• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.167-171
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• 2015

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.

• 고신대학교 의과대학 학술지
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• 제33권2호
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• pp.252-256
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• 2018

We report a case of difficult endotracheal intubation in a patient with tracheobronchopathia osteochondroplastica. A 65-year-old man was scheduled to undergo ulnar nerve decompression and ganglion excisional biopsy under general anesthesia. During induction of general anesthesia, an endotracheal tube could not be advanced through the vocal cords due to resistance. A large number of nodules were identified below the vocal cords using a $Glidescope^{(R)}$ video-laryngoscopy, and fiberoptic bronchoscopy revealed irregular nodules on the surface of the entire trachea and the main bronchus below the vocal cords. Use of a small endotracheal tube was attempted and failed. a laryngeal mask airway (LMA $Supreme^{TM}$) rather than further intubation was successfully used to maintain the airway.

• 한국응급구조학회지
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• 제16권2호
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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.

• Acute and Critical Care
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• 제33권4호
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• pp.276-279
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• 2018

In pediatric patients, a laryngeal mask airway (LMA) is usually used during minor surgeries that require general anesthesia. No esophageal injury has been reported after insertion of an LMA. We report a case of an esophageal injury with intramural dissection after an $i-gel^{(R)}$ (size, 1.5; Intersurgical Ltd.) insertion in a pediatric patient. A 2-month-old male infant was hospitalized for left inguinal herniorrhaphy. After induction of anesthesia, a trained resident tried to insert an $i-gel^{(R)}$. However, it was only successful after three attempts. Dysphagia was sustained until postoperative day 10, and the pediatrician observed duplication of the esophagus on gastroendoscopy. However, a whitish mucosal lesion, which looked like a scar, was observed, and previous lesions suggestive of esophageal duplication were almost healed on postdischarge day 11. His condition was diagnosed as dysphagia and esophagitis due to an esophageal laceration, not esophageal duplication. He was scheduled for symptomatic treatment with a proton pump inhibitor. In conclusion, although an esophageal injury or perforation in pediatric patients is rare, an LMA insertion or a procedure such as aspiration or nasogastric tube insertion should be performed gently to avoid a possible injury to the esophagus in pediatric patients.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권1호
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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

• 한국응급구조학회지
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• 제16권2호
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• pp.75-89
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• 2012

Purpose : This research was designed to provide basic data for advanced pre-hospital airway management by comparing the time to ventilation and success rate for tracheal intubation performed with Macintosh laryngoscope and intubating Laryngeal Mask Airway(ILMA) in a manikin. Methods : All participants were novice users among EMT-Paramedic students and were divided into two groups: (1) the group for Macintosh laryngoscope guided tracheal intubation(MLG-TI) (2) the group for ILMA guided tracheal intubation(ILMA-TI). After an introductory lecture and demonstration, each group made an attempt ten tracheal intubation to compare the ventilation time and success rate for tracheal intubation. Results : 1) There was significant difference in the time to ventilation through MLG-TI, the time to first and second ventilation through ILMA-TI of the 10 attempts. 2) The time to first ventilation through ILMA-TI was significantly shorter than that of ventilation through MLG-TI. 3) There was no significant difference between the time to ventilation through MLG-TI and the time to second ventilation through ILMA-TI. 4) The success rates of ILMA-TI were significantly higher than those of MLG-TI. Conclusion : ILMA-TI can be an alternative method for MLG-TI in advanced pre-hospital airway management.

• 한국화재소방학회논문지
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• 제28권6호
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• pp.76-81
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• 2014

이 연구는 RespiTrainer를 활용한 백밸브마스크 환기에서 1인 백밸브마스크, 2인 백밸브마스크, 전문기도삽관 별 호흡량과 기도압을 비교 분석하였다. 실험기간은 2014년 6월 2일부터 6월 10일까지이며, 수집된 자료는 SPSS 18.0을 이용하여 분석하였다. 그 결과 기관내삽관을 통한 환기 $497{\pm}78mL$, 2인 BVM 환기 $479{\pm}91mL$를 보였고, 1인 BVM 환기와 킹후두관기도기, 후두마스크 환기에서 각각 $386{\pm}59mL$, $365{\pm}05mL$, $351{\pm}35mL$를 보였다. 기도압에서도 기관내삽관을 통한 BVM 환기에서 가장 높은 기도압(11.67 cm $H_2O$)을 보였다. 결과적으로 기관내삽관을 통한 BVM 환기와 2인 BVM 환기에서 1/3 백 압착법은 적절하였다.

• 한국산학기술학회논문지
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• 제14권5호
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• pp.2360-2367
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• 2013

본 연구의 목적은 주행 중인 구급차에서 기관내 삽관과 후두마스크(LMA) 삽입의 신속성과 성공률을 비교하여 구급대원의 전문기도관리 능력을 향상시키는 데 있다. 연구방법은 C 지역 구급대원 중 1급 응급구조사 60명(대조군 30명, 실험군 30명)을 편의추출 하여 마네킹을 대상으로 측정을 하였다. 자료 분석은 SPSS WIN 14.0 Version을 사용하였다. 연구결과 기관내 삽관이 냄새맡기 자세에서 신속성이 좋은 것으로 나타났고(t=-4.038, p<.001), 중립자세에서 그룹 간 신속성 차이는 없었으나 기관내 삽관 시 16명(53.3%)에게 치아파절이 발생했다. 또한, 그룹 간 성공률 차이는 없었고 두 그룹 모두 실험 후 자신감이 향상된 것으로 나타났다. 결론적으로 냄새맡기 자세가 불가능한 외상성 환자는 후두마스크(LMA)의 사용이 효과적이고 구급대원의 기도관리 능력을 향상시키기 위하여 지속적인 교육이 필요할 것으로 사료된다.

• 한국산학기술학회논문지
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• 제13권12호
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• pp.5893-5900
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• 2012

심정지 또는 중증 외상 환자의 신속한 기도유지는 매우 중요하다. 본 연구의 목적은 후두튜브(LTS)와 후두마스크(PLMA)의 삽관 속도, 성공률, 교육 전 후 자신감 변화를 비교하여 병원 전 단계의 주축을 담당하고 있는 119구급대의 전문기도관리 능력을 향상 시키는데 있다. 연구 대상자는 119구급대원 중 1급 응급구조사 60명(LTS군 30명, PLMA군 30명)이며 마네킹을 대상으로 5분간 3회 실습 후 삽관 소요시간과 성공 여부, 자신감 변화를 측정하였다. 연구결과 LTS와 PLMA를 이용한 삽관 시간은 유의한 차이를 보였고(p=.000), 성공률은 유의한 차이가 없으며, 실험 후 자신감은 유의하게 상승하였다(p=.000). 결론적으로 경추가 고정되고 혀 부종이 있는 외상환자에게 신속한 삽관이 필요한 경우 LTS 사용이 효과적이며 교육을 통하여 전문기도관리 능력을 향상시킬 수 있을 것으로 사료된다.

• 한국응급구조학회지
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• 제13권1호
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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.