• The Korean Journal of Emergency Medical Services
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• v.23 no.1
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• pp.7-17
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• 2019

Purpose: The aim of this study was to verify the necessity of endotracheal intubation through video laryngoscope and to provide basic data to inform the provision of video laryngoscope education. Methods: Eighty paramedic students participated in this study. A survey was conducted from November 5, 2018 to December 7, 2018. Data were analyzed with independent t-tests, and the chi-squared test. Results: The video laryngoscope is a highly usable instrument that can easily be applied during training. The instrument provides better visual evaluation of the normal airway (p=.004), the airway in case of cervical collar and head fixation (p=.000), and the airway in case of tongue edema (p=.000). The time of endotracheal intubation in the normal airway was significantly less with the video laryngoscope compared with the direct laryngoscope. The success rate of tracheal intubation was significantly higher in the video laryngoscope group than in the direct laryngoscope. Conclusion: This study suggests the necessity of education on endotracheal intubation through video laryngoscope in the professional airway maintenance training course of emergency department students. The video laryngoscope is easier to apply than the direct laryngoscope in cases of intubation in various clinical situations.

• The Korean Journal of Emergency Medical Services
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• v.23 no.1
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• pp.87-99
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• 2019

Purpose: The aim of this study was conducted to assess the proficiency of both direct laryngoscopy and video laryngoscopy and the usefulness of each laryngoscope, thereby provide basic data for further education using video laryngoscopy. Methods: Forty one paramedic subjects participated in this study. Usability was measured with the System usability scale. The Macintosh direct laryngoscope and $C-MAC^{(R)}$ video laryngoscope were two instruments evaluated in the study. Results: Training with video laryngoscopy showed significantly better results within the categories of dental injury (p=.004), esophageal intubation (p=.001), and proper depth placement of intubation tubes (p=.019). The results of the System usability scale questionnaire and the degrees of visibility based on the Cormack & Lehane classification were also found to be better achieved with the video laryngoscopy (p=.000). Conclusion: This study suggests enhancing education with video laryngoscopy, which could reduce the risk of complications and duration of intubation while increasing the success rate among students and emergency medical technicians with little experience, rather than the existing method of only using direct laryngoscope, which requires considerable experience and skills.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.4
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• pp.189-193
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• 2013

We experienced dfficult airway management in a patient who had Ludwig angina with morbid obesity, dfficulty with mouth opening and neck extension. We planned to perform awake-nasotracheal intubation with fiberoptic bronchoscopy but the patient's condition was not suitable to do this procedure. Thus, we tried fiberoptic nasotracheal intubation under general anesthesia but we experienced difficult airway management due to epistaxis. We tried to use video laryngoscope instead of fiberpotic bronchoscopy but also failed to guide the tube into trachea due to limited mouth opening. We used video laryngoscope to make a view of vocal cord and used fiberoptic bronchoscope as an intubation guide of endotrachedal tube and successfully intubated the patient.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.195-202
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• 2020

Background: Nasotracheal intubation is the most commonly used method to secure the field of view when performing surgery on the oral cavity or neck. Like orotracheal intubation, nasotracheal intubation uses a laryngoscope. Hemodynamic change occurs due to the stimulation of the sympathetic nervous system. Recently, video laryngoscope with a camera attached to the end of the direct laryngoscope blade has been used to minimize this change. In this study, we investigated the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses during nasotracheal intubation with a video laryngoscope. Methods: Twenty-one patients, aged between 19 and 60 years old, scheduled for elective surgery were included in this study. Anesthesia was induced by slowly injecting propofol. At the same time, remifentanil infusion was initiated at 3.0 ng/ml via target-controlled infusion (TCI). When remifentanil attained the preset Ce, nasotracheal intubation was performed using a video laryngoscope. The patient's blood pressure and heart rate were checked pre-induction, right before and after intubation, and 1 min after intubation. Hemodynamic stability was defined as an increase in systolic blood pressure and heart rate by 20% before and after nasotracheal intubation. The response of each patient determined the Ce of remifentanil for the next patient at an interval of 0.3 ng/ml. Results: The Ce of remifentanil administered ranged from 2.4 to 3.6 ng/ml for the patients evaluated. The estimated optimal effective effect-site concentrations of remifentanil were 3.22 and 4.25 ng/ml, that were associated with a 50% and 95% probability of maintaining hemodynamic stability, respectively. Conclusion: Nasotracheal intubation using a video laryngoscope can be successfully performed in a hemodynamically stable state by using the optimal remifentanil effect-site concentration (Ce₅₀, 3.22 ng/ml; Ce₉₅, 4.25 ng/ml).

