• Clinical and Experimental Pediatrics
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• 제57권11호
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• pp.484-488
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• 2014

Purpose: Chronic upper airway obstruction causes hypoxemic pulmonary vasoconstriction, which may lead to right ventricle (RV) dysfunction. Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Therefore, we aimed to evaluate RV function in children with ATH. Methods: Twenty-one children (male/female, 15/6; mean age, $92.3{\pm}39.0$ months; age range, 4-15 years) with ATH and 21 healthy age- and gender-matched controls were included in this study. Tricuspid annular plane systolic excursion and RV myocardial performance index were measured by transthoracic echocardiography. Further, the plasma level of N-terminal of probrain natriuretic peptide (NT-proBNP), an indicator of RV function, was determined. Results: The snoring-tiredness during daytime-observed apnea-high blood pressure (STOP) questionnaire was completed by the patients' parents, and loud snoring was noted in the ATH group. The plasma NT-proBNP level was significantly higher in the ATH group than that in the controls ($66.44{\pm}37.63pg/mL$ vs. $27.85{\pm}8.89pg/mL$, P=0.001). The echocardiographic parameters were not significantly different between the groups. Conclusion: We were unable to confirm the significance of echocardiographic evidence of RV dysfunction in the management of children with ATH. However, the plasma NT-proBNP level was significantly higher in the ATH group than that in the control, suggesting that chronic airway obstruction in children may carry a risk for cardiac dysfunction. Therefore, more patients should be examined using transthoracic echocardiography. In addition, pediatricians and otolaryngologists should consider cardiologic aspects during the management of children with severe ATH.

• 대한장애인치과학회지
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• 제4권2호
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• pp.88-91
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• 2008

A female patient (14 years-old) with mental retardation was scheduled for ambulatory general anesthesia to treat peri-apical abscess and multiple dental caries. She had got cleft palate plasty at 5 years, but there was no past history of difficulty airway during general anesthesia or airway obstruction. Following induction of anesthesia using an inhalational anesthetic technique, conventional naso-tracheal intubation was tried. However, with conventional intubation technique we could not insert tube. And following several trial of intubation with laryngoscope, she developed an upper airway obstruction. Her lungs could not be ventilated using a facial mask and oxygen saturation was decreased. A #3 laryngeal mask airway (LMA) was inserted immediately, which allowed us to ventilate her lungs and restore the oxygen saturation. And dental treatment was carried out under LMA insertion successfully.

• 한국임상수의학회지
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• 제33권2호
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• pp.113-115
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• 2016

A 6 month-old castrated male Yorkshire terrier (weighing 1.0 kg) was presented with acute respiratory distress. Diagnostic imaging studies found post-obstructive pulmonary edema sequel to upper airway obstruction by a rubber plug lodged at thoracic esophagus. The rubber plug was removed endoscopically. After removal of this rubber plug with conventional therapy for pulmonary edema, the clinical condition of dog was stabilized. To the best knowledge of authors, this is the first case report describing postobstructive pulmonary edema in a dog in Korea.

• Tuberculosis and Respiratory Diseases
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• 제58권3호
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• pp.295-298
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• 2005

전방경추융합술을 시행한 후 역설상기도폐쇄와 중추성 무호흡이 발생하였던 증례를 경험하여 이를 보고하고자 한다. 환자는 48세 남자로 본원으로 전원되기 9개월 전에 5번과 6번 경추사이의 추간판탈출증으로 수술을 시행받았으며, 내원 2개월 전에는 가성관절증이 발생하여 자가골이식과 함께 전방접근법으로 5번과 6번 경추의 경추융합술을 시행받았다. 이 수술을 시행 후 환자는 코골이와 과도한 주간 졸음증, 불면증 등의 증세가 생겼으며 호흡시에 상기도부위에서 이상한 소리가 발생하였다. 코인두경 및 자기공명영상으로 호기시 코인두부위의 역설적 협착소견을 관찰할 수 있었고, 철야 수면다원검사에서 무호흡지수는 8.7/시간 (중추성 무호흡, 7.0/시간; 폐쇄성 무호흡, 1.7/시간)이었다. 경비적 지속성 기도양압치료를 시작하였으나 환자가 압력을 못견뎌하여 레이저목젖입천장성형술을 시행하였다. 수술 2개월 경과 후 무호흡과 더불어 임상증세는 현격히 호전되었다. 저자들은 이러한 역설상기도폐쇄가 비록 그 기전이 명확하지는 않지만 전방경추융합술과 관련되어 있다고 추정한다. 또한 이러한 상기도 폐쇄가 중추성 수면 무호흡을 유발할 수 있다는 것을 보여주는 증례라고 생각한다.

• 대한치과마취과학회지
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• 제11권1호
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• pp.32-37
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• 2011

Pulsus paradoxus has been defined as a decrease in systolic blood pressure (SBP) of 10 mmHg or more during inspiration. This report describes pulsus paradoxus detected by pulse oximetry during dental procedure. Case: A 10 years old boy who had impacted mandibular premolar with malformation scheduled for extraction under intravenous sedation with Fentanyl and Propofol. The patient showed upper airway obstruction with stridor and pulsus paradoxus. Though pulsus paradoxus is generally critical condition, in this case, respiration and other vital sign was maintained comparatively well with care in administering oxygen and considerate monitoring of pulse oximetry and capnography. Discussion: Noninvasive continuous monitoring of pulse oximetry allows recognition of pulsus paradoxus which can lead to serious problems. Clinicians should know very well about it and be able to manage of this kind of situation.

