• 고신대학교 의과대학 학술지
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• 제33권2호
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• pp.252-256
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• 2018

We report a case of difficult endotracheal intubation in a patient with tracheobronchopathia osteochondroplastica. A 65-year-old man was scheduled to undergo ulnar nerve decompression and ganglion excisional biopsy under general anesthesia. During induction of general anesthesia, an endotracheal tube could not be advanced through the vocal cords due to resistance. A large number of nodules were identified below the vocal cords using a $Glidescope^{(R)}$ video-laryngoscopy, and fiberoptic bronchoscopy revealed irregular nodules on the surface of the entire trachea and the main bronchus below the vocal cords. Use of a small endotracheal tube was attempted and failed. a laryngeal mask airway (LMA $Supreme^{TM}$) rather than further intubation was successfully used to maintain the airway.

• 한국응급구조학회지
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• 제21권3호
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• pp.7-16
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• 2017

Purpose: The purpose of the study was to investigate the effects of laryngeal mask airway (LMA) insertion from different positions, using different methods, on the quality of the insertion, for identifying a more convenient and effective insertion method. Methods: In a model ambulance, 30 paramedic students performed the LMA insertion procedure, in four different settings, combinations of the rescuer's position (at the head end of the patient, at the side of the patient), and insertion technique (index finger insertion, thumb insertion), in a randomized order. Quality of insertion index and convenience of use were measured. Results: The quality of insertion index (tidal volume, gastric insufflation, airway pressure, airway sealing pressure, midline positions, insertion success grade, and insertion time) were not significantly different among four different settings. However LMA insertion from the anterior (head) end, using the index finger method compared to the thumb method was found to be significantly more convenient. Conclusion: We recommend using the more convenient and familiar LMA insertion method, between index finger insertion and thumb insertion, regardless of rescuer's position.

• 대한후두음성언어의학회지
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• 제25권2호
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• pp.96-98
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• 2014

Injection laryngoplasty is simple and useful procedure in patient with vocal cord paralysis even under local anesthesia. For approaching vocal cord level, flexibility of neck mobility is required to operate injection laryngoplasty but it is relatively difficult to approach vocal cord in patient who has cervical fixations. Laryngeal mask airway (LMA) can be helpful:We use a LMA (I-gel$^{TM}$) during intubation without neck extension on flat supine position under general anesthesia and have a good operation filed. LMA with swivel connector give surgeons better surgical vision and make insertion of fibroscope easily during operation. Hyaluronic acid injection was done use needle (25 G, 5 cm) via percutaneous cricothyroid space : This procedure can be useful method for patients who suffer from not only weak voice but also dysphagia and aspiration high vagal palsy patient after spine surgery or uncooperative with awake injection laryngoplasty.

• 대한치과마취과학회지
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• 제13권4호
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• pp.221-224
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• 2013

Despite the laryngeal mask airway (LMA) has been widely used in anesthesia, its use is rare in the field of dentistry. Placing LMA in the oral cavity may interrupt dental treatment. However, there are some circumstances in which LMA is more advantageous than tracheal intubation for managing the airway. Especially, the reinforced LMA has a flexible tube shaft, rendering it more accessible for dental treatment. We report a case of dental treatment of a 3-year-old patient with hypoplastic left heart syndrome combined with pulmonary hypertension using reinforced LMA for airway management under general anesthesia. We also discuss the considerations of utilizing the reinforced LMA for dental treatment.

• 한국응급구조학회지
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• 제16권2호
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• pp.75-89
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• 2012

Purpose : This research was designed to provide basic data for advanced pre-hospital airway management by comparing the time to ventilation and success rate for tracheal intubation performed with Macintosh laryngoscope and intubating Laryngeal Mask Airway(ILMA) in a manikin. Methods : All participants were novice users among EMT-Paramedic students and were divided into two groups: (1) the group for Macintosh laryngoscope guided tracheal intubation(MLG-TI) (2) the group for ILMA guided tracheal intubation(ILMA-TI). After an introductory lecture and demonstration, each group made an attempt ten tracheal intubation to compare the ventilation time and success rate for tracheal intubation. Results : 1) There was significant difference in the time to ventilation through MLG-TI, the time to first and second ventilation through ILMA-TI of the 10 attempts. 2) The time to first ventilation through ILMA-TI was significantly shorter than that of ventilation through MLG-TI. 3) There was no significant difference between the time to ventilation through MLG-TI and the time to second ventilation through ILMA-TI. 4) The success rates of ILMA-TI were significantly higher than those of MLG-TI. Conclusion : ILMA-TI can be an alternative method for MLG-TI in advanced pre-hospital airway management.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.167-171
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• 2015

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.

