• 대한치과마취과학회지
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• 제5권2호
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• pp.107-111
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• 2005

Background: Nasotracheal intubation for general anesthesia is preferred for many oral and maxillofacial procedures because it ensures unhindered access to the operative site. Epistaxis and tube insertion failures are recognized complications of nasotracheal intubation. The aim of our study was to elucidate whether the nostril side used influenced epistaxis and insertion failure incidence. Methods: We studied 434 patients undergoing nasal intubation (July 2004- February 2005) with permission. Randomly, one side of nostril was selected with chart ID number. During nasotracheal intubation, epistaxis severity and tube insertion failure was observed by the anesthesiologist who inserted nasotracheal tube. Results: There was no significant difference between either nostril in epistaxis severity (chi-square test P = 0.860) and in the incidence of insertion failure (P = 0.867). Conclusions: In this study, both nostrils showed equal epistaxis and insertion failure incidence.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권5호
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• pp.417-421
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• 2007

Post-intubation granuloma of the larynx is a rare complication of general inhalation anesthesia, which is associated with direct mechanical irritation of laryngeal mucosa from trauma, prolonged period of endotracheal intubation, multiple intubations and endotracheal movement. This study was performed retrospectively to evaluate symptoms, incidence, duration and site for prevention of the intubation granuloma. The authors investigated 16 patients of intubation granuloma among 719 patients during 1 year period from August, 2005 to July, 2006 at the Department of Oral & Maxillofacial Surgery, Pusan National University Hospital. The results were as follows. 1. The incidence was 16/719 cases(2.2%) 2. The female to male ratio was 7:1 3. Hoarseness was the main symptom 4. Most cases occurred after 2-jaw orthognathic surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권4호
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• pp.221-227
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• 2015

Background: Endotracheal intubation induces clinically adverse cardiovascular changes. Various pharmacological strategies for controlling these responses have been suggested with opioids being widely administered. In this study, the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses to fiberoptic nasotracheal intubation was evaluated. Methods: Thirty patients, aged 18-63 years, scheduled for elective surgery were included. Anesthesia was induced with a propofol and remifentanil infusion via target-controlled infusion (TCI). Remifentanil infusion was initiated at 3.0 ng/mL, and the response of each patient determined the Ce of remifentanil for the next patient by the Dixon up-and-down method at an interval of 0.5 ng/mL. Rocuronium was administered after propofol and remifentanil reached their preset Ce; 90 seconds later fiberoptic nasotracheal intubation was initiated. Non-invasive blood pressure and heart rate (HR) were measured at pre-induction, the time Ce was reached, immediately before and after intubation, and at 1 and 3 minutes after intubation. The up-and-down criteria comprised a 20% change in mean blood pressure and HR between just prior to intubation and 1 minute after intubation. Results: The median effective effect-site concentration ($EC_{50}$) of remifentanil was $3.11{\pm}0.38ng/mL$ by the Dixon's up-and-down method. From the probit analysis, the $EC_{50}$ of remifentanil was 3.43 ng/mL (95% confidence interval, 2.90-4.06 ng/mL). In PAVA, the EC50 and EC95 of remifentanil were 3.57 ng/mL (95% CI, 2.95-3.89) and 4.35 ng/mL (95% CI, 3.93-4.45). No remifentanil-related complications were observed. Conclusions: The $EC_{50}$ of remifentanil for minimizing the cardiovascular changes and side effects associated with fiberoptic nasotracheal intubation was 3.11-3.43 ng/mL during propofol TCI anesthesia with a Ce of 4 ug/mL.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권4호
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• pp.207-212
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• 2015

Background: The ideal alternative airway device should be intuitive to use, yielding proficiency after only a few trials. The Clarus Video System (CVS) is a novel optical stylet with a semi-rigid tip; however, the learning curve and associated orodental trauma are poorly understood. Methods: Two novice practitioners with no CVS experience performed 30 intubations each. Each trial was divided into learning (first 10 intubations) and standard phases (remaining 20 intubations). Total time to achieve successful intubation, number of intubation attempts, ease of use, and orodental trauma were recorded. Results: Intubation was successful in all patients. In 51 patients (85%), intubation was accomplished in the first attempt. Nine patients required two or three intubation attempts; six were with the first 10 patients. Learning and standard phases differed significantly in terms of success at first attempt, number of attempts, and intubation time (70% vs. 93%, $1.4 {\pm}0.7$ vs. $1.1{\pm}0.3$, and $71.4{\pm}92.3s$ vs. $24.6{\pm}21.9s$, respectively). The first five patients required longer intubation times than the subsequent five patients ($106.8{\pm}120.3s$ vs. $36.0{\pm}26.8s$); however, the number of attempts was similar. Sequential subgroups of five patients in the standard phase did not differ in the number of attempts or intubation time. Dental trauma, lip laceration, or mucosal bleeding were absent. Conclusions: Ten intubations are sufficient to learn CVS utilization properly without causing any orodental trauma. A relatively small number of experiences are required in the learning curve compared with other devices.

