• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.4
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• pp.235-239
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• 2015

The Combitube is an emergency airway-maintaining device, which can supply oxygen to dyspneic patients in emergency situations following two-jaw surgery. These patients experience difficulty in opening the mouth or have a partially obstructed airway caused by edema or hematoma in the oral cavity. As such, they cannot maintain the normal airway. The use of a Combitube may be favorable compared to the laryngeal mask airway because it is a thin and relatively resilient tube. A healthy 24-year-old man was dyspneic after extubation. Oxygen saturation fell below 90% despite untying the bimaxillary fixation and ambubagging. The opening of the mouth was narrow; thus, emergency airway maintenance was gained by insertion of a Combitube. The following day, a facial computer tomography revealed that the airway space narrowing was severe compared to its pre-operational state. After the swelling subsided, the patient was successfully extubated without complications.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.1
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• pp.49-53
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• 2016

Background: General anesthesia is frequently considered for pediatric patients, as they often find it difficult to cooperate and stay calm during administration of potentially painful treatments. Sedation can overcome these adversities; however, this is challenging while maintaining unobstructed airways. Methods: The study involved 11 pediatric dental patients treated with LMA under deep sedation with sevoflurane, from 2011 through 2015. LMA size, sevoflurane concentration, and the vital signs of patients were assessed through a chart review. Results: The age distribution of the patients ranged from 6 to 10 years old. A total of 3 patients underwent mesiodens extraction, while the remaining 8 underwent an surgically assisted orthodontic forced tooth eruption The average sedation period was approximately 45 minutes and the LMA size was $2\small{^1/_2}$. The sevoflurane concentration was maintained at 2% on average, and overall, the measurements of vital signs were within the normal range; the patients had an average blood pressure of 98/49 mmHg, breathing rate of 26 times/min, pulse frequency of 95 times/min, $SpO_2s$ level of 99 mmHg, and $ETCO_2$ level of 41.2 mmHg. Conclusions: Deep sedation with sevoflurane coupled with LMA may be applied successfully in pediatric patients who undergo mesiodens extraction or a surgically assisted orthodontic forced tooth eruption

• The Korean Journal of Emergency Medical Services
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• v.16 no.2
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• pp.23-30
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• 2012

Purpose : This study was designed to compare the easiness and speed of insertion of three supraglottic airway devices(SADs) in a manikin setting. Methods : Three different SADs - Laryngeal Mask Classic(cLMA), I-gel and Streamlined Liner of the Pharynx Airway(SLIPA) were applied. One hundred and nineteen paramedical students with(group H) or without (group L) previous airway experience were taught brief manikin training about the use of the cLMA, I-gel and SLIPA. The students inserted each device in a randomized order. Time to effective ventilation was recorded in seconds from holding the device to the first chest inflation. Success was determined as adequate chest wall movement. Results : The insertion attempts were lesser in I-gel($1.00{\pm}0.00$) and SLIPA($1.05{\pm}0.27$) than cLMA($1.16{\pm}0.41$, p<.05). The shortest time to insertion was recorded for I-gel($10.5{\pm}3.0sec$), followed by the SLIPA($12.9{\pm}4.5sec$) and cLMA($19.6{\pm}4.1sec$, p<.05). There were no significant differences in the insertion attempts and insertion time of I-gel between group L and group H. But in cLMA, longer insertion time and more insertion attempts were recorded in group L than group H. Conclusion : Both I-gel and SLIPA were superior to cLMA in the easiness and speed of insertion. Even in novice students, I-gel showed an excellent result in a manikin.

• Journal of The Korean Dental Society of Anesthesiology
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• v.3 no.1 s.4
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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.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.12
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• pp.5893-5900
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• 2012

It is very critical to promptly maintain airway of cardiac arrest cases or serious traumatic cases. The purpose of this study is to compare intubation rate, successful rate and pre-/post-education self-confidence between laryngeal tube (LTS) and proseal laryngeal mask (PLMA), so that it may contribute to improving the ability of 119 emergency team - a pivotal role in pre-hospitalization process - to carry out advanced airway management. In order to achieve the purpose, total 60 paramedics (Class I) who worked for incumbent 119 emergency team were asked to join a practical experiment and were also divided into two groups (LTS group: 30 people, PLMA group: 30 people). In details, they were all asked to take 3 sessions of practice (5 minutes per session) using dummy model to quantitatively measure the time and success/failure of intubation and the change of their self-confidence. As a result, it was found that there were statistically significant differences in the time of intubation between LTS and PLMA group (p=.000), but there was no significant difference in the rate of successful intubation between these two groups, and self-confidence of two groups tended to significantly increase after experiment (p=.000). Conclusively, if it is necessary to promptly apply intubation to traumatic cases with immobilized cervical vertebral and lingual edema, LTS can be useful as an effective means of intubation. And it is expected that continuing intubation training using LTS will improve the ability of emergency team to perform advanced airway management for traumatic cases.

