then immediately after intubation and at 3, 5, 10, 15 and 20 minutes after incubation. Results : All group experienced significantly increased blood pressure and pulse rate upon arrival at the pre-anesthesetic and opeating rooms, as compared to when patients rates in the ward. After intubation and for subsequent 5 minutes, significant changes were measured. Patients then recovered to preblock value. In Group I, no statistical significance was recorded between subgroup I-S and I-O. However in Group II, there were significant differences between sub-group II-S and II-O. In evaluating pulse rate changes, there were no significant differences between Group I-S and I-O; nor II-S and II-O. Conclusion : The proper diagnosis of Stellate Ganglion Block had some measure of protective effect on hemodynamics following endotracheal intubation, especially in hypertensive patients.

• Journal of Chest Surgery
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• 제35권11호
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• pp.835-838
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• 2002

편평상피 세포암으로 우측 폐 상엽 절제술을 시행한 68세 남자 환자에서 나타난 기엥바레 증후군에 대하여 보고하고자 한다. 환자는 수술 후 6일 째 갑작스럽고 양측성의 하지의 근력약화 및 호흡부전과 감각실조를 호소했다. 응급으로 기관내 삽관 후 인공환기기를 거치했다. 근력 약화 후 2일, 20일, 40일째 전기진단적 검사를 시행하였다. 운동신경전도장애가 현저하게 나타났다. 지속적인 운동말단신경잠시, 전도 시간의 분산, 부분적인 운동신경전도차단이 나타났으며 이와 같은 것들은 기엥바레 증후군의 진단적 특징이다. 보조적인 치료와 함께 정주적 면역 글로불린의 부가적인 사용을 시행하였으며 병세는 근력 약화 후 6주만에 회복되었다.

• Journal of Korean Biological Nursing Science
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• 제16권2호
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• pp.123-132
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• 2014

Purpose: The purpose of this study was to compare and analyze the effects of gargling using normal saline or essential oil on oral bacterial colonization of the subjects who did transoral endotracheal intubation for general anesthesia. Methods: A repeated measures, non-equivalent control group pretest-posttest design was used in this study. The subjects of the study included 58 people; the gargling group with normal saline (n=19); the gargling group with essential oil (n=20); and the control group (n=19). Data were collected from University hospitals in a Korean province from August 13-31, 2012. The collected data were analyzed with $X^2$-test, t-test, ANOVA and Scheff$\acute{e}$ test using SPSS 19.0. Results: Although statistically significant differences among the three groups did not appear in the change of the aerobic bacterial colony before and after the experiments, the aerobic bacterial colony of the gargling group with normal saline ($71.58{\pm}143.39$) and the group with essential oil ($6.95{\pm}332.07$) have increased less compared to the control group ($145.42{\pm}385.01$). The change of the anaerobic bacterial colony before and after the experiments, the control group was ($167.58{\pm}483.58$) and the gargling group with essential oil was ($169.70{\pm}291.60$) and increased, while the gargling group with normal saline ($-42{\pm}331.09$) reduced, but statistically significant differences have not appeared. Conclusion: These findings indicated that oral gargling with normal saline is effective in reducing anaerobic bacterial colonization.

• Pediatric Infection and Vaccine
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• 제25권2호
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• pp.101-106
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• 2018

6세 남아가 인플루엔자 A 바이러스 감염 이후 급성 호흡부전 상태에서 내원하였다. 기관 삽관 이후 인공 호흡 및 산화 질소공급에도 호흡성 산증 및 저산소증의 호전이 없어 내원 9시간 이후 체외막 산소 공급을 이용하여 호흡 보조를 시행하였다. 내원 12시간 이후 기관지경을 이용하여 우측 중간 기관지부터 상엽 구멍을 막고 있는 단단한 점액 마개를 제거하였다. 이후 환자는 신경계와 호흡기계 후유증 없이 퇴원하였다. 저자들은 플라스틱 기관지염으로 인한 급성 호흡 부전 상태의 환자에서 신속한 체외막 산소 공급 및 기관지경술의 처치를 시행함으로써 후유증 없이 치료한 사례를 보고한다.

• 대한임상독성학회지
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• 제13권1호
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• pp.11-18
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• 2015

Purpose: The aim of this study was to compare the clinical characteristics in emergency endotracheal intubation between patients with acute drug intoxication and medical disease. Methods: Data for airway registry collected in two emergency departments (ED) between April 2006 and March 2010 were reviewed retrospectively. The airway registry data included patient's demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. Results: A total of 1480 patients were enrolled; 62 patients were classified as belonging to the intubation group after the drug intoxication group. No significant differences in Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, and complications after intubation were observed between patients with acute drug intoxication and medical disease. However, significant difference was observed for indication of emergency endotracheal intubation. While emergency endotracheal intubations were usually performed in medical patients because of failure of airway patency, they were performed in intoxicated patients with the goal of preventing serious complications. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcome of intoxicated patients are not significantly different from those for medical patients.

