• Kosin Medical Journal
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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.

• The Korean Journal of Emergency Medical Services
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• 제21권3호
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• pp.7-16
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• 2017

Purpose: The purpose of the study was to investigate the effects of laryngeal mask airway (LMA) insertion from different positions, using different methods, on the quality of the insertion, for identifying a more convenient and effective insertion method. Methods: In a model ambulance, 30 paramedic students performed the LMA insertion procedure, in four different settings, combinations of the rescuer's position (at the head end of the patient, at the side of the patient), and insertion technique (index finger insertion, thumb insertion), in a randomized order. Quality of insertion index and convenience of use were measured. Results: The quality of insertion index (tidal volume, gastric insufflation, airway pressure, airway sealing pressure, midline positions, insertion success grade, and insertion time) were not significantly different among four different settings. However LMA insertion from the anterior (head) end, using the index finger method compared to the thumb method was found to be significantly more convenient. Conclusion: We recommend using the more convenient and familiar LMA insertion method, between index finger insertion and thumb insertion, regardless of rescuer's position.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• 제25권2호
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• pp.96-98
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• 2014

Injection laryngoplasty is simple and useful procedure in patient with vocal cord paralysis even under local anesthesia. For approaching vocal cord level, flexibility of neck mobility is required to operate injection laryngoplasty but it is relatively difficult to approach vocal cord in patient who has cervical fixations. Laryngeal mask airway (LMA) can be helpful:We use a LMA (I-gel$^{TM}$) during intubation without neck extension on flat supine position under general anesthesia and have a good operation filed. LMA with swivel connector give surgeons better surgical vision and make insertion of fibroscope easily during operation. Hyaluronic acid injection was done use needle (25 G, 5 cm) via percutaneous cricothyroid space : This procedure can be useful method for patients who suffer from not only weak voice but also dysphagia and aspiration high vagal palsy patient after spine surgery or uncooperative with awake injection laryngoplasty.

• Journal of The Korean Dental Society of Anesthesiology
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• 제13권4호
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• pp.221-224
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• 2013

Despite the laryngeal mask airway (LMA) has been widely used in anesthesia, its use is rare in the field of dentistry. Placing LMA in the oral cavity may interrupt dental treatment. However, there are some circumstances in which LMA is more advantageous than tracheal intubation for managing the airway. Especially, the reinforced LMA has a flexible tube shaft, rendering it more accessible for dental treatment. We report a case of dental treatment of a 3-year-old patient with hypoplastic left heart syndrome combined with pulmonary hypertension using reinforced LMA for airway management under general anesthesia. We also discuss the considerations of utilizing the reinforced LMA for dental treatment.

• The Korean Journal of Emergency Medical Services
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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.

• 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.

• Journal of Digital Convergence
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• 제14권12호
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• pp.369-375
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• 2016

Purpose of this study was to compare the easiness of insertion of three Supraglottic airway devices(SADs) in a neutral and cervical neck collar position in a manikin setting. Three different SADs-Laryngeal Mask Classic (LMA), I-gel and Streamlined Liner of the Pharynx Airway(SLIPA) were applied. Thirty nine emergency medical technicians (EMTs) who are working in Korea 119 rescue services were taught briefly about the use of the LMA, I-gel and SLIPA in a manikin setting. The time to effective ventilation was shorter in I-gel ($10.5{\pm}2.2$, $11.4{\pm}5.7$) and SLIPA ($12.3 {\pm}5.1$, $12.0{\pm}6.8$) than LMA ($17.2{\pm}3.2$, $18.5{\pm}5.5$) in a neutral and cervical neck collar position, respectively(p<0.05). There was no difference between head positions in each of the airways. In conclusion, in the speed of insertion, I-gel and SLIPA were superior to LMA in the neutral and cervical collar setting of a manikin.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• 제27권2호
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• pp.122-125
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• 2016

Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using $C-MAC^{(R)}$ video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.

• Fire Science and Engineering
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• 제28권6호
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• pp.76-81
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• 2014

The purpose of this study was to comparative analysis of tidal volume and airway pressure after one-rescuer BVM, two-rescuer BVM, advanced airway devices with a Bag-valve mask using RespiTrainer. The data were obtained from June 2 to 10 in 2014. The collected data were analyzed using the SPSS WIN 18.0 program. The results showed that BVM ventilation using the endotracheal intubation produced higher mean tidal volume $497{\pm}78mL$, Two-rescuer ventilation $479{\pm}91mL$ One-rescuer ventilation $386{\pm}59mL$, King LTS-D $365{\pm}05mL$, Laryngeal mask airway (LMA) $351{\pm}35mL$. Peak airway pressure was higher in BVM ventilation using the endotracheal intubation. As a result, the study confirmed that the BVM Ventilation by endotracheal intubation and Two-rescuer BVM ventilation to one third the bag depth squeeze method is appropriate.

• 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.