• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.4
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• pp.235-239
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• 2015

The Combitube is an emergency airway-maintaining device, which can supply oxygen to dyspneic patients in emergency situations following two-jaw surgery. These patients experience difficulty in opening the mouth or have a partially obstructed airway caused by edema or hematoma in the oral cavity. As such, they cannot maintain the normal airway. The use of a Combitube may be favorable compared to the laryngeal mask airway because it is a thin and relatively resilient tube. A healthy 24-year-old man was dyspneic after extubation. Oxygen saturation fell below 90% despite untying the bimaxillary fixation and ambubagging. The opening of the mouth was narrow; thus, emergency airway maintenance was gained by insertion of a Combitube. The following day, a facial computer tomography revealed that the airway space narrowing was severe compared to its pre-operational state. After the swelling subsided, the patient was successfully extubated without complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.3
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• pp.146-152
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• 2024

Objectives: This prospective observational study aimed to assess the clinical outcomes of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer. The study described the frequencies and types of procedures for securing the airway and the duration and types of postoperative ventilatory support. We compared the findings with those of the TRACHY study. Patients and Methods: One hundred patients undergoing oral cavity oncological surgeries were included. Airway assessment included inter-incisor gap, Mallampati class, neck movements, and radiological features. Surgical parameters, postoperative ventilatory support, and complications were documented. Results: The buccal mucosa was the most common cancer site (48.0%), and direct laryngoscopy was deemed difficult in 58.0% of patients. Awake fibreoptic intubation or elective tracheostomy was required in 43.0% of cases. Thirty-three patients were extubated on the table, and 34 patients were successfully managed with a delayed extubation strategy. In comparison with the TRACHY study, variations were observed in demographic parameters, tumour characteristics, and surgical interventions. Our mean TRACHY score was 1.38, and only five patients had a score ≥4. Prophylactic tracheostomy was performed in 2.0% of cases, in contrast to the TRACHY study in which 42.0% of patients underwent the procedure. Conclusion: The study emphasizes the challenges in airway management for oral cavity cancer surgery. While prophylactic tracheostomy may be necessary in specific cases, individualized approaches, including delayed extubation, are preferrable to maximize safety. Our findings contribute to better understanding and managing perioperative challenges in oral cancer patients and highlight the need for personalized strategies. Scoring systems like TRACHY should not be accepted as universally applicable.

• Korean Journal of Adult Nursing
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• v.24 no.5
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• pp.509-519
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• 2012

Purpose: This retrospective study was designed to examine the frequency of unplanned extubation, and to identify the related factors of unplanned extubation in medical intensive care unit patients. Methods: Data were collected from medical records of patients who received intubation in a medical intensive care unit. One hundred eighteen patient charts were selected for the study. The Patient Severity Classification Scale and unplanned extubation risk factors were examined. Data were analyzed with descriptive statistics, $x^2$-test, Fisher's exact test and Mann-Whitney U test. Results: The incidence of unplanned extubation was 11 (9.32%) out of 118 patients who had undergone intubation. There were statistically significant differences between the unplanned extubation and work shift ($x^2$=61.52, p=.001), ventilation mode (p=.001), number of days of ventilator application (U=366.00, p=.038) and administration of sedatives (p=.025). Conclusion: Unplanned extubation is affected by the following variables: a) whether a nurse is in night shift, b) whether ventilation is mandatory, c) duration of ventilation use and d) administration of sedatives.

• Journal of The Korean Dental Society of Anesthesiology
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• v.7 no.1
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• pp.1-5
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• 2007

Background: It is well known that nasotracheal intubation is comfort for patient compared to oral intubation. We sometimes delay extubation when it is thought that the patient can not maintain airway, or there may be other emergency associated with airway. And we sometimes experience complaint of discomfort of nasotracheal tube. But, we could not find any report on degree of discomfort of delayed nasotracheal intubation. Methods: Eighteen patients in whom extubation of nasotraceal tube was delayed after operation because of difficulties of airway mamagement were selected. We surveyed the discomfort of nasotracheal tube with 0 to 10 visual analogue scale (VAS) and compared with the pain of operation site (VAS). Result: The VAS of nasotracheal intubation was $6.7{\pm}3.4$, and VAS of the primary operation site was $3.5{\pm}2.4$, and VAS of flap harvest site was $5.5{\pm}2.7$. 10 of the patients complained of nasotracheal suction extremely and 6 patients complained of respiratory difficulties. Conclusions: Nasotracheal intubation was discomfort and there must be intervention.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.329-337
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• 1997