• Asian-Australasian Journal of Animal Sciences
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• 제23권4호
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• pp.515-520
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• 2010

The response of broiler chicks to intubation of nutrients (starch, casein, soybean oil or their combinations) into the crop immediately after hatch was evaluated for performance, intestinal development, meat yield and immune competence up to 35 d of age. A control group with no access to feed and two test groups fed either inert material (sawdust) or starter diet for the initial 24 h after hatch were compared with nutrient intubated groups (n = 7). A total of 300 broiler chicks were equally distributed to 10 dietary groups with 6 replicates of 5 chicks each. After 24 h of hatch, all groups were fed ad libitum the starter (0-21 d) and finisher diets (22-35 d). Results indicated that post-hatch intubation of starch into the crop significantly (p${\leq}$0.05) improved body weight (at 14 and 35 d of age), readyto-cook meat yields, weights of breast muscle and small intestine segments, cell-mediated immune response, ND titers and weight of bursa compared to chicks starved or fed sawdust during the initial 24 h after hatch. However, chicks with access to feed immediately after hatch or intubation of starch, soybean oil, starch+casein, starch+soybean oil or starch+casein+soybean oil exhibited similar positive effects. Intubation of casein either alone or in combination with soybean oil was superior to the starved or sawdust fed groups, but inferior to other groups for all the parameters studied. It was concluded from the study that intubation of starch individually or in combination with casein and/or soybean oil effectively circumvented the negative effects of post-hatch starvation for 24 h. Among the nutrients intubated, carbohydrate (starch) was better utilized by the chicks than protein (casein) or fat during the initial post-hatch period.

• Journal of Trauma and Injury
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• 제33권3호
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• pp.195-203
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• 2020

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

• 한국응급구조학회지
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• 제14권1호
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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.

• 대한장애인치과학회지
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• 제15권1호
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• pp.89-93
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• 2019

본 증례 보고는 기관 삽관 경험이 있는 조산아에서 상악 유전치의 발육장애가 나타난 증례이다. 본 증례들에서는 기관 삽관으로 인해 치관 형태 이상, 법랑질 결함, 맹출 지연이 나타났다. 또한 치배의 변위로 인한 맹출 경로 이상, 치근 만곡, 후속 영구치의 비정상적인 치근 형성도 나타났다. 이환 치아에 대해서는 예방적 수복치료 및 관리, 적절한 시기에 발치를 고려해야 한다. 소아치과의사는 삽관 경험이 있는 조산아에서 나타날 수 있는 상황에 대해 이해하고, 적절한 개입을 통해 구강 건강 증진을 도모해야 한다.

• 한국컴퓨터정보학회논문지
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• 제25권12호
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• pp.227-233
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• 2020

본 연구는 성문위기도기 인후두 튜브(Supraglottic Airway Laryngopharyngeal Tube, SALT)와 직접 후두경을 이용하여 어려운 자세에서 기관내삽관의 신속성과 자신감, 용이성 등을 비교하여 전문기도관리 시행 능력을 향상 시키는데 있다. 연구대상은 J도 소방서에서 근무하고 있는 1급 응급구조사 30명을 대상으로 무작위 교차방법(Randomized crossover design)으로 디자인한 실험연구로 자료 분석은 SPSS 20.0 Version을 사용하였다. 어려운 자세에서 SALT를 이용한 기관내삽관은 직접 후두경을 이용한 기관내삽관 보다 신속성에서 유의한 차이를 보였으며(p<.001), 자신감과 용이성에서도 유의한 차이를 나타냈다(p<.001). 직접 후두경을 사용한 기관내삽관이 어려운 환경이나 외상환자의 경우 SALT를 이용한다면 안전하고 신속한 삽관을 할 수 있을 것이다. 또한 전문기도관리의 효율성 향상을 위해서 국내 현장에 SALT의 도입이 필요 할 것으로 사료된다.

• Journal of Chest Surgery
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• 제54권1호
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• pp.17-24
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• 2021

Background: Although extracorporeal membrane oxygenation (ECMO) is generally performed percutaneously, the technology is deployed under sedation and necessitates endotracheal intubation. However, in some patients, the use of venoarterial (VA) ECMO without intubation may be beneficial. Herein, we describe our experiences with VA ECMO performed without prior endotracheal intubation. Methods: A total of 783 patients treated with VA ECMO at a single center between January 2013 and July 2018 were reviewed retrospectively. We included patients who underwent successful VA ECMO implementation without prior endotracheal intubation, and excluded those who were younger than 18 years, had ongoing cardiopulmonary resuscitation status, and had poor quality of the vessels needed for percutaneous cannulation. The primary study outcome was in-hospital survival. Results: In total, 50 patients were included in this study, 94% of whom showed cardiogenic shock. The mean age of the study participants was 56.3±14.5 years. The median VA ECMO support time was 7 days (range, 2-13 days). Twenty-one patients (42%) did not receive ventilator care during the VA ECMO support period, while 29 patients (58%) progressed to intubation after VA ECMO implementation. The rates of survival at discharge and weaning success were 82% (n=41) and 92% (n=46), respectively, and 80% (n=40) of patients presented good Glasgow-Pittsburgh Cerebral Performance Categories scores at discharge. Conclusion: Even in patients with cardiogenic shock, percutaneous VA ECMO can be introduced safely without prior endotracheal intubation by an experienced care team. The application of nonintubated VA ECMO might be a feasible strategy in selected cases.