• 디지털융복합연구
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• 제14권12호
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• pp.369-375
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• 2016

본 연구는 환자의 경추보호대 착용 여부에 따른 후두마스크기도기(LMA)와 I-gel, Streamlined Liner of the Pharynx Airway(SLIPA) 등 3가지 성문위기구의 삽관 용이성을 비교하기 위해 시행되었다. 응급의료현장에서 활동 중인 119 구급대원 39명에게 3가지 성문위기구에 대한 짧은 교육을 시행한 후 삽관시간과 삽관시도횟수를 측정하였다. 삽관시간은 중립위와 경추보호대 착용 시 모두 I-gel($10.5{\pm}2.2$, $11.4{\pm}5.7$), SLIPA($12.3 {\pm}5.1$, $12.0{\pm}6.8$), LMA($17.2{\pm}3.2$, $18.5{\pm}5.5$) 순으로 빨랐다 (p<0.05). 각 기도기별 중립위와 경추보호대 착용 시 삽관시간의 차이는 없었다. 결론적으로 I-gel과 SLIPA가 LMA보다 중립위와 경추보호대 착용 시 모두에서 삽관시간이 더 빠른 결과를 보였다.

• 대한후두음성언어의학회지
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• 제27권2호
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• pp.122-125
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• 2016

Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using $C-MAC^{(R)}$ video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.

• 한국화재소방학회논문지
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• 제28권6호
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• pp.76-81
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• 2014

이 연구는 RespiTrainer를 활용한 백밸브마스크 환기에서 1인 백밸브마스크, 2인 백밸브마스크, 전문기도삽관 별 호흡량과 기도압을 비교 분석하였다. 실험기간은 2014년 6월 2일부터 6월 10일까지이며, 수집된 자료는 SPSS 18.0을 이용하여 분석하였다. 그 결과 기관내삽관을 통한 환기 $497{\pm}78mL$, 2인 BVM 환기 $479{\pm}91mL$를 보였고, 1인 BVM 환기와 킹후두관기도기, 후두마스크 환기에서 각각 $386{\pm}59mL$, $365{\pm}05mL$, $351{\pm}35mL$를 보였다. 기도압에서도 기관내삽관을 통한 BVM 환기에서 가장 높은 기도압(11.67 cm $H_2O$)을 보였다. 결과적으로 기관내삽관을 통한 BVM 환기와 2인 BVM 환기에서 1/3 백 압착법은 적절하였다.

• Acute and Critical Care
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• 제33권4호
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• pp.276-279
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• 2018

In pediatric patients, a laryngeal mask airway (LMA) is usually used during minor surgeries that require general anesthesia. No esophageal injury has been reported after insertion of an LMA. We report a case of an esophageal injury with intramural dissection after an $i-gel^{(R)}$ (size, 1.5; Intersurgical Ltd.) insertion in a pediatric patient. A 2-month-old male infant was hospitalized for left inguinal herniorrhaphy. After induction of anesthesia, a trained resident tried to insert an $i-gel^{(R)}$. However, it was only successful after three attempts. Dysphagia was sustained until postoperative day 10, and the pediatrician observed duplication of the esophagus on gastroendoscopy. However, a whitish mucosal lesion, which looked like a scar, was observed, and previous lesions suggestive of esophageal duplication were almost healed on postdischarge day 11. His condition was diagnosed as dysphagia and esophagitis due to an esophageal laceration, not esophageal duplication. He was scheduled for symptomatic treatment with a proton pump inhibitor. In conclusion, although an esophageal injury or perforation in pediatric patients is rare, an LMA insertion or a procedure such as aspiration or nasogastric tube insertion should be performed gently to avoid a possible injury to the esophagus in pediatric patients.