• 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 Dental Anesthesia and Pain Medicine
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• 제17권4호
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• pp.265-270
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• 2017

Background: Endotracheal intubation during anesthesia induction may increase airway resistance ($R_{aw}$) and decrease dynamic lung compliance ($C_{dyn}$). We hypothesized that prophylactic treatment with a transdermal ${\beta}2$-agonist tulobuterol patch (TP) would help to reduce the risk of bronchospasm after placement of the endotracheal tube. Methods: Eighty-two American Society of Anesthesiologists (ASA) category I or II adult patients showing obstructive patterns were divided randomly into a control and a TP group (n = 41 each). The night before surgery, a 2-mg TP was applied to patients in the TP group. Standard monitors were recorded, and target controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. Simultaneously, end-tidal carbon dioxide, $R_{aw}$, and $C_{dyn}$ were determined at 5, 10, and 15 min intervals after endotracheal intubation. Results: There was no significant difference in demographic data between the two groups. The TP group was associated with a lower $R_{aw}$ and a higher $C_{dyn}$, as compared to the control group. $R_{aw}$ was significantly lower at 10 min (P < 0.05) and 15 min (P < 0.01), and $C_{dyn}$ was significantly higher at 5 min (P < 0.05) and 15 min (P < 0.01) in the TP group. A trend towards a lower $R_{aw}$ was observed showing a statistically significant difference 5 min after endotracheal intubation (P < 0.01) in each group. Conclusions: Prophylactic treatment with TP showed a bronchodilatory effect through suppressing an increase in $R_{aw}$ and a decrease in $C_{dyn}$ after anesthesia induction without severe adverse effects.

• 대한기관식도과학회지
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• 제18권2호
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• pp.41-44
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• 2012

Acquired tracheoesophageal fistula (TEF) can occur rarely from various causes. Recently, cuff-related tracheal injury after endotracheal intubation with the orotracheal tube and tracheostomy cannula is the most common etiology of nonmalignant TEF. Since cuff-related TEF is usually preventable with proper selection of the cuffed tube and close monitoring of cuff pressure. Although most patients present increased secretions, recurrent pneumonia, or coughing after swallowing, a high index of suspicion is required in patients at risk for developing a TEF. Surgical correction for the defectis required. In most cases, primary closure of the esophageal defect and tracheal resection and end-to-end anastomosis give the best results.

• Journal of Trauma and Injury
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• 제28권2호
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• pp.75-78
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• 2015

Mandible dislocation during endotracheal intubation is an unusual occurrence but easy to be overlooked for its unfamiliarity. We recently had a case of iatrogenic bilateral dislocation of a temporomandibular joint during orotracheal intubation and emphasize the importance of an early awareness of this possible complication.

• 대한소아치과학회지
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• 제41권1호
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• pp.40-46
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• 2014

Treacher collins 증후군(TCS)는 25,000명에서 50,000명당 1명의 빈도로 발생하는 상염색체우성의 유전질환이다. 상, 하악의 발육 부전, 부정교합, 양측성 이개 기형, 안검렬의 반몽고증 사면, 구순구개열, 외이도 폐쇄, 중이와 내이의 기형으로 인한 청각 소실등의 구강악안면 부위의 특징을 보여 태생 이후 성인기에 이르기까지 여러 차례에 걸친 외과적 수술을 거치게 된다. 하악골의 형성저하로 하악골이 짧고 후방 위치되며 후방 위치하는 혀와 후비공의 협착과 폐쇄로 인해 상기도가 좁아지게 되는데 이로 인해 기관삽관의 어려움이 따른다. 따라서 치근 발육이 미약한 소아청소년 시기의 TCS 환자의 기관 삽관 시 상악 전치부의 손상 가능성이 매우 높다. 본 증례는 전신마취 유도를 위한 기관 삽관 도중 상악 전치의 완전 탈구가 발생한 TCS 환아의 치험례를 통해 기도 삽관 시사전의 마우스가드 제작의 유용성에 대하여 알리고자 한다.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.127-129
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• 2011

