• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.26-26
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• 1991

기관 절개술은 절대적으로 필요한 수술 방법임에도 불구하고 경우에 따라서는 매우 심각한 합병증이나 후유증을 유발하고 있어 가능한 피하는 것이 좋으며 부득이하여 시술을 하더라도 그 적절한 시기를 정하기 어려운 경우가 많다. 특히 유소아에서는 최근에 개량된 삽관튜브의 출현으로 비교적 장기간의 기관삽관이 가능해지자 기관절개술의 적용예가 많이 감소하기는 하였으나 합병증이나 후유증을 너무 우려한 나머지 기관절개술을 기피하거나 적절한 수술시기를 놓쳐 더욱 어려운 입장에 처하게 되기도 한다. 저자들은 1977년도부터 1990년까지 세브란스 병원에서 기관절개술을 시행받은 15세이하의 유소아 환자 94례에서 기관절개술의 원인 질환과 적용시기 및 합병증을 알아보고 기관삽관과의 관계를 후향적으로 조사하여 다음의 결과를 얻었다. 1. 유소아 기관 절개술의 원인 질환은 두부외상이 28례(29.8%)로 가장 많았고, 신경계 질환 17례(18%), 기도 감염 10례(10.6%)의 순이었고 그 외 선천적 기형 종양, 외상, 감염 등으로 다양한 분포를 보였다. 2.기관 절개술전에 기관삽관을 시행하지 않았던 예는 18례(19.1%)이고 기관삽관을 시행했던 예는 76례(80.9%)이며, 38례(40.4%)는 일주이내에 기관절개술을 시행하였고 12례(12.8%)는 2주이내에, 8례(8.5%)는 3주이내, 6례(6.4%)는 4주이내에 시행하였으며 12례(12.8%)는 기관 삽관후 4주이후에 기관절개술을 시행하였다. 3.기관 절개술후, 합병증은 26례(27.7%)에서 있었고 육아조직 형성이 14례(14.9%) 였고 기관 협착이 12례(12.8%)의 순이었다. 4.인공 호흡기률 사용하였던 46례(48.9%)중 14례(14.9%)에서 합병증이 있었고, 인공 호흡기를 사용치 않았던 48례(51.5%)에서는 12례(12.8%)에서 합병증이 발생하였다. 5.삽관 발거를 시행할 수 있었던 예는 47례(50%)였으며, 기관 절개술후 1개월이내에 시행한 예가 21례(16%), 6개월이내 시행한 예가 16례(17%), 2년이내에 시행한 예가 6？(6.4%)였으며 2년 이후 시행할 수 있었던 예도 4례(4.3%) 있었다. 6.기관 절개술 환자중 26례(27.7%)는 원인 질환으로 결국은 사망하였으며, 21례(22.3%)는 삽관 발거를 하지 않은 상태에서 퇴원하여 추적이 불가능하였다.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.82-82
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• 1993

Tracheostomy was done to form temporary opening in the trachea, to remove secretion, to maintain ventilation and to protect against aspiration. In recent times, with the development of care methods such as low pressure cuff, endotracheal intubation is being combined with tracheostomy in the treatment of patients who are treated long period in the intensive care units and the duration from endotracheal intabation to tracheostomy is like to prolong. To determine the proper time of tracheostomy in the patient in the intensive care units, authors reviewed retrospectively the 96 patients who received the tracheostomy procedure among the 8776 patients who were admitted in the intensive care units of Asan medical center form March 1990 to March 1993, and analyzed the complications of tracheostomy, decannulation and the cause of decannulation failure according to disease, age indication of endotracheal intubation and duration of endotracheal intubation.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.13-23
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• 1995

후두 및 기관협착증은 선천적으로 발생하기도 하지만 대부분이 후천적으로 발생한다. 후천적인 원인으로는 외부로부터의 외상에 의하기도 하지만 대개가 기관내 삽관 후유증으로 발생하는 것으로 알려져 있다. 기관내 삽관에 의한 기도 점막의 손상은 대부분 가역적이기는 하지만 영구적으로 협착을 초래하는 경우, 그 치료에 있어서 많은 노력이 필요할 뿐만 아니라 치료 자체가 매우 까다롭고 실패 할 수도 있다. 따라서 후두 및 기관협착증의 원인을 정확히 이해하고 예방하는 것이 매우 중요하다. 이러한 관점에서 후두 및 기관협착증의 선천적, 후천적 원인들에 대해서 검토하여 보았다. 특히 기도 내 삽관에 따른 협착증이 가장 많은 빈도를 차지하는 만큼, 이의 병태생리와 발생에 관여하는 여러 인자들에 대해서 중점적으로 문헌 고찰하였다.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.154-161
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• 2007

