• Journal of Chest Surgery
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• 제13권4호
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• pp.503-506
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• 1980

A 37 year old male patient was suffered from severe labored breathing caused by post tracheostomy stenosis, which was localized at the mediastinal trachea [cuffed tracheal stenosis] and ranged 1.5 cm in length and approximately 3 ram. in diameter on tracheogram. After dilation of tracheal stenosis with dilator, endotracheal intubation was tried for induction of anesthesia and control of respiration during operation. A tube was placed just beyond the tracheal stenosis without respiratory difficulty. Under the endotracheal anesthesia, circumferential resection of the mediastinal trachea containing the stenosis, approximately 2 cm in length [4 tracheal rings}, was carried out and primary direct end to end anastomosis was performed with interrupted submucosal sutures [3-0 Dexon] and mobilization of trachea Postoperative tracheostomy was not performed. The patient was completely relieved from dyspnea immediately after operation. Post-operative convalescence was entirely uneventful and at present, about 3 months after operation, he is now conducting a usual life. From the literature and our experience, the etiology and treatment of post-tracheostomy stenosis were discussed.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권2호
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• pp.135-138
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• 2017

Intraoperative airway obstruction is perplexing to anesthesiologists because the patient may fall into danger rapidly. A 74-year-old woman underwent an emergency incision and drainage for a deep neck infection of dental origin. She was orally intubated with a 6. 0 mm internal diameter reinforced endotracheal tube by video laryngoscope using volatile induction and maintenance anesthesia (VIMA) with sevoflurane, fentanyl ($100{\mu}g$), and succinylcholine (75 mg). During surgery, peak inspiratory pressure increased from 22 to $38cmH_2O$ and plateau pressure increased from 20 to $28cmH_2O$. We maintained anesthesia because we were unable to access the airway, which was covered with surgical drapes, and tidal volume was delivered. At the end of surgery, we found a longitudinal fold inside the tube with a fiberoptic bronchoscope. The patient was reintubated with another tube and ventilation immediately improved. We recognized that the tube was obstructed due to dissection of the inner layer.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권3호
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• pp.219-223
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• 2017

In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device. We report a successful airway conversion under the aid of both, a fiberoptic bronchoscope and a C-MAC video laryngoscope.

• Journal of Korean Neurosurgical Society
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• 제39권6호
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• pp.419-422
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• 2006

Objective : Endotracheal tube cuff-pressure[ETCP] increases significantly during anterior cervical spine surgery with neck retraction. Clinically, postoperative hoarseness with sore throat is correlated with vocal cord edema due to longer intubation time and higher ETCP during neck retraction. Methods : Fifty patients of anterior cervical spine surgery were randomized to a control [no adjustment, 25 cases] and a treatment group [ETCP adjusted to 20mmHg, 25 cases]. Patients were blinded to their group assignments. They were questioned about the presence of ischemic symptoms [sore throat, dysphagia, hoarseness] postoperatively at different time points; 4 hours, 24 hours, and 1 week postoperatively. Results : No differences between groups at 4 hours and 1 week postoperatively were demonstrated. At 24 hours, 36% of patients in the treatment group complained of sore throat while 56% of control group patients did [p < 0.05]. Female patients correlated with development of all ischemic discomfort [p < 0.05 : sore throat, hoarseness, dysphagia]. Conclusion : Our results suggest that postoperative ischemic symptom following anterior cervical spine surgery may be associated with the two predictors; increased ETCP during neck retraction and female. The simple procedure of maintaining ETCP to 20mmHg can prevent postoperative tracheal ischemic symptom.

