• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.2
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• pp.167-171
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• 2021

We describe the successful insertion of a nasotracheal tube following repeated cuff rupture. The patient was a 55-year-old woman with a history of nasal trauma and multiple rhinoplasties, who underwent elective Lefort I osteotomy and bilateral sagittal split osteotomy for correction of skeletal facial deformity. During fiberoptic bronchoscope-guided nasal intubation after the induction of general anesthesia, the tracheal tube repeatedly ruptured in both nares, despite extensive preparation of the nasal airways. We covered the cuff with a one-inch tape, intubated to the level of the oropharynx, pulled the tracheal tube out through the mouth, and removed the tape. The tracheal tube was then backed out to the level of the uvula, and was successfully advanced.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.1
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• pp.49-53
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• 2020

Cri-du-chat syndrome (CdCS) is caused by the deletion of the short arm of chromosome 5. Most patients with CdCS develop intellectual disabilities. Therefore, they have poor oral hygiene and a high caries index. However, treating such patients is not an easy task, because of the difficulty in communication. General anesthesia may be a useful option in adult patients with CdCS and intellectual disability. General anesthesia should be administered very carefully, owing to the presence of comorbid diseases, which may need airway management. Infants with CdCS need general anesthesia if they have a concomitant cardiac anomaly. Intubation is reportedly difficult for such patients was, owing to the structural and functional abnormalities in the larynx and vocal cords. The purpose of this study was to report a case of difficult intubation while inducing general anesthesia in a patient with CdCS during dental treatment, due to a narrow larynx and trachea.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.213-217
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• 2024

Numerous neoplastic lesions can arise in the orofacial region in the pediatric populations. Odontogenic tumors typically affect the mandible more than the maxilla. Airway management can be challenging in pediatric oral tumors because of the distorted anatomy and physiological variations. Conventional awake fiberoptic intubation is not always possible owing to limited cooperation from the pediatric populations. Herein, we report the case of a 1-year-old child with odontogenic myxoma of the mandible and an anticipated difficult airway. Given the expected difficulties in the airway, video laryngoscope-assisted orotracheal intubation under general anesthesia with maintenance of spontaneous breathing was scheduled. Proper planning and thorough examinations are vital for successful airway management in pediatric patients.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.223-229
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• 2017

The beauty of the laryngeal mask is that it forms an air tight seal enclosing the larynx rather than plugging the pharynx, and avoid airway obstruction in the oropharynx. The goal of its development was to create an intermediate form of airway management face mask and endotracheal tube. Indication for its use includes any procedure that would normally involve the use of a face mask. The laryngeal mask airway was designed as a new concept in airway management and has been gaining a firm position in anesthetic practice. Despite wide spread use the definitive role of the laryngeal mask airway is yet to be established. In some situations, such as after failed tracheal intubation or in oral surgery its use is controversial. There are several unresolved issues, for example the effect of the laryngeal mask on regurgitation and whether or not cricoids pressure prevents placement of mask. We review the techniques of insertion, details of misplacement, and complications associated with use of the laryngeal mask. We then attempt to clarify the role of laryngeal mask in air way management during anesthesia, discussing the advantages and disadvantages as well as indications and contraindications of its use in oral and maxillofacial surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.195-202
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• 2020

Background: Nasotracheal intubation is the most commonly used method to secure the field of view when performing surgery on the oral cavity or neck. Like orotracheal intubation, nasotracheal intubation uses a laryngoscope. Hemodynamic change occurs due to the stimulation of the sympathetic nervous system. Recently, video laryngoscope with a camera attached to the end of the direct laryngoscope blade has been used to minimize this change. In this study, we investigated the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses during nasotracheal intubation with a video laryngoscope. Methods: Twenty-one patients, aged between 19 and 60 years old, scheduled for elective surgery were included in this study. Anesthesia was induced by slowly injecting propofol. At the same time, remifentanil infusion was initiated at 3.0 ng/ml via target-controlled infusion (TCI). When remifentanil attained the preset Ce, nasotracheal intubation was performed using a video laryngoscope. The patient's blood pressure and heart rate were checked pre-induction, right before and after intubation, and 1 min after intubation. Hemodynamic stability was defined as an increase in systolic blood pressure and heart rate by 20% before and after nasotracheal intubation. The response of each patient determined the Ce of remifentanil for the next patient at an interval of 0.3 ng/ml. Results: The Ce of remifentanil administered ranged from 2.4 to 3.6 ng/ml for the patients evaluated. The estimated optimal effective effect-site concentrations of remifentanil were 3.22 and 4.25 ng/ml, that were associated with a 50% and 95% probability of maintaining hemodynamic stability, respectively. Conclusion: Nasotracheal intubation using a video laryngoscope can be successfully performed in a hemodynamically stable state by using the optimal remifentanil effect-site concentration (Ce₅₀, 3.22 ng/ml; Ce₉₅, 4.25 ng/ml).

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.301-304
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• 2018

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received $50{\mu}g$ of fentanyl 2-3 times (total $2.2-2.3{\mu}g/kg$) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1-4 times (total 0.02-0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.307-312
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• 2017

Background: The aim of this study was to estimate the optimal depth of nasotracheal tube placement. Methods: We enrolled 110 patients scheduled to undergo oral and maxillofacial surgery, requiring nasotracheal intubation. After intubation, the depth of tube insertion was measured. The neck circumference and distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch were measured. To estimate optimal tube depth, correlation and regression analyses were performed using clinical and anthropometric parameters. Results: The mean tube depth was $28.9{\pm}1.3cm$ in men (n = 62), and $26.6{\pm}1.5cm$ in women (n = 48). Tube depth significantly correlated with height (r = 0.735, P < 0.001). Distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch correlated with depth of the endotracheal tube (r = 0.363, r = 0.362, and r = 0.546, P < 0.05). The tube depth also correlated with the sum of these distances (r = 0.646, P < 0.001). We devised the following formula for estimating tube depth: $19.856+0.267{\times}sum$ of the three distances ($R^2=0.432$, P < 0.001). Conclusions: The optimal tube depth for nasotracheally intubated adult patients correlated with height and sum of the distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch. The proposed equation would be a useful guide to determine optimal nasotracheal tube placement.

• 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.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.219-221
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• 2024

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.1
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• pp.12-17
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• 2018

Objectives: Airway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients. Materials and Methods: This is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients. Results: The use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction. Conclusion: Based on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option.