• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.19.1-19.7
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• 2015

Background: The purpose of this retrospective study was to investigate the usefulness of tracheostomy scoring system in the decision of postoperative airway management in oral cancer patients. Materials and methods: A total of 104 patients were reviewed in this retrospective study, who underwent radical resection with or without neck dissection and free flap reconstruction due to oral cancer. The patients were classified into three groups according to the timing of the extubation; extubated groups (n = 51), overnight intubation group (n = 45), and tracheostomy group (n = 8). Cameron's score was used to evaluate the relation between the state of the patient's airway and the type of the operation. Results: Tracheostomy was performed in eight patients (8/104, 7.7 %). A total of 22 patients (21.2 %) had more than 5 points of which 17 patients (77.3 %) did not have a tracheostomy and any postoperative emergency airway problems. The tracheostomy scores were significantly different among the three groups. Hospital stay showed a significant correlation with the tracheostomy score. Conclusions: The scoring system did not quite agree with the airway management of the authors' clinic; however, it can be one of the clinical factors predicting the degree of the postoperative airway obstruction and surgical aggressiveness for recovery. The further studies are needed for clinically more reliable scoring systems.

• 대한두경부종양학회지
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• 제34권1호
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• pp.45-47
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• 2018

Thyroid hematoma secondary to a blunt trauma is a rare problem. Despite the rarity, it can be a life-threatening condition with tracheal compression. Both surgical exploration and conservative management have been suggested for thyroid hematoma. However, there is still controversy on the optimal treatment. A 67-year old man who progressed severe dyspnea and neck swelling was transferred to the emergency department with a blunt anterior neck trauma after traffic accident. Contrast enhanced neck computed tomography scan showed huge hematoma within the right thyroid gland and slight tracheal deviation without prominent airway obstruction. One day later, anterior neck swelling was aggravated and the patient was intubated to prevent airway obstruction. After 3 days, hematoma resolution was revealed and extubation was done. We report this case with a review of literature.

• Tuberculosis and Respiratory Diseases
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• 제71권1호
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• pp.59-61
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• 2011

Obstructive Fibrinous Tracheal Pseudomenbrane (OFTP) is a rarely known but potentially fatal complication of endotracheal intubation. Sudden respiratory failure shortly after extubation is not infrequent in the ICU. However, these cases are commonly diagnosed as laryngospasm, retention of secretion or laryngeal edema. A 68-year-old woman presented with a 6-day history of progressive dyspnea. She had undergone invasive ventilator care for 24 hours. The patient was discharged from the hospital with improvement after having an extubation. However, after 3 days she revisited the emergency department with progressive dyspnea. The patient was diagnosed with OFTP from the results of chest CT and bronchoscopy. This is the first case studied in detail using CT images, pulmonary function test, and bronchoscopy.

• 대한간호학회지
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• 제45권2호
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• pp.280-292
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• 2015

Purpose: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. Methods: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE. Results: Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. Conclusion: Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.

• Journal of Medicine and Life Science
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• 제16권2호
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• pp.43-45
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• 2019

Intraoperative delivery of salbutamol (${\beta}_2$ agonist) through a breathing circuit may be performed in asthma patient. A 28-year-old woman with a history of asthma was diagnosed with chronic sinusitis and bilateral nasal polyps, and an endoscopic sinus surgery was performed. The patient was recommended salbutamol nebulization every 4 hours during the perioperative period because of the risk of asthma attack. At the end of the operation, when salbutamol was sprayed through the tube before extubation and the connector tip went inside the tube during injection. The patient was immediately referred to the pulmonary medicine department for bronchoscopy, where the foreign body was removed safely without any complications. When general anesthesia is performed on a patient who usually uses an inhaler for asthma, caution is required because the tip that connects the inhaler and the breathing circuit can aspirate into the endotracheal tube and enter the lungs when applying the inhaler before waking up the patient.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권4호
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• pp.261-265
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• 2018

Rett syndrome (RS) is a neurodevelopmental disorder characterized by loss of cognitive, motor, and social skills, epilepsy, autistic behavior, abnormal airway patterns, gastroesophageal reflux, nutritional problems, and severe scoliosis. Although girls with RS show normal or near-normal growth until 6-8 months, they lose their skills after that. The anesthetic management of these patients requires care because of all these clinical features. Especially in the postoperative period, prolonged apnea is common and extubation is delayed. In this case report, the effect of using sugammadex was presented in a 16-year-old girl with RS. The patient's all bimaxillary teeth and 4 wisdom teeth were extracted under general anesthesia in one session with minimal surgical trauma and moderate bleeding. Sugammadex can be a rapid and reliable agent for the reversal of the neuromuscular block in neurodegenerative patients.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권3호
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• pp.205-211
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• 2024

A 7-year-old girl visited the Samsung Medical Center emergency room for primary tooth aspiration during primary tooth extraction under conscious sedation with N₂O. The patient showed no signs of respiratory complications. Chest radiography and CT revealed a tooth in the right bronchi. Foreign body removal using rigid bronchoscopy was performed on the day of aspiration. With close monitoring of the airway in the pediatric ICU, extubation was performed the next day, and the patient was discharged the same day. The primary objective of this case report was to highlight the potential risk of aspiration associated with the use of N₂O gas for conscious sedation.

• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.723-730
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• 1995

Background: Noninvasive ventilation has been used extensively for the treatment of patients with neuromuscular weakness or restrictive chest wall disorders complicated by hypoventilatory respiratory failure. Recently, noninvasive positive pressure ventilation has been used in patients with alveolar hypoventilation, chronic obstructive pulmonary disease(COPD), and adult respiratory distress syndrome. Sanders and Kern reported treatment of obstructive sleep apnea with a modification of the standard nasal CPAP device to deliver seperate inspiratory positive airway pressure(IPAP) and expiratory positive airway pressure(EPAP). Bi-level positive airway pressure(BiPAP) unlike nasal CPAP, the unit delivers a different pressure during inspiration from that during expiration. The device is similar to the positive pressure ventilator or pressure support ventilation. Method and purpose: Bi-level positive airway pressure(BiPAP) system(Respironics, USA) was applied to seven patients with acute respiratory failure and three patients on conventional mechanical ventilation. Results: 1) Two of three patients after extubation were successfully achieved weaning from conventional mechanical ventilation by the use of BiPAP ventilation with nasal mask. Five of seven patients with acute respiratory failure successfully recovered without use of conventional mechanical ventilation. 2) $PaO_2$ 1hour after BiPAP ventilation in acute respiratory failure patients significantly improved more than baseline values(p<0.01). $PaCO_2$ 1hour after BiPAP ventilation in acute respiratory failure patients did not change significantly more than baseline values. Conclusion: Nasal mask BiPAP ventilation can be one of the possible alternatives of conventional mechanical ventilation in acute respiratory failure and supportive method for weaning from mechanical ventilation.

• Journal of Chest Surgery
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• 제40권4호
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• pp.313-316
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• 2007

전신마취 회복기에 발생하는 음압성 페부종은 드물게 발생하나, 여러 종류의 수술 후 발생할 수 있는 잠재적으로 심각한 합병증이다 음압성 페부종의 발생 기전은 기관 내 튜브 발관 후 심한 자발적인 호흡시도와 성문폐쇄 및 후두경련으로 인한 기도폐쇄와 연관하여 현저하게 기도 내 음압이 상승하여 생긴다고 한다. 저자들은 건장한 26세 남자 환자에서 양성 늑골종양에 대한 늑골 부분절제술 후 기관 내 튜브 발관 후 심한 음압성 폐부종과 각혈이 발생하였으나 성공적으로 보존적 치료를 시행하였다. 이에 문헌고찰과 함께 보고한다.

• Clinical and Experimental Pediatrics
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• 제65권4호
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• pp.188-193
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• 2022

Background: Respiratory distress syndrome (RDS) is a common cause of hospitalization and death in preterm infants who require surfactant treatment and respiratory support. Purpose: This study aimed to compare the clinical outcomes of minimally invasive surfactant therapy (MIST) and the INtubation, SURfactant administration, and Extubation (INSURE) technique in preterm infants with RDS. Methods: In this clinical trial, 112 preterm infants born at 28-36 weeks of gestation and diagnosed with RDS randomly received 200-mg/kg surfactant by MIST or the INSURE method. In the MIST group, surfactant was administered using a thin catheter (5F feeding tube); in the INSURE group, surfactant was administered after intubation using a feeding tube and the tracheal tube was removed after positive pressure ventilation was started. Nasal continuous positive airway pressure was applied in both groups for respiratory support and the postprocedure clinical outcomes were compared. Results: The mean hospitalization time was shorter for infants in the MIST group than for those in the INSURE group (9.19±1.72 days vs. 10.21±2.15 days, P=0.006). Patent ductus arteriosus was less frequent in the MIST group (14.3% vs. 30.4%, P=0.041). Desaturation during surfactant administration occurred less commonly in the MIST group (19.6% vs. 39.3%, P=0.023). There were no significant intergroup differences in other early or late complications. Conclusion: These results suggest that surfactant administration using MIST could be a good replacement for INSURE in preterm infants with RDS since its use reduced the hospitalization time and the number of side effects.