• Journal of Dental Anesthesia and Pain Medicine
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• 제20권3호
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• pp.155-160
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• 2020

Submental or submandibular intubation has been reported to cause fewer complications than tracheostomy. However, the risk of infection is always inherent because oral wounds are exposed to microbial flora and bacteria in the oral cavity. A novel technique of submandibular intubation was devised to reduce infection and injury to the soft tissues. We would like to report a novel safe technique that can be performed in patients requiring submental or submandibular intubation. This is the first report of submandibular intubation using a sterile disposable camera cable drape. This novel technique of submandibular intubation is safer, more sterile, easier, and less invasive than conventional submandibular intubation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권3호
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• pp.151-156
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• 2016

Objectives: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권2호
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• pp.99-104
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• 2016

Objectives: Submental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries. Materials and Methods: In five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes. Results: We were able to execute this procedure safely in a short time without any intraoperative or postoperative complications. Conclusion: Submental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients.

• 대한치과의사협회지
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• 제15권2호
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• pp.111-114
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• 1977

The case of the extensive dentigerous cyst treated by intubation technique is reported. 1) An incision is made, and the sterile polyethylene tube is inserted into the prepared opening so that it gently contacts the base of the lesion in 11 year old man. 2) The purpose to maintain vitality of adjacent tooth was achieved by means of intubation in lesion. 3) After 9 months, the extensive periapical lesion was completely replaced with new bone tissue.

• 대한치과마취과학회지
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• 제1권1호
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• pp.10-15
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• 2001

Background: This prospective study was designed to compare the cardiovascular response to endotracheal insertion of either an orotracheal tube or a nasotracheal tube Methods: 120 ASA physical status I and II surgical patients requiring general anesthesia and tracheal intubation were studied and assigned to two groups: orotracheal intubation group (n = 60) and nasotracheal intubation group (n = 60). Patients were premedicated with midazolam 0.05 mg/kg and glycopyrrolate 0.005 mg/kg intramuscularly and anesthesia was induced with thiopental sodium 5 mg/kg and succinylcholine 0.1 mg/kg intravenously. Systolic blood pressure (SBP), diastolic blood pressure (DBP). mean arterial pressure (MAP) and heart rate (HR) were assessed noninvasively before induction of anesthesia and immediately after intubation, 1 min, 2 min, 3 min, and 5 min after intubation. Results: Cardiovascular responses such as SBP, DBP, MAP and HR were similar for both techniques and no significant differences between two groups were observed until 5 min after intubation. Conclusions: In healthy ASA I and II patients with normal blood pressure, induction doses of thiopental sodium 5 mg/kg and succinylcholine 0.1 mg/kg didn't attenuated the cardiovascular response to laryngoscopy and tracheal intubation. Insertion of an endotracheal tube may be the most invasive stimulus during intubation procedures. (JKDSA 2001; 1: 10-15)

• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.154-161
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• 2007

직접 후두경하에 기관내 삽관의 난이도를 Cormack & Lehane 등급에 따라 분류하여 등급 3 또는 4에 해당하는 환자 40명을 대상으로 하였다. 모든 환자들이 적절한 마취 심도에 도달한 후 직접 후두경으로 성대와 후두개의 노출 여부를 판단하여 Cormack & Lehane 등급 3 또는 4에 해당되면 직접 후두경을 제거하고 대신 Bonfils intubation fibrescope으로 기관내 삽관을 시도하였다. 기관내 삽관의 성공 여부, 삽관 시도 횟수, 삽관에 소요되는 시간, 턱에서 갑상연골의 상부 방패패임까지의 길이(thyromental distance), 턱에서 흉골 상부까지 의 길이(sternomental distance) 그리고 $SpO_2$가 90%이하로 감소하는 지의 여부를 기록하였다. 이 외에 기관내 삽관동안 폐내흡인, 역류, 기관지경련, 기도 폐쇄, 경추 손상 그리고 치아 손상 여부 등이 발생하는지를 관찰하였다. Cormack & Lehane 등급 3에서는 96.9%의 기관내 삽관 성공률을 보였으며 등급 4에서는 50%의 성공률을 나타내어 등급 간 통계적으로 유의한 차이가 있었다(P<0.01). 기관내 삽관에 소요된 시간은 등급 3에서 20 (10-49[7-300]) 초였고 등급 4에서 180 (31-300[10-300])초로 통계적으로 유의하였다(P=0.01). 기관내 삽관시 $SpO_2$가 90% 이하로 감소된 경우는 등급 3에서 3.1%, 등급 4에서 50%로 통계적으로 유의한 차이를 나타내었다(P<0.01). 기관내 삽관성공률과 삽관에 소요된 시간으로 보아 Bonfils intubation fibrescope은 Cormack & Lehane 등급 3인 환자에서 유용한 기도 관리 장비로 보이나 등급 4인 환자에서는 항상 선택적으로 사용할 수 있는 기도 관리 장비라고는 할 수 없으며, 기관내 삽관 시 다른 대체 장비가 필요할 가능성도 있음을 알아야 하겠다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.181-184
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• 2015

Airway difficulties are a major concern for anesthesiologists. Even though fiberoptic intubation is the generally accepted method for management of difficult airways, it is not without disadvantages-requires patient cooperation, and cannot be performed on soiled airway or upper airways with pre-existing narrowing pathology. Additionally, fiberoptic bronchoscopy is not available at every medical institution. In this case, we encountered difficult airway management in a 71-year-old man with a high Mallampati grade and a thick neck who had undergone urologic surgery. Several attempts, including a bronchoscope-guided intubation, were unsuccessful. Finally, blind nasal intubation was successful while the patient's neck was flexed and the tracheal cartilage was gently pressed down. We suggest that blind nasal intubation is a helpful alternative in difficult airway management and it can be a lifesaving technique in emergencies. Additionally, its simplicity makes it a less expensive option when advanced airway technology (fiberoptic bronchoscopy) is unavailable.

• The Korean Journal of Pain
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• 제7권2호
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• pp.175-180
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• 1994

The impact of cardiovascular changes occurred by endotracheal intubation is risky for patients with ischemic heart disease, or intracranial pathologic conditions typically impairing cerebral autoregulatory mechanisms. Therefore, multiple approaches have been utilized to limit the impact of intubation and reduce damage of central nervous and cardiovascular systems. These approaches include modifications in intubation technique to diminish circulatory stimuli and pharmacologic modifications of either the sensory afferent path or the circulatory response itself. We tried the stellate ganglion block, a kind of sympathetic block, for the same purpose and evaluated the results. The results of study are as follows, 1) Blood pressure and heart rate increased significantly after intubation as compared with preintubation in both control group and SGB group. 2) The difference of the two groups is not found. We conclude the above method does not control cardiovascular consequences of endotracheal intubation.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권6호
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• pp.604-607
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• 2008

턱밑 기관내 삽관술은 기본적인 수술적 술기가 필요하지만, 간단하고 안전하며 술식이 빠른 장점을 가지고 있다. 또한 술 중 악간 고정이 가능하며, 수술 시야를 확보할 수 있으며, 술 후 합병증이 적고 기관절개술로 인한 부작용을 줄일 수 있다는 장점을 가지고 있다. 따라서 기본적인 술기의 습득과 마취과와의 협조가 동반된다면 많은 분야에서 사용 될 수 있는 방법이라고 생각된다.