• Journal of Chest Surgery
• /
• 제32권8호
• /
• pp.765-767
• /
• 1999

기관 삽관으로 인한 기관 기관지 파열은 매우 드문 합병증이다. 저자들은 이중관 튜브의 삽관후 발생한 기관 파열을 경험하였다. 76세 여자 환자가 간헐적인 기침과 흉부 불편감을 주소로 내원하였다. 재발된 선천성 좌측주 기관지 식도 루 진단하에 수술을 시행하였다. 수술중 우연히 기관파열이 관찰되었고 기관파\ulcorner은 풍선의 과팽창에 의한 것이었으며 파열부위의 기관을 prolene과 흡수성 봉합사를 이용하여 단단 문합 하였다. 수술후 환자는 합병 증없이 퇴원하였으며 외래를 통해 추적 관찰 중이다.

• 대한기관식도과학회지
• /
• 제3권2호
• /
• pp.261-269
• /
• 1997

When performing an endotracheal intubation or tracheotomy to an unconscious patient in emergent situations, one should consider the possibility of later complication of laryngo-tracheal stenosis which can result in difficulties in decannulation. Laryngo-tracheal stenosis is a bothersome problem developing as a complication of treatment by tracheotomy with a cuffed tube and long-term endotracheal intubation with assisted ventilation. One hundred twenty-three cases of laryngo-tracheal stenosis patients during the four yew period from May 1992 to April 1996 were restrospectively reviewed according to several parameters such as the duration of intubation, site of stenosis, treatment modality and, site of tracheostoma. The present report is an analysis of these materials to search for the possible etiologic factors and its proper preventive methods. It was desirable that the endotracheal intubation should be limited within 20 days at most. Tracheotomy performed by non-otolaryngologists has a tendency to be on a higher level of trachea. Technical precautions should be taken into consideration when doing a tracheotomy. The success rate of decannulation of tracheal T-tube was 78.8% and it required average 11 months.

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

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제24권2호
• /
• pp.81-90
• /
• 2024

Nasotracheal intubation (NTI) plays an important role in pediatric airway management, offering advantages in specific situations, such as oral and maxillofacial surgery and situations requiring stable tube positioning. However, compared to adults, NTI in children presents unique challenges owing to anatomical differences and limited space. This limited space, in combination with a large tongue and short mandible, along with large tonsils and adenoids, can complicate intubation. Owing to the short tracheal length in pediatric patients, it is crucial to place the tube at the correct depth to prevent it from being displaced due to neck movements, and causing injury to the glottis. The equipment used for NTI includes different tube types, direct laryngoscopy vs. video laryngoscopy, and fiberoptic bronchoscopy. Considering pediatric anatomy, the advantages of video laryngoscopy have been questioned. Studies comparing different techniques have provided insights into their efficacy. Determining the appropriate size and depth of nasotracheal tubes for pediatric patients remains a challenge. Various formulas based on age, weight, and height have been explored, including the recommendation of depth-mark-based NTI. This review provides a comprehensive overview of NTI in pediatric patients, including the relevant anatomy, equipment, clinical judgment, and possible complications.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제21권2호
• /
• pp.167-171
• /
• 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.

• 한국응급구조학회지
• /
• 제24권2호
• /
• pp.123-131
• /
• 2020

Purpose: This study aimed to find out the effectiveness of gum elastic bougies for intubation in comparison to stylet according to airway type using a manikin. Methods: The study subjects were 52 paramedic students who intubated using a Macintosh laryngoscope and compared stylet and gum elastic bougie use in a 7.5 mmID endotracheal tube, on a manikin with either normal or difficult airway. Difficult airway was made Philadelphia neck collar. Collected data included intubation time, accuracy and ease of intubation, later analyzed by frequency analysis, descriptive analysis, independent t-test, chi square test, paired t-test, and McNemar test using SPSS Statistics 18.0. Results: There was a significant difference in intubation time according to intubation device and airway type (p=.000). There was no significant difference in accuracy of intubation according to intubation device or airway type (normal airway p=1.000, difficult airway p=.052). There was a significant difference in ease of intubation scale according to intubation device and airway type (p=.000, p=.000). Conclusion: Based on the speed and ease of intubation, gum elastic bougie is recommended for intubation in patients with difficult airways such as those with cervical injury.

