• Journal of Oral Medicine and Pain
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• 제42권2호
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• pp.44-48
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• 2017

Chronic temporomandibular joint dislocation is defined as an acute dislocation that cannot be reduced or that recurs for more than one month. The management of dislocation depends on patient status and the duration of dislocation and ranges from conservative reduction to a surgical approach. In the present cases, a 64-year-old male was referred to our department for treatment of chronic dislocation for 6 weeks. The dislocation might be occurred by endotracheal intubation. A 70-year-old female was referred to our department with repeat right condyle dislocation after reduction of dislocation at a local clinic. When she visited for later treatment of new dentures, her condyle had been dislocated again for several weeks. In both cases, we tried to treat the dislocation with several manipulations, which were unsuccessful. Finally, chronic dislocation was successfully treated by surgical traction under general anesthesia without relapse. Surgical traction is a simple, effective option with the lowest morbidity of surgical procedures for chronic dislocation when conservative reduction is unsuccessful.

• 대한치과마취과학회지
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• 제12권4호
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• pp.235-241
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• 2012

Although sevoflurane sedation have the advantage of the reduction of anxiety and pain relief, difficult airway is attributed to increased agitation, tachycardia, desaturation, ventilation difficulty, sedation failure. In the sedation for dental treatment, we should pay more attention to the airway management because dental procedures take place in the mouth of airway unlike any other area. The layngeal mask airway (LMA) has become commonly used device for airway management during anesthesia for relatively short procedures, such as minor oral surgery and dental procedures. It can be inserted without use of a larygoscope and muscle relexants, and insertion is easy to achieve and generally takes less time than endotracheal intubation. The LMA is an excellent barrier against aspiration of saliva, blood within the surgical field but should not be used in patients at risk of aspiration In this study, we reported that after a failure of airway management in inhalation sedation, we performed the short-emergency dental treatment successfully, using a laryngeal mask.

• Journal of Chest Surgery
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• 제11권3호
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• pp.321-325
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• 1978

Coarctation of the aorta was rare condition among the congenital cardiovascular defects in Korea. We experienced a case of coarctatlon of the aorta [postductal type], which was successfully corrected by resection and end to end anastomosis. This patient, 21 years male patient, was admitted to the medical department for evaluation of hypertension, headache and exertional dyspnea during 4 years, and transferred to the department of chest surgery for operation. On physical examination, blood pressures were measured on both extremity, measuring 190/100mmHg on the arm and 100/80mmHg on the leg. Systolic murmur was heard on 2nd to 3rd left intercostal space and left sternal border. On simple chest x-ray, rib notching was seer/on low border of right 3rd and left 4th rib. Final preoperative diagnosis was made by the retrograde aortic catheterization and aortography, which showed the typical configuration of postductal type of coarctation with poststenotic dilatation of the aorta. On 20th, July, 1978, under the general anesthesia with endotracheal intubation, resection of coarctation of the aorta and end to end anastomosis was performed. During clamp for resection, blood pressure of upper extremity was elevated to 200/140mmHg, and controlled by Arfornad. During recovery, blood pressure over 160ramrig in systole was controlled by Reserpine for 8days postoperatively. At discharge, postoperative 8th day, brachial and femoral artery pressure was 145/85 mmHg and 135/80mmHg. After discharge, there was no evidence of specific symptoms and hypertension without antihypertensive drug.

• Journal of Chest Surgery
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• 제10권1호
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• pp.17-24
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• 1977

The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tube has produced, apparently with increasing frequency, three lesions which have serious ceminical manifestations such as tracheal stenosis, tracheomalasia, and localized tracheal erosion. Extensive resection and reconstruction of the trachea must be necessary because conservative treatment has generally failed in the fully developed stenotic lesion. of the mediastinal trachea following extensive resection is best accomplished by direct anastomosis of the patient`s own tracheobronchial tissue. Any replacement of the mediastinal trachea must be air tight and laterally rigid, and must heal dependably. A variety of materials has been used for substitution following circumferential excision of tracheal segments within the mediastinum. These attempts have often failed because of early leak or late stenosis. We have successfully performed circumferential resection and primary end-to-end anastomosis of the trachea for 4 cases of post-intubation tracheal stenosis located a few centimeter below the tracheostomy stoma in the period of 3 years between 1974 and 1976. The lesion in one patient was found in the upper trachea which was approached anteriorly through a cervicomediastinal incision with division of the upper sternum. Other three located in the lower half of the trachea were operated through a high transthoracic incision with appropriate hilar mobilization in addition to cervical flexion for the development of the cervical trachea into the mediastinum. There were no hospital death, but suture line granulations occurred in two patients were managed by bronchoscopic removal of granulations without difficulties.

• 대한간호학회지
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• 제44권2호
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• pp.149-158
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• 2014

Purpose: This study was conducted to compare effects of open and closed suctioning methods on lung dynamics (dynamic compliance, tidal volume, and airway resistance) and hypoxemia (oxygen saturation and heart rate) in mechanically ventilated patients. Methods: This study was a cross-over repeated design. Participants were 21 adult patients being treated with endotracheal intubation using a pressure-controlled ventilator below Fraction of Inspired Oxygen ($FiO_2$) 60% and PEEP $8cmH_2O$. Data were collected at baseline and 1, 2, 3, 4, 5, and 10 minutes after suctioning. Data were analyzed using two-factor ANOVA with repeated measures on time and suctioning type. Results: Effects of the interaction between suction type and time were significant for oxygen saturation and heart rate but not significant for dynamic compliance, tidal volume, or airway resistance. Prior to performance of suctioning, tidal volume and oxygen saturation were significantly lower, but airway pressure and heart rate were significantly higher using the closed suctioning method as compared with the open suctioning method. Conclusion: For patients on ventilator therapy below $FiO_2$ 60% and PEEP $8cmH_2O$, open suctioning performed after delivery of 100% $FiO_2$ using a mechanical ventilator may not have as much negative impact on lung dynamics and hypoxemia as closed suctioning.