Background : This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for cases of difficult tracheal intubation. Materials and Methods : For patients with an ASA physical status 1 or 2 betwen the ages of 20-90, direct laryngoscopy was performed and the layngoscopic view graded according to the Cormack and Lehane classification. Forty patients with Cormack and Lehane grade 3 or 4 were intubated using the Bonfils intubation fibrescope. During intubation, the success rates for tracheal intubation, overall time to intubation, number of attempts and adverse effects were recorded. The Thyromental and sternomental distances were recorded after the orotracheal intubation. Results : The success rates were significantly higher in Cormack and Lehane grade 3 (96.9%) patients compared to grade 4 (50%) (P<0.01). The time to intubation was significantly faster in patients with grade 3 compared to grade 4 (20 (10-49[7-300]) sec vs. 180 (31-300[10-300]) sec, P=0.01). The number of cases with a $SpO_2$<90% was significantly lower in patients with grade 3 (3.1%) compared to grade 4 (50%) (P<0.01). Conclusion : In patients with Cormack and Lehane grade 3, tracheal intubation using the Bonfils intubation fibrescope appears to be an effective technique for the management of a difficult intubation. However, the Bonfils intubation fibrescope can not always be used for the management of a difficult intubation in grade 4 patients; for these patients other effective instruments should be considered for difficult intubations.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1997.04a
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• pp.116-116
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• 1997

배경 및 목적: 전신마취를 위하여 시행한 기관내 삽관은 삽관튜브와 성대내면의 접촉에 의한 압력과 마찰로 후두 미세한 손상을 주게된다. 저자들은 단기간 기관내 삽관 전,후의 음성분석을 통하여 손상의 유무와 회복을 측정할 수 있는 객관적인 음성지표를 찾아보고자 하였다. 대상 및 방법: 만성 중이염 수술시 전신마취를 목적으로 경구기관 튜브를 거치한 성인 남자 10명과 여자 15명 환자를 대상으로 수술 1일전과 술후 24시간 후 각각 "a"음을 연장 발성시켜 CSL 4300B (KAY elemetrics Corp)의 MDVP(multidimensional voice program)을 이용하여 harmonic to noise ratio(NHR), Jitter, Shimmer, Fundamental frequency를 측정 비교하였다. 결 과: 남녀 모두에서 Jitter, Shimmer는 각각 평균 0.70%에서 1.06%, 1.92%에서2.28%로 증가되는 경향을 보였으나 통계학적 유의성은 없었다. Fundamental frequency는 여자에서 평균 220Hz에서 221Hz로 남자는 125Hz에서 128Hz로 변화를 보이지 않았고 harmonic to noise ratio(NHR)또한 평균 0.11로 수술 전, 후 변화를 관찰할 수 없었다. 결 론: 이상의 결과로 2내지 6시간의 단기간 삽관으로 인한 성대의 손상은 경미하여 24시간 이내에 회복되는 것으로 판단된다. 향후 6시간 이상의 기관내삽관이나 수일이상의 장기간 삽관후의 음성지표의 측정등의 연구가 필요할 것으로 사료된다.