• 성인간호학회지
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• 제28권6호
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• pp.628-636
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• 2016

Purpose: This study examined the effects of a program designed to prevent ventilator-associated pneumonia (VAP) on VAP rate and endotracheal colonization. The program focused on aspiration prevention and oral care. Methods: A nonequivalent control group post-test only design was utilized. One hundred patients admitted to a medical intensive care unit (MICU) or coronary care unit (CCU) were assigned to either a experimental group (n=50) or a control group (n=50). The participants were selected 48 hours following an endotracheal intubation. VAP prevention program given to the experimental group includes keeping the head of the bed to $30^{\circ}{\sim}45^{\circ}$ high, maintaining continuous endotracheal cuff pressure at 25 cm $H_2O$, performing endotracheal suction before change position, and providing oral care with 0.1% chlorhexidine every four hours. The control group received usual care. Data were analyzed using t-test, $x^2$ test, Mantel-Haenszel $x^2$ and Cox proportional harzard regression model. Results: The experimental group showed a lower VAP rate than the control group although the difference was not statistically significant ($x^2=0.79$, p=.375). The experimental group showed lower colonization in tracheal secretion than the control group ($x^2=14.59$, p<.001). Conclusion: Results showed that a VAP prevention program is effective in reducing colonization of tracheal secretion. Therefore, VAP prevention programs are recommended as an ICU nursing intervention.

• 한국화재소방학회논문지
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• 제29권5호
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• pp.104-109
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• 2015

이 연구는 RespiTrainer를 활용한 옥시레이터 EM-100 환기에서 기관내삽관, 킹후두관기도기, 아이-겔, 마스크를 통한 호흡량과 기도압을 비교 분석하였다. 실험기간은 2015년 7월 20일부터 7월 21일까지이며, 수집된 자료는 SPSS 18.0을 이용하여 분석하였다. 연구결과 기관내삽관이 537 ml (95% CI 530~545 ml), 킹후두관기도기 502 ml (95% CI 499~506 ml), 아이-겔 488 ml (95% CI 485~491 ml), 산소마스크 499 ml (95% CI 496~503 ml)의 환기량을 보였다. 기도압력은 기관내삽관이 $11.34cmH_2O$ (95% CI $11.21{\sim}11.41cmH_2O$), 킹후두관기도기 $10.67cmH_2O$ (95% CI $10.60{\sim}10.75cmH_2O$), 아이-겔 $10.42cmH_2O$ (95% CI $10.35{\sim}10.67cmH_2O$), 산소마스크 $10.61cmH_2O$ (95% CI $10.55{\sim}10.68cmH_2O$)로 측정되었다. 결과적으로 옥시레이터 EM-100을 이용한 인공호흡으로 적절한 호흡량이 전달되는 것을 확인할 수 있었다.

• Clinical and Experimental Pediatrics
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• 제50권10호
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• pp.959-964
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• 2007