• Journal of Yeungnam Medical Science
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• v.35 no.2
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• pp.219-221
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• 2018

Management of airway in a child with Cornelia de Lange Syndrome (CdLS) should be given due consideration because most of them have the problems related to difficult airway. The GlideScope video laryngoscope can be attempted during routine intubation, however it is mostly used in case of difficulty. With adequate preoperative airway assessment, we used the pediatric video laryngoscope as useful alternative airway device in a child with CdLS and orotracheal intubation proceeded uneventfully.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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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.

• The Korean Journal of Emergency Medical Services
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• v.14 no.1
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• pp.5-18
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• 2010

Objective : This study compares Video laryngoscope and Direct laryngoscope in tracheal Intubation on rapidity and accuracy by paramedic and aims to improve efficiency of airway management and survival rate in pre-hospital treatment for the patients with severe trauma, cardiac arrest or dyspnea caused by acute diseases. Methods : 60 paramedics were recruited from 13 fire stations located in C province. With the consent of the paramedics, likelihood ratio test was carried out and they were divided into two different groups; DL group (30) and GVL group (30). Regarding intubation conditions, difficult airway grade I, grade II and grade III as well as sniffing position and neutral position were examined. This study also compared between ambulance in motion and in stand still. Frequency, average and standard deviation were analyzed with statistics program, SPSS WIN 17.0 and repeated measure design was introduced to examine inter-relations between position, grade and groups. Results : Intubation was performed more rapidly in neutral position and GVL than in sniffing position and DL(F = 15.260, p = .000). Rapidity value was better with grade I and grade II than grade III and better with GVL than DL(F = 32.629, p = .000). Accuracy value was higher with neutral position and GVL than sniffing position and DL(F = 5.008, p = .011). grade III was less accurate than grade I, grade II and GVL was more accurate than DL(F = 10.966, p = .000). Ambulance motion status did not show any statistically significant differences in accuracy and rapidity. Conclusion : Given this study results, neutral position is better for the patient with severe trauma. For a better survival, GVL intubation can be considered since GVL can enhance accuracy as well as rapidity regarding difficult airway. Since there is no significant differences in ambulance motion factors, intubation can be recommended even in moving ambulance for shortening traveling time to a hospital.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.219-223
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• 2017

In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device. We report a successful airway conversion under the aid of both, a fiberoptic bronchoscope and a C-MAC video laryngoscope.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.313-316
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• 2017

Mask ventilation, the first step in airway management, is a rescue technique when endotracheal intubation fails. Therefore, ordinary airway management for the induction of general anesthesia cannot be conducted in the situation of difficult mask ventilation (DMV). Here, we report a case of awake intubation in a patient with a huge orocutaneous fistula. A 58-year-old woman was scheduled to undergo a wide excision, reconstruction with a reconstruction plate, and supraomohyoid neck dissection on the left side and an anterolateral thigh flap due to a huge orocutaneous fistula that occurred after a previous mandibulectomy and flap surgery. During induction, DMV was predicted, and we planned an awake intubation. The patient was sedated with dexmedetomidine and remifentanil. She was intubated with a nasotracheal tube using a video laryngoscope, and spontaneous ventilation was maintained. This case demonstrates that awake intubation using a video laryngoscope can be as good as a fiberoptic scope.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.1
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• pp.1-17
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• 2024

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.