• 대한치과마취과학회지
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• 제2권2호
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• pp.114-117
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• 2002

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

• 대한임상독성학회지
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• 제18권1호
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• pp.42-46
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• 2020

Tetramine toxicity due to sea snail ingestion is generally mild and has a good prognosis. Tetramine toxicity acts on the acetylcholine receptor, affecting the neuromuscular junction and autonomic nervous system. A 78-year-old female patient visited the emergency room with vomiting and dyspnea after eating sea snails. At the time of admission, the vital signs recorded were 140/80 mmHg-105/min-24/min-36.5℃, and 90% oxygen saturation. Arterial blood test revealed hypercapnia (pCO₂ 58.2 mmHg) and respiratory acidosis (pH 7.213, HCO₃^- 22.5 mmol/L), whereas other blood tests showed no specific findings. Due to decreased consciousness and hypoxia, endotracheal intubation and mechanical ventilation were administered to the patient. Successful weaning was accomplished after 12 hrs, and the patient was discharged without any further complications. Although tetramine toxicity rarely results in acute respiratory failure due to paralysis of the respiratory muscle, caution is required whilst treating the patient.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1299-1304
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• 1992

We experienced 5 cases of tracheal stenosis and 7 cases bronchial stenosis treated surgically at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Hanyang University during 5 years. The causes of tracheal stenosis were prolonged endotracheal intubation 1 case, tracheostomy 1 case, the sequela of endobronchial tuberculosis 2 cases and tracheomalacia 1 case. The causes of bronchial stenosis were all endobronchial tuberculosis. The managements of tracheal stenosis were tracheal resection and end to end anastomosis. The resected lengths of trachea were 1.5cm, 3cm and 7.5cm. One case of suglottic stenosis was underwent the resection of trachea, 8cm in length, and the laryngotracheal anastomosis was done, but the re-stenosis of trachea was developed after 4 weeks post-operatively. One case of tracheomalacia was done permanent tracheostomy only, because the entire trachea was adhered to the surrounding tissue. The managements of bronchial stenosis were resection of involved lobe or one lung, in the 5 case. One case with Lt. main bronchial stenosis and atelectasis of Lt. upper lobe was done the lobectomy of Lt. upper lobe only and then, the Lt. pneumonectomy was done re-operatively because the atelectasis of Lt. lower lobe had continued. The other one case with stenosis of Rt. main bronchus, failed the insertion of metalic stent, was underwent the Rt. upper lobe lobectomy, sleeve resection and side to end anastomosis

• 중환자간호학회지
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• 제2권2호
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• pp.42-55
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• 2009

Purpose: Despite numerous evidence based preventive strategies of ventilator associated pneumonia (VAP) have been introduced, the incidence rate of VAP continues in an unacceptable range. The purposes of this review were to identify risk factors and diagnosis of VAP and to introduce current evidence based preventive strategies of VAP. Methods: A comprehensive literature search using keywords, including ventilator associated pneumonia were entered into a search engine. A number of highly pertinent papers relevant to the purpose of the review were identified. The papers that discussed specific preventive strategies of VAP were selected for analysis and inclusion in this review. Results: A number of evidence based preventive strategies that nurses can implement in their clinical practice to prevent VAP were identified. Such strategies include hand washing, use of protective gloves and gowns, oral care, stress ulcer prophylaxis, avoidance of unnecessary intubation, weaning protocol, sedation vacation, use of non-invasive ventilation, semi-recumbent position, continuous aspiration of subglottic secretions, and maintenance of proper endotracheal tube cuff pressure. Staff education is essential in preventing VAP. Conclusion: Preventive strategies of VAP should be applied to daily nursing care and each critical nurse should play a functional role in preventing VAP.

• 성인간호학회지
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• 제22권1호
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• pp.70-79
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• 2010

Purpose: This study was conducted to develop a Web-based learning program on cardiopulmonary emergency care for clinical nurses and to evaluate learners' responses. Methods: Based on the assessment of learning needs of clinical nurses, a total of three self-directed learning modules were developed according to the procedure of the ADDIE (assessment, design, development, implementation, & evaluation) model. Results: Each learning module included the emergency treatments and drugs used in the real patients' situations with cardiopulmonary crisis, which had been adopted from the emergency department of a C University hospital located in G-city. Real video clips for endotracheal intubation and ACLS (advanced cardiac life support) were developed with the help of the staff of the department of emergency medicine using a human simulator, $SimMan^{(R)}$. The program published on the Web was evaluated by 20 clinical nurses who are working in the emergency department and wards of a C-University hospital. About 80% of the respondents were satisfied with the program contents, design, and learning strategy. Conclusions: Web-based learning programs on cardiopulmonary emergency care are needed for clinical nurses as educational material for staff education to increase their knowledge for making immediate clinical decisions and in giving skilled care in emergency situations.