• Journal of the Health Care and Life Science
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• v.11 no.2
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• pp.375-380
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• 2023

This study aims to develop a laryngoscope that can more quickly remove foreign substances in the mouth and perform endotracheal intubation and confirm its usefulness. A laryngoscope suitable for the purpose was manufactured and conducted on 30 fourth-year students at H University. The experimental method was to perform oral suction and endotracheal intubation after inserting a laryngoscope when there was no foreign material, and when there was a foreign material, endotracheal intubation was performed using a laryngoscope with an aspirator attached. When a foreign body was present, suction was performed using the existing method and the developed integrated laryngoscope. The suction time was shorter when the integrated laryngoscope was used than the existing method, and a statistically significant difference was found (p< .000). In the case of the time required for endotracheal intubation, the time required for endotracheal intubation was shorter when the integrated laryngoscope was used than the conventional method, and a statistically significant difference was found (p< .000). The development of an integrated laryngoscope with an aspirator is a useful device that can more effectively remove foreign substances and perform endotracheal intubation when there are foreign substances in the mouth.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.11
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• pp.5292-5298
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• 2012

The purpose of this study is to perform the effectively advanced airway management in an emergency patient with cardiac arrest and trauma by comparing the appearance of influence in a change of visual-field height upon endotracheal intubation according to a change in position with intubation of paramedics in a moving ambulance and by analyzing the appearance of the influence in a patient's change in position with intubation upon speed in endotracheal intubation. Research subjects were randomly extracted 60(30 people for control group, 30 people for experimental group) people as the paramedics who are working at 13 fire stations in C Province. Data analysis was carried out ${\chi}^2$-test, independent t-test, paired t-test by using SPSS WIN 14.0 Version. As a result of research, to improve speed of the advanced airway management, it is considered to be likely effective in a patient's sniffing position and in the endotracheal intubation in the upper space of the main stretcher. The self-confidence in intubation after experiment increased significantly. Thus, the continuous education(training) on the intubation position and method within ambulance is considered to be likely needed for improving efficiency of the advanced airway management.

• Journal of the Korea Society of Computer and Information
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• v.24 no.10
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• pp.167-174
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• 2019

In this paper, We propose the purpose the examine the physical factors that influence the success rate during the endotracheal intubation and to provide the basic data for effective intubation success. The subject of this study was 42 students in emergency rescue department who had completed the BLS Health Care-provider and a specialized airway maintenance course dealing with endotracheal intubation and it is a similar experimental study after the non-equivalence single group. For data analysis, SPSS 23.0 Version was used. The study methods were measuring the grip fotce of subjects, the angle of arm during intubation tube, distance from manikin, palm length, etc. The results showed that there was a correlation between the time of successful endotracheal intubation and the physical characteristics. In particular, when performing endotracheal intubation, it was related to the angle of the arm and the execution time of the performer, and the narrower the angle of the arm, the shorter the execution time. The results of this study suggest that successful endotracheal intubation could be implemented if the operator tried to reduce the angle of the arm when performing endotracheal intubation, and through further research on various job groups, identify the possibility of clinical use will be necessary.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1976.06a
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• pp.87.2-87
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• 1976

Laryngeal granuloma following endotracheal anesthesia was reported as traumatic granuloma of the larynx by Clausen in 1932. Thereafter Harrison reported that 4% of the intubated cases developed larynx and upper respiratory tract injuries and 1% of the above mentioned injured cases later developed laryngeal granuloma with symptoms including voice change and even dyspnea in severe cases. The endotracheal intubation has been wedely used for general anesthesia or patency of the air way .and the reported cases of the laryngal granuloma Fig. 5. as its complication have been increased in number worldwidely. For a year from March 1975 to Feb. 1976, the authors have experienced the nine cases of laryngeal granuloma in our department and this is the report of clinical findings on these cases along with literature review.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1987.05a
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• pp.16.2-16
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• 1987

최근 전신마취의 발달로 외과영역에서는 괄목할만한 수술적 진전을 보여 왔으나, 이에 못지 않게 전신마취에 의한 여러 가지 합병증의 보고가 늘고 있다. 특히 이비인후과영역에서는 술후 뚜렷한 원인없이 사성 및 호흡곤란 등을 호소하는 환자들을 종종 접하게 되며, 추정할 수 있는 유인으로는 대개 후두 및 기관점막의 염증, 후두결절, 후두육아종 등이 대부분이나 때로 매우 희귀하지만 원인 불명의 성대마비로 인한 경우도 있다. 저자는 최근 술전에 전혀 후두증상이 없었던 환자로서 기관내 삽관마취하 이하선 혼합종수술후에 속발한 일측성 반회신경마비례를 경험하였기에 문헌적 고찰과 함께 보고하고자 한다.