Purpose: Nasotracheal or oral intubation procedure is widely used for facial bone fractures. However, during the operation intubated tube can interfere or obstruct the view of the operator. We authors used a modified submental intubation method in panfacial bone fracture patients for intact airway and the operation view. Methods: After intravenous induction of anaesthesia, traditional orotracheal tubation was done. A horizontal incision was made 2 cm from the midline, 2 cm medial to and parallel with the mandible in the submental region. 1 In order to approach to the floor of the oral cavity, a haemostat was pushed through the soft tissues. A chest tube front cover was applied to the intubation tube and the tube was inserted through the submental tunnel. Orotracheal tube was disconnected and pulled back through the soft tissue and secured with a suture. Results: The procedure took about 30 minutes and there were no problems during the intubation. Intraoral manipulation and occlusal checks were free without any interference. Extubation was also easily done without any complications such as lung aspiration, infection, hematoma, or fistula. Conclusion: Submental endotracheal intubation is fast, safe, easy to use and free from the concern about the tube being pull back again. Conventional submental intubations are being held without any coverage of the tip. We authors applied the modified method to the trauma patients and obtained satisfactory results. From the above advantages, modified submental intubation can be widely available not only in fractured patients, but also in aesthetic or orthognathic surgeries.

• Clinical and Experimental Pediatrics
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• 제60권9호
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• pp.273-281
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• 2017

To date, preterm infants with respiratory distress syndrome (RDS) after birth have been managed with a combination of endotracheal intubation, surfactant instillation, and mechanical ventilation. It is now recognized that noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to elective intubation after birth. Recently, a meta-analysis of large controlled trials comparing conventional methods and nasal CPAP suggested that CPAP decreased the risk of the combined outcome of bronchopulmonary dysplasia or death. Since then, the use of NIV as primary therapy for preterm infants has increased, but when and how to give exogenous surfactant remains unclear. Overcoming this problem, minimally invasive surfactant therapy (MIST) allows spontaneously breathing neonates to remain on CPAP in the first week after birth. MIST has included administration of exogenous surfactant by intrapharyngeal instillation, nebulization, a laryngeal mask, and a thin catheter. In recent clinical trials, surfactant delivery via a thin catheter was found to reduce the need for subsequent endotracheal intubation and mechanical ventilation, and improves short-term respiratory outcomes. There is also growing evidence for MIST as an alternative to the INSURE (intubation-surfactant-extubation) procedure in spontaneously breathing preterm infants with RDS. In conclusion, MIST is gentle, safe, feasible, and effective in preterm infants, and is widely used for surfactant administration with noninvasive respiratory support by neonatologists. However, further studies are needed to resolve uncertainties in the MIST method, including infant selection, optimal surfactant dosage and administration method, and need for sedation.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권1호
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• pp.61-65
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• 2016

Intubation may lead to several dental complications. Furthermore, a tooth damaged during intubation may be subsequently dislocated. In the present case, the upper primary incisor was avulsed during intubation and, unbeknownst to the anesthesiologist, displaced to the larynx. We report here on the findings and indicate appropriate treatment. Intubation for general anesthesia in children can result in tooth damage and/or dislocation of primary teeth with subsequent root resorption. Prevention is key, and thus it is critical to evaluate the patient's dental status before and after intubation. Furthermore, anesthesiologists and dentists should pay close attention to this risk to prevent any avulsed, dislocated, or otherwise displaced teeth from remaining undetected and subsequently causing serious complications.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권5호
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• pp.245-252
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• 2019

This paper describes the potential oral complications in preterm infants who have undergone orotracheal intubation. Neonatal intubation may have adverse effects on the developing deciduous teeth, oral soft tissues, and even the permanent teeth. However, endotracheal intubation may be essential for the survival of premature infants, owing to incomplete tracheal development. Excessive pressure to the oral tissue must be avoided, in cases where orotracheal intubation is inevitable. Moreover, the potential oral complications must be considered when neonatal intubation is performed for the patient's survival, and subsequent reevaluation and proper oral health care are needed.

• 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.