Background : Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. Methods : The subjects were 34 patients(M : F = 20 : 14, mean age = $61{\pm}17yre$) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group 1(decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. Results : Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26%(9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.6%(4/14) of group 2 and 44%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p > 0.01). In three cases of group 3 whose respiratory indices could be measured until 48 hr after extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. Conclusions : Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubation may increase in the patients who have increased WOB immediately after extubation.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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• pp.313-316
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• 2016

Airway obstruction in pediatric patients always poses a challenge for anesthesiologists. Beckwith-Wiedemann syndrome causes various abnormalities such as macroglossia and omphalocele. Patients with these abnormalities often need corrective surgeries. Management of difficult airway caused by conditions such as macroglossia in patients with this syndrome could be challenging. We encountered a case of difficult airway in an infant with Beckwith-Wiedemann syndrome. It was predicted that macroglossia might cause difficult ventilation, intubation, and extubation. Preoperative assessment and preparations for difficult airway should be considered.

• Journal of Korean Critical Care Nursing
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• v.15 no.3
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• pp.88-100
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• 2022

Purpose : This study aimed to identify risk factors for unplanned reintubation after planned extubation and to analyze the clinical outcomes in patients admitted to the intensive care unit after cardiac surgery. Methods : The study examined patients who underwent intubation and planned extubation admitted to the intensive care unit after cardiac surgery between January 1, 2017, and December 31, 2021. The reintubation group comprised 58 patients underwent unplanned reintubation within 7 days of planned extubation. The maintenance group comprised 116 patients who did not undergo reintubation and were matched with the reintubation group using the rational for matching criteria. Data were collected retrospectively from electronic medical records. We used the independent t-test, Mann-Whitney U test, 𝑥²-test, Fisher's exact test, and logistic regression analysis with SPSS/WIN 27.0. Results : The multivariate logistic regression analysis demonstrated that albumin (odds ratio [OR]=0.38, 95% confidence interval [CI]=0.20-0.72), surgery time (OR=1.54, 95% CI=1.20-1.97), PaO₂ before extubation (OR=0.85 per 10 mmHg, 95% CI=0.75-0.97), postoperative arrhythmia (OR=2.82, 95% CI=1.22-6.51), reoperation due to bleeding (OR=4.65, 95% CI=1.27-17.07), and postoperative acute renal failure (OR=2.97, 95% CI=1.09-8.04) were risk factors for unplanned reintubation. The reintubation group had a higher in-hospital mortality rate (𝑥²=33.74, p<.001), longer intensive care unit stay (Z=-7.81, p<.001), and longer hospital stay than the maintenance group (Z=-8.29, p<.001). Conclusion : These results identified risk factors and clinical outcomes of unplanned reintubation after planned extubation after cardiac surgery. These findings should be considered when developing and managing an intervention program to prevent and reduce the incidence of unplanned reintubation.

• Journal of Korean Academy of Nursing
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• v.44 no.5
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• pp.573-580
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• 2014

Purpose: This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation. Methods: Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model. Results: Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients). Conclusion: Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.

• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.455-458
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• 2015

Excessive dynamic airway collapse (EDAC) is a disease entity of excessive reduction of the central airway diameter during exhalation, without cartilage collapse. An 80-year-old female presented with generalized edema and dyspnea at our hospital. The patient was in a state of acute decompensated heart failure due to pneumonia with respiratory failure. We accordingly managed the patient with renal replacement therapy, mechanical ventilation and antibiotics. Bronchoscopy confirmed the diagnosis of EDAC. We scheduled extubation after the improvement of pneumonia and heart condition. However, extubation failure occurred due to hypercapnic respiratory failure with poor expectoration. Her EDAC was improved in response to high flow nasal oxygen therapy (HFNOT). Subsequently, the patient was stabilized and transferred to the general ward. HFNOT, which generates physiologic positive end expiratory pressure (PEEP) effects, could be an alternative and effective management of EDAC. Further research and clinical trials are needed to demonstrate the therapeutic effect of HFNOT on EDAC.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.3
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• pp.127-131
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• 2013

We experienced failed airway management in a patient who had partial mandibulectomy and reconstruction with free-flap. 40 year-old man (height: 164 cm, body weight: 59 kg) with malignant melanoma on #38 tooth area of mandibular body was scheduled for partial mandibulectomy and reconstruction with free flap. Approximately fifteen-hours after surgery, the patient was extubated without complication. Seven hours after extubation, we experienced respiratory failure andfailed airway managementdue to airway edema and neck. We failed orotracheal intubation with direct laryngoscopy andlaryngeal mask airway, thus we tried tracheostomy but the patient was hypoxic state for more than 30 minutes. The patient had got hypoxic brain damage in whole cerebral cortex and basal ganglia. We should have the policy of airway management of the patients who have massive oro-maxillo-facial surgery and all medical personnel who treat these patients should be educated the policy and airway management methods.