• 대한두개안면성형외과학회지
• /
• 제24권2호
• /
• pp.87-90
• /
• 2023

Endotracheal intubation is often necessary in the course of animal experiments, especially in craniofacial surgery. However, endotracheal intubation can be a major burden in this context. The authors performed simple and cost-saving method using a 200 µL yellow micropipette tip, and the success of this method was demonstrated by X-ray and autopsy. We used a total of 30 rats. After the rats were fixed with a plaster, the trachea and vocal cords were visualized with the tongue pulled back. Under direct visualization of the vocal cords, a curving micropipette tip was advanced into the trachea. This method can be learned quickly and applied successfully by general experimenters. We successfully intubated all 30 rats without any complications. The success rate of micropipette tip intubation was 100%. This procedure was performed by one experimenter within 2 to 3 minutes after induction of anesthesia. We demonstrated its superiority by X-ray and autopsy. Herein, we describe endotracheal intubation of rats using micropipette tips. To the best of our knowledge, this method is novel and represents the simplest and most efficient means of intubation in rats, providing an alternative to conventional endotracheal intubation.

• 대한치과마취과학회지
• /
• 제10권2호
• /
• pp.190-196
• /
• 2010

Difficult airway management including difficult intubation, difficult ventilation and difficult mask ventilation is a life threatening issue during anesthesia care. A 23-year-old woman with Treacher Collins syndrome was scheduled for distraction osteogenesis. She had hypoplasia of mandible and malar bone, bilateral deformities of auricles with partial deafness and antimongoloid slant of the palpebral fissures. A 56-year-old woman with mandibular hypoplasia due to childhood trauma was scheduled for distraction osteogenesis. She had a history of difficult intubation. We anticipated a difficult intubation and ventilation. Fiberoptic bronchoscopic guided awake intubation was selected for anesthesia induction. After intravenous injection of midazolam and remifentanil, 10% lidocaine pump spray on the pharyngolarynx with a direct laryngoscope and on the nasal canal. However fiberoptic bronchoscopic guided awake intubation was failed due to severe gag reflex. After intravenous injection of propofol and remifentanil using the target controlled infusion (TCI), mask ventilation was easily performed and, after intravenous injection of vecuronium, fiberoptic bronchoscopic guided intubation was easily performed using a wire reinforced endotracheal tube. The operation was completed successfully without any adverse events.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제17권4호
• /
• pp.281-287
• /
• 2017

Background: Various techniques have been introduced to decrease complications during nasotracheal intubation. A common practice is to use nasal packing with a cotton stick and 0.01% epinephrine jelly. However, this procedure can be painful to patients and can damage the nasal mucosa. Xylometazoline spray can induce effective vasoconstriction of the nasal mucosa without direct nasal trauma. In this study, we aimed to compare the efficacy of these two methods. Methods: Patients were randomly allocated into two groups (n = 40 each): xylometazoline spray group or epinephrine packing group. After the induction of general anesthesia, patients allocated to the xylometazoline spray group were treated with xylometazoline spray to induce nasal cavity mucosa vasoconstriction, and the epinephrine packing group was treated with nasal packing with two cotton sticks and 0.01% epinephrine jelly. The number of attempts to insert the endotracheal tube into the nasopharynx, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. An anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5 min after intubation and postoperative complications. Results: No significant intergroup difference was observed in navigability (P = 0.465). The xylometazoline spray group showed significantly less epistaxis during intubation (P = 0.02). However, no differences were observed in epistaxis 5 min after intubation or postoperative epistaxis (P = 0.201). No inter-group differences were observed in complications related to nasal intubation and nasal pain. Conclusion: Xylometazoline spray is a good alternative to nasal packing for nasal preparation before nasotracheal intubation.

• 대한치과마취과학회지
• /
• 제13권4호
• /
• pp.189-193
• /
• 2013

We experienced dfficult airway management in a patient who had Ludwig angina with morbid obesity, dfficulty with mouth opening and neck extension. We planned to perform awake-nasotracheal intubation with fiberoptic bronchoscopy but the patient's condition was not suitable to do this procedure. Thus, we tried fiberoptic nasotracheal intubation under general anesthesia but we experienced difficult airway management due to epistaxis. We tried to use video laryngoscope instead of fiberpotic bronchoscopy but also failed to guide the tube into trachea due to limited mouth opening. We used video laryngoscope to make a view of vocal cord and used fiberoptic bronchoscope as an intubation guide of endotrachedal tube and successfully intubated the patient.