목 적 : 태변 흡인 증후군에 이환된 환아의 임상적 고찰과 분만 직후의 기관내 삽관을 통한 태변 흡입이 태변 흡인 증후군의 예후에 미치는 영향을 알아보고자 하였다. 방 법 : 2004년 1월부터 2006년 6월까지 2년 6개월 동안 제일 병원 신생아 집중 치료실에 입원한 환아 중에서 태변 흡인 증후군으로 이환된 44명을 대상으로 하였고, 이중 출생 직후 활발하지 않아 신생아 소생술 지침에 따라 기관 삽관을 통하여 태변 흡인을 시행하였으나 태변 흡인 증후군으로 이환된 군(12명)과 출생 직후 활발하여 기관 삽관을 하지 않았으나 태변 흡인 증후군으로 이환된 군(32명)으로 분류하여 각 군의 임상적 특징, 산과적 위험인자, 동반 질환, 치료 방법, 입원 기간 등을 의무기록을 통하여 후향적으로 비교 분석 하였다. 결 과 : 태변 흡인 증후군으로 이환된 환아에서 조기 흡인군과 조기 비흡인군에서 평균 재태 연령, 평균 출생 체중, 성별, 분만 방식 등은 통계적으로 유의한 차이가 없었으나 평균 아프가 점수는 조기 흡인군에서 1분, 5분 모두에서 유의하게 낮았으며, 동반 질환으로는 지속성 폐동맥 고혈압(13.6%), 신생아 경련(9.1%), 기흉 및 기종격(6.8%)에서 높은 빈도로 나타났다. 인공 호흡기 치료는 35예(79.5%)에서 시행하였고, 고빈도 진동성 환기법으로 치료 받은 환아는 조기 비흡인군에서 1예 있었으며 폐계면 활성제 치료를 받았던 환아는 조기 흡인군에서 1예(8.3%), 조기 비흡인군에서 5예(15.6%)로 조기 비흡인군에서 많았으나 통계적인 의미는 없었다. 기계적 환기 요법의 치료 기간과 입원 기간은 조기 비흡인군에서 길었으나 통계적으로 유의한 차이가 없었으나 총 산소 치료 기간은 조기 비흡인군에서 통계적으로 의미있게 길었다. 결 론 : 본 연구를 통해 태변 흡인 증후군 환아의 조기 비흡인군에서 폐 계면 활성제의 사용이 많았고, 기계적 환기 요법 치료 기간, 입원 기간 등이 길었지만 통계적으로 유의한 차이는 없었으며, 총 산소 치료 기간은 통계적으로 조기 흡인군에 비하여 유의하게 길었던 것으로 조사되었다. 그러므로 태변 착색아 중에서 활발한 군에 대한 더 세부적인 지침이 필요하다고 사료되며, 신경학적 후유증의 장기 예후에 대한 더 많은 연구와 추적 관찰이 필요하다.

• Clinical and Experimental Pediatrics
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• 제63권1호
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• pp.3-7
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• 2020

High-flow nasal cannula (HFNC) is a relatively safe and effective noninvasive ventilation method that was recently accepted as a treatment option for acute respiratory support before endotracheal intubation or invasive ventilation. The action mechanism of HFNC includes a decrease in nasopharyngeal resistance, washout of dead space, reduction in inflow of ambient air, and an increase in airway pressure. In preterm infants, HFNC can be used to prevent reintubation and initial noninvasive respiratory support after birth. In children, flow level adjustments are crucial considering their maximal efficacy and complications. Randomized controlled studies suggest that HFNC can be used in cases of moderate to severe bronchiolitis upon initial low-flow oxygen failure. HFNC can also reduce intubation and mechanical ventilation in children with respiratory failure. Several observational studies have shown that HFNC can be beneficial in acute asthma and other respiratory distress. Multicenter randomized studies are warranted to determine the feasibility and adherence of HFNC and continuous positive airway pressure in pediatric intensive care units. The development of clinical guidelines for HFNC, including flow settings, indications, and contraindications, device management, efficacy identification, and safety issues are needed, particularly in children.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권2호
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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.

• 대한기관식도과학회지
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• 제7권1호
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• pp.19-23
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• 2001

Background and Objectives： Larynx granuloma is a exophytic inflammatory mass and may result from gastroesophageal reflux disease and a traumatic or prolonged endotracheal intubation. There has been a controversy in the treatment of larynx granuloma. Our aim of study is to know the results of the conservative management and surgery for larynx granuloma. Materials and Methods : We have reviewed and analyzed medical records of 71 Patients who were diagnosed and treated as larynx granuloma in Asan medical center from 1989 to 2000 retrospectively. And questionnaires on present patient's status were answered via telephone. Results : Forty four cases were treated by conservative management and 29 cases were treated by surgery. The total Percentages of improvement after treatment were 85.7 o/o after conservative management and 75.9% after surgery. In intubation granuloma percentages of improvement were 86.4% after conservative management and 73% after surgery. In contact granuloma percentages of improvement were 85% after conservative management and 78.5% after surgery. Conclusion : Resolution and treatment periods are longer in contact granuloma compared to intubation granuloma in the groups of conservative management. (P＜0.05) There is no significant difference of their outcome between conservative management and surgery. (P＞0.05) Although this study is retrospective, conservative management is the first treatment in the management of larynx granuloma.