• 대한기관식도과학회지
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• 제4권2호
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• pp.235-239
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• 1998

Warfarin sodium is a widely used oral anticoagulant and it sometimes causes hemorrhage in various sites such as traumatic or operative wounds, urologic organs, gastrointesitnal tract and subcutaneous tissues. Warfarin induced hemorrhage in upper respiratory tract causing upper airway obstruction is extremely rare. Despite the life-threatening nature of this complication, the symptoms are obscure like sore throat or hoarseness, suggesting infection and early diagnosis can be delayed. Careful medical history is emphasized When bleeding is observed, the patient should be admitted for close observation and prompt treatment. Recently we have exrperienced a case of laryngeal and upper tracheal submucosal hemorrhage induced by long term warfarin in 64 years old mm. We described the case with a review of the literature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권5호
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• pp.422-427
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• 2004

안검열의 외하방 편위, 관골 형성부전, 하악골 형성부전, 하악 후퇴증, 소이증, 설하수, 구개열 등의 소견으로 간헐적인 청색증, 흉곽 함몰, 급성 기도 폐색에 의한 호흡곤란과 연하곤란 등의 임상 소견을 나타낸 Treacher Collins 증후군을 가진 환아에서 출생직후에 구강저골막하박리술과 설구순접합술을 이용한 외과적 치료를 시행한 결과 급성 기도 폐색에 의한 호흡곤란과 수유장애의 해소 뿐만 아니라 혀의 전방 재위치 등 만족할 만한 결과를 얻을 수 있었다. 향후 성장이 완료될 때까지 주기적 경과 관찰을 시행할 예정이며, 성장과정 중에 발생할 두개안면기형에 대해서는 정신사회학적 측면을 고려하여 가능한 한 조기에 교정해주고, 어느 일부분에 국한된 수술보다는 안면윤곽을 고려하여 복합적인 수술을 시행해야 할 것으로 사료된다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권4호
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• pp.235-238
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• 2019

Corticobasal degeneration (CBD) is a rare neurodegenerative disease characterized by dystonia, cognitive deficits, and an asymmetric akinetic-rigid syndrome. Little information is available regarding anesthetic management for CBD patients. Our patient was a 55-year-old man with CBD complicated by central sleep apnea (CSA). Due to the risk of perioperative breathing instability associated with anesthetic use, a laryngeal mask airway was used during anesthesia with propofol. Spontaneous respiration was stable under general anesthesia. However, respiratory depression occurred following surgery, necessitating insertion of a nasopharyngeal airway. Since no respiratory depression had occurred during maintenance of the airway using the laryngeal mask, we suspected an upper airway obstruction caused by displacement of the tongue due to residual propofol. Residual anesthetics may cause postoperative respiratory depression in patients with CBD. Therefore, continuous postoperative monitoring of $SpO_2$ and preparations to support postoperative ventilation are necessary.

• 전자공학회논문지
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• 제51권4호
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• pp.201-209
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• 2014

폐쇄성 수면 무호흡 증후군은 수면 중 부분적인 혹은 완전한 상기도 폐쇄로 인한 호흡 장애 질환이다. 본 연구에서는 폐쇄성 수면 무호흡 증후군 환자와 정상인에서의 호흡하는 동안의 상기도 움직임 변화를 분석하기 위하여 광류 방법을 사용하였다. 정상인 6명과 폐쇄성 수면 무호흡 증후군 환자 5명에 대해, 기도 면적 분석 방법과 광류 방법을 적용하여 흡기와 호기에서의 차이의 절대 값을 비교하였다. 통계적 분석 결과, 기도면적 분석 방법과 광류 방법은 각각 유의수준 10%(p값 0.0977)와 1%(p값 0.0011)에서 유의한 결과를 얻었다. 따라서 광류 방법을 이용함으로써 기존의 연구에서 폐쇄성 수면 무호흡 증후군 환자의 진단에 있어 더 정확한 정보를 얻는데 도움이 될 것으로 기대된다.

• Imaging Science in Dentistry
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• 제50권2호
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• pp.105-115
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• 2020

Purpose: This study investigated the position of the hyoid bone and its relationship with airway dimensions in different skeletal malocclusion classes using cone-beam computed tomography (CBCT). Materials and Methods: CBCT scans of 180 participants were categorized based on the A point-nasion-B point angle into class I, class II, and class III malocclusions. Eight linear and 2 angular hyoid parameters(H-C3, H-EB, H-PNS, H-Me, H-X, H-Y, H-[C3-Me], C3-Me, H-S-Ba, and H-N-S) were measured. A 3-dimensional airway model was designed to measure the minimum cross-sectional area, volume, and total and upper airway length. The mean crosssectional area, morphology, and location of the airway were also evaluated. Data were analyzed using analysis of variance and the Pearson correlation test, with P values <0.05 indicating statistical significance. Results: The mean airway volume differed significantly among the malocclusion classes(P<0.05). The smallest and largest volumes were noted in class II (2107.8±844.7 ㎣) and class III (2826.6±2505.3 ㎣), respectively. The means of most hyoid parameters (C3-Me, C3-H, H-Eb, H-Me, H-S-Ba, H-N-S, and H-PNS) differed significantly among the malocclusion classes. In all classes, H-Eb was correlated with the minimum cross-sectional area and airway morphology, and H-PNS was correlated with total airway length. A significant correlation was also noted between H-Y and total airway length in class II and III malocclusions and between H-Y and upper airway length in class I malocclusions. Conclusion: The position of the hyoid bone was associated with airway dimensions and should be considered during orthognathic surgery due to the risk of airway obstruction.