• The Korean Journal of Emergency Medical Services
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• v.25 no.3
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• pp.7-16
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• 2021

Purpose: The I-gel device is Korea's most frequently used airway management method during pre-hospital cardiopulmonary resuscitation (CPR). This study aimed to compare changes in ventilation volume according to the fixation method with a simulated manikin. Methods: We placed I-gel into an advanced life support simulator and compared tape and band fixation conditions. CPR was performed according to the 2020 Korean CPR guidelines, using a mechanical chest compression device and an adult bag. The positional shift of I-gel and the ventilation volume of the simulated manikin were measured after performing CPR for 20 minutes. Five trials were carried out in each setting. Statistical analysis was carried out with SPSS 27.0. P < .05 was considered significant. Results: Positional shift after 20 minutes of CPR was as follows: tape fixation, 7.2 ± 0.2 mm; band fixation, no change, indicating a significant difference between the two groups (p=.003). The mean ventilation volume was tape fixation, 482.63 ± 30.84 mL; band fixation, 544.96 ± 22.98 mL, showing a significant difference (p=.002). Conclusion: When using the I-gel during pre-hospital CPR, using a band-type fixing device with elasticity rather than fixing the tape provides stable and appropriate ventilation by maintaining the fixed position.

• Clinical and Experimental Pediatrics
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• v.60 no.9
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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 the Korea Academia-Industrial cooperation Society
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• v.14 no.5
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• pp.2360-2367
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• 2013

The purpose of this study was to improve the paramedics skills to manage advanced airway by comparing speed and success rate between endotracheal intubation and laryngeal mask airway(LMA) insertion in a moving ambulance. Sixty subjects were randomly recruited and samely divided into control group and experimental group. And they were asked to join a practical experiment using dummy model. Data analysis was done by SPSS WIN 14.0 Version. As a result of this research, in terms of difference in speed according to patient's intubation posture, the speed of control group was indicated to be good in sniffing position(t=-4.038, p<.001). There was no difference in speed between two groups in neutral position. In the neutral posture given the endotracheal intubation, tooth fracture occurred in 16 people(53.3%). There was no difference in success rate between two groups. As for a change in self-confidence before and after experiment, the post self-confidence was indicated to have been enhanced in both groups. In conclusion, it is effective to use LMA in the traumatic patient who is unable to receive endotracheal intubation in sniffing position. It is very important for the paramedics to receive the continuous training of the airway management skills.

• Fire Science and Engineering
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• v.26 no.5
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• pp.54-60
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• 2012

This study is the analysis of the actual state of hospital-based training in level 1 emergency medical technicians (EMTs) in fire station. The survey was carried out to 42 fire fighters having level 1 emergency medical technician certification from May 11 to 12 in 2012. The results showed 56.5 %, that the level 1 EMTs of roles had direct experienced. Level 1 EMTs performance frequency of clinical practice that endotracheal intubation 66.9 %, laryngeal mask airway 8.4 %, intravenous access 76.6 %, nitroglycerin sublingual 61.2 %, bronchodilator inhalation 50.0 %, fluid loading 73.8 %, ventilator apply 57.6 %, dextrose injection 57.6 %. It is necessary to investigate the continuous study on the education among the level 1 EMTs and the continuous evaluation and analysis of problems, supplemented of guidebook, practical education programs and regulation upon the operation and management of a hospital-based skill training.

• The Korean Journal of Emergency Medical Services
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• v.13 no.1
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• pp.87-96
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• 2009

Purpose : To grasp the mental burden for legal responsibility that rescue members have in the performance of job. Method : Questionnaire was presented to rescue members serving in 2 direct control safety centers of fire station located in Seoul, Daejon, Incheon, Kwangju, Busan, Daegu and Ulsan. Results : 1. Questioned whether they have mental burden for legal responsibility while performing job on the site, the rescue members responded : very burdensome in 38.0%, burdensome in 56.0%, moderate in 4.5%, not burdensome in 1.0%, no burden at all in 0.5%. 2. Questioned on the first aid treat for which they have the most mental burden, the rescue members responded : intubation into trachea laryngeal mask airway(LMA) in 40.4%, automatic external defibrillator in 16.3%, securing vein providing sap(medicine) in 10.8%, basic cardiopulmonary resuscitation in 7.2%, eliminating foreign matters inserted into body in 5.4%, stanching external bleeding and treating injury in 5.4%, fixing extremities and spine by using splint in 1.8%, measuring the symptom of vitality in 1.2%, providing oxygen in 0.0%. 3. Questioned whether experiencing legal problem or firm petition(complaint) raised by patient while serving as rescue members, they responded : experiencing a complaint in 41.6%, experiencing no complaint in 58.4%. Asked to indicate the stress level in the scale of which they suffered when lawsuit or firm petition was raised, 0(weak)-10(strong), they answered 8.8 in average. 4. Questioned whether 119 rescue members put the legal responsibility in case that they cause damage to patients intentionally in performing, they responded to the inquiry 3.66 in average(of 5.00). It represented meaningful differences (F=2.874, p=.024) whether they had license or not. 5. In future, legal action will raise against the rescue member by 99% because of people's rights improvement(63.1%), high expectations for the rescue system(29.5%), non-licensed rescue members(5.1%). Conclusion : It was found that the rescue members had severe mental burden for advanced life support which was investigated to have low enforcement rate in the preceding research, for instance, intubation into trachea securing vein management by using automatic external defibrillator. To improve the qualitative level of rescue service in the fire fighting, it may be required to construct the environment that eliminates the mental burden of rescue members for legal responsibility.