• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.2
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• pp.118-121
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• 2008

Background: This retrospective study aims to describe the airway management and to search predictive parameter for difficult intubation in 700 patients undergoing oromaxillary surgery. Methods: The medical records of 700 patients undergone oromaxillary surgery were reviewed for airway management during perioperative period. The cases of difficult intubation were selected and those radiologic findings were reviewed. The mandibular depth (MD), mandibular length (ML), thyromental distance (TMD) were measured. Results: In 41 cases difficult intubation were recorded in anesthetic record. The grade of Cormack and Lehane was III in 36 patients and IV in 5 cases. The MD of difficult intubation cases was $4.2{\pm}3.2\;cm$. The ML of difficult intubation cases was $10.1{\pm}3.8\;cm$. The TMD of difficult intubation cases was $5.9{\pm}4.3\;cm$. Under the fiberoptic guided awake intubation was undertaken in 75 patient. In none of the cases was failed nasotracheal intubation. Conclusions: The patients undergoing oromaxillar surgery have a potentially difficult airway but, if managed properly during perioperative preiod, morbidity and mortality can be reduced or avoided. The radiologic findings were poor predict for difficult intubation. The fiberoptic guided awake intubation is a safe alternative to direct laryngoscopic intubation.

• Journal of the Korean Home Economics Association
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• v.35 no.1
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• pp.99-110
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• 1997

This research was focused on the identification of difficult temperament of childhood. In order to identify the difficult temperament of childhood 336 of 3 and 6 graders were investigated. the difficult temperament of childhood was defined as the cahracteristics which were perceived as difficult for taking care of by mothers related to negative mother's attitude and related to the children's low competence. Mothers felt difficult in caring for the children with high activity and negative mood. Mothers showed negative attitude to the children with negative mood and low persistence. And the children with unpredictability and low persistence had lower perceived competence. In short high activity unpredictability negative mood and low persistence might be said as difficult temperament of childhood, These temperament categories-activity predictability mood and persistence-appeared as one factor in factor analysis. unpredictability negative mood and low persistency were shown as the difficult temperament in other studies but high activity should be examined more carefully.

• Korean Journal of Child Studies
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• v.18 no.2
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• pp.191-211
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• 1997

This study investigated the characteristics of children perceived as difficult by their mothers and compared these characteristics with the "difficult temperament" from the NYLS. The subjects were 36 mothers who have more than one child between 3 and 6 years of age. The descriptions from in-depth interviews were analyzed qualitatively. The results showed that (1) Korean mothers perceived the difficult temperament of their child as low adaptability, low rhythmicity in sleep habits, negative mood, and high activity. High response sensitivity was perceived as both a positive and a difficult characteristic. (2) The temperament of their children mothers perceived as most difficult for child rearing were negative mood and low manageability. (3) The activity, adaptability, rhythmicity, response sensitivity, mood and manageability characteristics of Korean children's difficult temperament was different from the difficult temperament of the Nyls.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.190-196
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• 2010

Difficult airway management including difficult intubation, difficult ventilation and difficult mask ventilation is a life threatening issue during anesthesia care. A 23-year-old woman with Treacher Collins syndrome was scheduled for distraction osteogenesis. She had hypoplasia of mandible and malar bone, bilateral deformities of auricles with partial deafness and antimongoloid slant of the palpebral fissures. A 56-year-old woman with mandibular hypoplasia due to childhood trauma was scheduled for distraction osteogenesis. She had a history of difficult intubation. We anticipated a difficult intubation and ventilation. Fiberoptic bronchoscopic guided awake intubation was selected for anesthesia induction. After intravenous injection of midazolam and remifentanil, 10% lidocaine pump spray on the pharyngolarynx with a direct laryngoscope and on the nasal canal. However fiberoptic bronchoscopic guided awake intubation was failed due to severe gag reflex. After intravenous injection of propofol and remifentanil using the target controlled infusion (TCI), mask ventilation was easily performed and, after intravenous injection of vecuronium, fiberoptic bronchoscopic guided intubation was easily performed using a wire reinforced endotracheal tube. The operation was completed successfully without any adverse events.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.6
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• pp.309-315
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• 2019

Objectives: The aim of this study was to evaluate the validity of the existing classification and difficulty index of impacted mandibular third molars in clinical situations and propose a more practical classification system. Materials and Methods: This study included 204 impacted mandibular third molars in 154 patients; panoramic x-ray images were obtained before tooth extraction. Factors including age, sex, and pattern of impaction were investigated. All impacted third molars were classified and scored for spatial relationship (1-5 points), depth (1-4 points), and ramus relationship (1-3 points). All variables were measured twice by the same observer at a minimum interval of one month. Finally, the difficulty index was defined based on the total points scored as slightly difficult (3-4 points), moderately difficult (5-7 points), very difficult (8-10 points), and extremely difficult (11-12 points). Results: The strength of agreement of the total points scored and difficulty index were 0.855 and 0.746, respectively. Most cases were classified as moderately difficult (73.0%). Although only 13 out of 204 cases (6.4%) were classified as extremely difficult, patients classified as extremely difficult were the oldest (P<0.05). Conclusion: For difficulty classification, the authors propose one more difficult category beyond the existing three-step difficulty index: the clinician should consider the patient's age in the difficulty index evaluation.

