• Journal of Medicine and Life Science
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• v.16 no.2
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• pp.43-45
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• 2019

Intraoperative delivery of salbutamol (${\beta}_2$ agonist) through a breathing circuit may be performed in asthma patient. A 28-year-old woman with a history of asthma was diagnosed with chronic sinusitis and bilateral nasal polyps, and an endoscopic sinus surgery was performed. The patient was recommended salbutamol nebulization every 4 hours during the perioperative period because of the risk of asthma attack. At the end of the operation, when salbutamol was sprayed through the tube before extubation and the connector tip went inside the tube during injection. The patient was immediately referred to the pulmonary medicine department for bronchoscopy, where the foreign body was removed safely without any complications. When general anesthesia is performed on a patient who usually uses an inhaler for asthma, caution is required because the tip that connects the inhaler and the breathing circuit can aspirate into the endotracheal tube and enter the lungs when applying the inhaler before waking up the patient.

• Tuberculosis and Respiratory Diseases
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• v.57 no.5
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• pp.434-438
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• 2004

Background : An excessive endotracheal cuff pressure can cause tracheal injury, and insufficient cuff pressure may not generate an effective cuff seal. The peak inspiratory pressure influences the minimal occlusion pressure of the endotracheal tube cuff. However, the relationship between the minimal occlusion pressure and the tidal volume has not been investigated. This study was conducted to estimate the relationship between the tidal volume and the minimal occlusion pressure of the cuff. Methods : Ten mechanically ventilated patients were included. The minimal occlusion pressure of the cuff was measured using a pressure gauge. The basal tidal volume was increased and decreased as much as 10% whilst maintaining the same peak inspiratory pressure. The, minimal occlusion pressures were then measured in the high and low tidal volume state, respectively. Results : The peak inspiratory pressure was $32.6{\pm}4.72cmH_2O$ and the minimal occlusion pressure was $19.0{\pm}2.26$ mmHg in the basal ventilator setting. There was a significant relationship between the peak inspiratory pressure and the minimal occlusion pressure(r=0.77, p<0.01). The minimal occlusion pressure of the cuff was increased to $20.3{\pm}2.4$ mmHg in the high tidal volume state(p<0.05), and decreased to $16.8{\pm}3.01$ mmHg in the low tidal volume state (p<0.001). Conclusion : The minimal occlusion pressure of the cuff can be influenced by changes in the tidal volume as well as by the peak inspiratory pressure.

• Tuberculosis and Respiratory Diseases
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• v.55 no.1
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• pp.59-68
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• 2003

Background : In intubated patients, cultures of endotracheal aspirates (EA) are apt to contamination throughout the endotracheal tube. Therefore, the identification of etiologic agents via conventional EA cultures is not always reliable. In order to differentiate a pulmonary infection from a non-infectious disease, and to identify the true etiologic agent of acute pulmonary infection, blinded protected specimen brushing (PSB) was used, and its efficacy evaluated. Methods : In 51 intubated patients, with suspected pneumonia, blind PSB were performed, and the results compared with blood and EA cultures. A protected specimen brush was introduced through the endotracheal tube, and settled at the affected large bronchus. A specimen brush was introduced to the expected region using the blind method. The tip of the brush was introduced with an aseptic technique after vigorously mixed for 1 minute in $1cm^3$ of Ringer's lactate solution. The specimens were submitted for quantitative culture within 15 minutes, with a culture being regarded as positive if the colony forming units were above $10^3/ml$. Results : Of the 51 patients, 15 (29.4%) had community-acquired pneumonia (CAP), 27 (52.9%) hospital-acquired pneumonia (HAP) and 9 (17.6%) non-infectious diseases. The sensitivity and specificity of the quantitative PSB culture for the diagnosis of pneumonia were 52.4 and 88.9%, respectively. The sensitivity and specificity of EA were 78.6 and 77.8%, respectively. The blind PSB was superior to the EA for the identification of true etiologic agents. Of 53 episodes of 27 HAP patients, MRSA (Methicillin-resistant staphylococcus aureus) (41.5%) was the most common causative agent followed by Pseudomonas aeruginosa (15.1%), Klebsiella sp. (7.5%) and Acinetobacter sp. (7.5%). Conclusions : As a simple, non-invasive diagnostic modality, the blind PSB is a useful method for the differentiation of a pulmonary infection from non-infectious diseases and to identify the etiologic agents in intubated patients. A blind PSB can be performed without bronchoscopy, so is safer, more convenient and cost-effectiveness for patients where bronchoscopy can not be performed.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.76-76
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• 1993

Endotracheal intubation is common technique for general anesthesia or patency of airway. However, laryngeal intubation granuloma is the most common sequale of endotracheal intubation in otolaryngologic field. From 1982 to 1992, the authors had experienced 16 cases intubation granuloma. The following results were as follows; 1. Age distribution was mostly in the 20 to 49 years old group (84 %).The sex ratio of male to female was 1:7, predominantly in female. 2. Main sx. were hoarse in 12(75%), F.B. sensation in 3(18%), dyspnea in 1 (6%). 3. The side of lesion was bilateral in 6 cases (37%) and unilateral in 10 cases (63%). Unilateral had the 3 cases (30%) in left and the 7 cases (70%) in right. The location of mass was vocal process of arytenoid cartilage in 8 cases(50%), post 1/3 of vocal cord in 6 cases (37 %) and middle 1/3 of vocal cord in 2 cases (12 %). 4. The duration between extubation and onset of symptom in less than a month was most frequent in 7 cases (44 %) out of 16 cases. 5. The most common operation was cesarean section in 6 cases (37 %). 6. Mean duration of intubation time was 2 hour 5 minutes. 7. Composition of used intubation tube was red rubber tube. 8. One case (6 %) was recurred.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.235-238
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• 1996

Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperhidrosis, especially when the upper limbs are affected. We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which made it easier to perform the explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure. On the 4th postoperative day, pulmonary edema and heart failure were cured; and the patient was extubated. But in the evening of the same day ST-segment elevation and Q-wave were noted on ECG monitoring. On the 13th postoperative day coronary angiography was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronary spasm, treated by vasodilator. On the 14 day, after surgery, he was discharged to return to work.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1502-1507
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• 1992

Between February and July 1992, videothoracoscopic bullectomy was performed in nineteen patients with primary spontaneous pneumothorax. The indications of this surgery are recurrent in 12, persistent airleakage in 4 and previous contralateral pneumothorax in 3 patients. For the good operative field, we used double lumen endotracheal tube and put the CO2 gas into the thoracic cavity to make the lung collapse. We usually apply the endoGIA or electric cauterization for handling the bleb or bullae and there were 9 cases with of endoGIA only, 4 electric cauterization only and 6 both procedures. To evaluate the advantage of the Videothoracoscopic surgery, we compared surgical results with that of the tho-racotomy group[19 patients]. There were significant differences in operative time[93.8$\pm$41.9 min and 17.1$\pm$53.9 min, p< 0.01] and postoperative airleakage duration[35.6$\pm$113.3 hours and 117.9$\pm$214.4 hours, p<0.05] between the Videothoracoscopy and thoracotomy group. Tube indwelling time was shortened in Videothoracoscopy group[p<0.05]. The hospital stay was very short[p<0.01] and the patients needed analgesic injection less frequentley in videthoracoscopic group[p<0.05] In conclusion, we prefer the Videothoracoscopic procedure to the thoracotomy in uncomplicateed patients with pneumothorax because of simple procedure and good results.

• Journal of Chest Surgery
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• v.25 no.8
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• pp.800-805
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• 1992

Acquired, nonmalignant tracheoesophageal fistula is an uncommom and difficult problem to manage. The most commom cause is a complication of endotracheal or tracheostomy tubes. Most are diagnosed while patients still require mechanical ventilation. The principle of treatment is two stage operation. First, new tracheostomy tube is placed so that the baloon is below the fistula, and gastrostomy and feeding jejunostomy are made for the drainage and feeding. Finally after weaning from the mechanical ventilation, tracheal resection and reconstruction are made, and the esophageal defect is closed in two layers and a viable strap muscle interposed into the two suture site to prevent recurrence. Recently, we experienced a case of acquired nonmalignant tracheoesophageal fistula which was developed during mechanical ventilation. She was successfully treated with the above two stage operation.

• Journal of Veterinary Clinics
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• v.22 no.3
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• pp.214-219
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• 2005

This experiment was conducted in order to identify the effect of the laryngeal mask airway and it's clinical utility on cardiovascular system, intraocular pressure and stress reaction at the time of anesthesia care. The heart rate, systolic arterial pressure, diastolic arterial pressure and intraocular pressure were significantly reduced in the experimental group to be compared with the control group. But, there were no significant differences in mean arterial pressure, central venous pressure and blood cortisol concentration between both groups. In view of the above results, it is thought that the airway management using the laryngeal mask airway will be useful to reduce the stress condition in the induction of anesthesia.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.812-816
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• 1985

In the past several years the popularity of the motor cycle has produced an increasing incidence of the injuries to the larynx and trachea. Most of all on accidents come to death and survivors to the hospital are rare. Early diagnosis and to keep air way are necessary to initiate proper treatment in injury of upper air way. Meticulous apposition of mucous membrane and reconstitution of laryngeal skeleton are important. We experienced a rare case of 26 year old men with cricothyroidal transection after trauma. On Oct. 17, 1985, the patient struck his neck on baggage frame of truck when dropping from his motor cycle on sudden stop. Emergency tracheal intubation on distal segment of trachea was accomplished by otolaryngologist in a local clinic. He was transferred to our hospital. Exploration 2 hours later revealed complete separation of cricoid cartilage from thyroid cartilage. The recurrent laryngeal nerve could not be identified. Anastomosis of thyroid and cricoid was accomplished and Portex endotracheal tube was inserted as splint for 10 days. No stenosis developed. The air way appeared adequate for moderate physical activity though paramedian fixation of vocal cord paralysis. Postoperative follow-up course has been good after he discharged on POD 14 days.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.6
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• pp.375-378
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• 2018

Endotracheal intubation is commonly associated with laryngeal injury that often resolves spontaneously without any complication. However, stenosis or granulomatous lesions are generally found on the tracheal wall or vocal process at the tube cuff level, caused by excessive cuff pressure. We present a case of fatal vocal cord granuloma leading to dyspnea following orthognathic surgery and sustained intubation for 14 hours.