• 대한치과마취과학회지
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• 제3권1호
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• pp.28-33
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• 2003

Background: The fundamental responsibility of an anesthesiologist is to maintain adequate gas exchange. Failure to maintain a patent airway can result in brain damage or death. Generally, in patients with mandibular prognathism, who have the protruded mandible, the mask ventilation was thought to be not easy. The purpose of this study was to observe the degree of the difficulty of airway management in mandibular prognathism using some anatomic criteria for defining and grading difficulty of airway and difficulty of endotracheal intubation with direct laryngoscope. Methods: The observations and measurements are done to the 54 patients with mandibular prognathism, who were scheduled for corrective esthetic surgery. The case study is done to the 30 patients with normal mandible for control group. In all patients, mouth opening distance (MOD), mouse opening angle (MOA), mandibular length (ML), mandibular depth (MD), thyromental distance (TMD), thyromental area (TMA), Mallampati grades, and Cormack and Lehane grades are measured. T-test and Chi-square test are done (P < 0.05). Results: In the mandibular prognathism cases, the measurements of MD, TMD and TMA are more greater than those of controls (P < 0.05). Mallampati grades with tongue thrust are higher in the female mandibular prognathism cases than those of female controls. Most of the grades of the mandibular prognathism cases with Cormack and Lehane grading system are I or II being easy intubation cases (P < 0.05) Conclusions: In the patients of mandibular prognathism, the intubation with laryngoscope will be easer than that of normal mandible in general. It is for that their laryngeal aperture can be easily visible when the laryngoscope are used.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
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• pp.10.3-11
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• 1982

근래에 기도 협착의 발생빈도는 수술요법의 괄목할만한 진전과 Low pressure cuff가 개발된 후 현저히 감소하고 있으나 호흡부전으로 Ventilator를 사용하는 경우와 심한 상기도 감염이나 손상이 있을 때 또는 장기간 삽관을 함으로서 발생하는 기관 협착증은 아직도 이비인후과 영역에 있어서 난제라고 하겠다. 이러한 기도 협착증의 치료로는 기계적으로 확장을 하거나 협착 부위를 수술적으로 제거하고 조직을 이식하는 여러 방법들이 있어서 그적응증에 따라 각각 사용되어 오고 있으나 아직까지도 만족할만한 결과를 얻지 못하는 때가 많은 실정이다. 1959년 Lester가 우연히 늑골의 잔존 연골피막으로부터 신생 연골이 재생된 것을 발견한 이후 Skoog(1972), Sohn(1974), Ohlsen(1975)등은 동물 실험을 통하여 연골 피막으로 부터의 연골 재생에 관하여 다각적인 보고를 하였다. 임상적으로 이개, 비중격, 늑골 및 피부편등 여러 가지 다양한 조직들이 기관의 결손 또는 협착 부위의 재생에 사용되어 왔으나 기관의 정상적인 지지 조직의 연골이며 또한 연골피막이 연골의 재생을 가능케 한다는 점에 입각하여 기관의 재건에 연골피막의 사용가능성을 알아 보고저 다음의 실험을 하였다, 가토의 이개연골에서 연골피막을 취한후 인위적으로 만든 가토의 기관 결손부위에 이식한 다음 2주부터 8주경과 할때 까지의 재생 변화를 관찰하여 다음과 같은 결론을 얻었다. (결론) 1) 기관결손 부위의 재생은 대조군에서는 결손부위에 섬유질 및 혈관으로 구성되었으나 이식군에서는 비후된 연골피막과 섬유질로 구성되었다. 2) 점막의 재생은 대조군과 이식한군 모두에서 2주경과 표본부터 정상점막으로 완전히 재생 되었다. 3) 이식 부위의 변화를 보면 2주-모세혈관의 확장과 염증반응을 동반하며 섬유조직의 증식시작이 관찰되었다. 4주-점차 모세혈관의 확장이 감소하며 염증반응의 감소가 있으며 점막하층의 섬유조직의 증식이 있고 1개의 표본에서 연골피막내에 미숙연골 세포군이 존재. 6주-경도의 모세혈관의 확장과 만성염증반응이 존재하며 점막하층의 섬유조직화가 존재하였으며 2개의 표본에서 연골피막내에 연골 세포군 및 골화현상이 존재하였다. 8주-경미한 모세혈관의 확장이 존재하였으나 염증반응은 소실되었고 점막하층에 심한 섬유화를 동반하였다. 표본 2개에서 연골 피막내에 연골 세포군의 존재가 관찰되었다. 4 ) 이식방법을 달리한 경우에도 연골 및 점막의 재생에는 유의한 차이를 발견할 수 없었다. 5) 연골피막 이식부위에서 미숙연골 세포군과 endo-chondrial ossification을 관찰할 수 있었으나 대조군에서는 결손부위의 섬유화만이 관찰되었다. 이상의 결과로 볼때 연골피막은 기관결손부위의 재진에 적합한 조직이라할 수 있었다. 그러나 40 례의 표본중 5례의 표본에서만 연골의 세포군을 관찰할 수 있어 이로 미루어 볼때 연골피막으로 부터 신생 연골이 재생된다 확인하기는 불충분하다고 생각되며 앞으로의 추시가 요망된다 하겠다.