• Korean Journal of Childcare and Education
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• v.13 no.3
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• pp.103-119
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• 2017

Objective: This study investigated the relationships between preschoolers' difficult temperament, resilience, problematic behaviors, and maternal parenting stress. In addition, the research examined the moderating effects of resilience on the relationships between maternal parenting stress, preschoolers'difficult temperament and problematic behaviors Methods: The participants were 200 four to six year olds attending kindergartens and daycare centers in Seoul, Gyeonggi-do, or Gangwon-do. Mothers completed the questionaries to measure children's temperament, parenting stress, and problem behaviors. Children's resilience was assessed by teacher ratings. Results: Significant correlations were found among maternal parenting stress, preschoolers' difficult temperament and problematic behaviors. Moreover, resilience moderated the associations between difficult temperament and problematic behaviors but it did not moderate the relation between maternal parenting stress and problematic behaviors. Conclusion/Implications: The results suggest that it is necessary to provide comprehensive intervention to reduce maternal parenting stress and improve preschoolers'resilience in order to prevent their problematic behaviors.

• Tunnel and Underground Space
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• v.28 no.1
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• pp.1-24
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• 2018

The use of TBM (tunnel boring machine) gradually increases in worldwide tunneling projects. TBM machine are often applied to more difficult and complex geological conditions in urban area, and many problems and difficulties have been reported due to these geological conditions. However, in Korea, there is a lack of research on difficult grounds so far. This paper discussed general aspects of investigation method, and problems of TBM tunneling in difficult grounds. Construction cases that passed through the difficult grounds in worldwide were analyzed and the typical difficult grounds were classified into 11 cases. For each case, the definition and general problems were summarized. Particularly, for mixed ground and boulder ground, and fault zone, which are frequent geological conditions in urban area with shallow depth, classification system, investigation methods and major considerations were discussed, and proposed the direction of future research. This paper is a basic study for the development of TBM construction technology in difficult ground, and it is expected that it will be useful for related research and construction of TBM in difficult ground in the future.

• Korean Journal of Child Studies
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• v.12 no.2
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• pp.173-191
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• 1991

The purpose of the present study was to examine the relationship between infants' crying associated with their temperament and mothers' subjective responses to their crying. The subjects were 212 mothers and their 4- to 8-month-old infants living in Seoul, Korea. RITQ and EASI were administered to mothers. Mothers' perceptions of tape recordings of infants' crying were recorded. The data were analyzed by t-test and ${\chi}^2$ test. The main results were that (1) infant's temperament could be divided into five groups: the easy, the intermediate-low, the intermediate-high, the difficult, and the slow-to-warm up infant groups. The more negatively emotional and impulsive the mother's temperament, the more difficult was the infant's temperament. (2)The crying of the difficult infants was perceived more as an indication of major physical discomfort than that of the easy infants. (3)Both mothers of difficult and mothers of easy infants displayed differences in maternal interventions by type of infant cries: cries of difficult infants elicited more maternal intervention of "soothing" or "picking up" than those of easy infants. On the other hand, cries of easy infants elicited more maternal intervention of "playing with toy" and "leaving him alone, if possible" than those of difficult infants.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.1
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• pp.33-37
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• 2012

Dental treatment under general anesthesia is considered a good way for behavioral control in disabled patients. General anesthesia for disabled patients sometimes requires difficult airway management. In this case, intra-oral camera is great helpful to intubation. Originally, the intra-oral camera is designed to facilitate diagnosis dental disease. The intra-oral camera is very efficient on intubation. Laryngeal photo taken by Intra-oral camera can be good guide for difficult intubation. In this report, an 11-year-old boy with chromosomal anomaly received dental care under general anesthesia. And he had a potentially difficult airway. We achieved nasotracheal intubation successfully with intra-oral camera.

• The Korean Journal of Emergency Medical Services
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• v.24 no.2
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• pp.123-131
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• 2020

Purpose: This study aimed to find out the effectiveness of gum elastic bougies for intubation in comparison to stylet according to airway type using a manikin. Methods: The study subjects were 52 paramedic students who intubated using a Macintosh laryngoscope and compared stylet and gum elastic bougie use in a 7.5 mmID endotracheal tube, on a manikin with either normal or difficult airway. Difficult airway was made Philadelphia neck collar. Collected data included intubation time, accuracy and ease of intubation, later analyzed by frequency analysis, descriptive analysis, independent t-test, chi square test, paired t-test, and McNemar test using SPSS Statistics 18.0. Results: There was a significant difference in intubation time according to intubation device and airway type (p=.000). There was no significant difference in accuracy of intubation according to intubation device or airway type (normal airway p=1.000, difficult airway p=.052). There was a significant difference in ease of intubation scale according to intubation device and airway type (p=.000, p=.000). Conclusion: Based on the speed and ease of intubation, gum elastic bougie is recommended for intubation in patients with difficult airways such as those with cervical injury.