• Journal of Yeungnam Medical Science
• /
• 제22권1호
• /
• pp.104-112
• /
• 2005

Because of location, a mediastinal mass may cause complications such as a major airway obstruction, a superior vena caval obstruction, and cardiac compression during general anesthesia. The patient's condition need to be assessed by several methods to predict the risks associated with general anesthesia. The authors took computed tomographs for a preoperative evaluation of two patients with an anterior mediastinal mass, and the risk of perioperative complications was predicted by measuring the tracheal area. The patients were managed according to the preoperative evaluation but severe ventilation impairments were encountered during anesthesia. In one patient, stable ventilation could not be maintained until spontaneous breathing appeared. The operation was cancelled and the patient was brought into the ICU. In the other patient, a tracheal tube was inserted deeper in an attempt to pass the narrowed tracheal portion due to mediastinal tumor compression resulting in improved ventilation.

• Journal of Chest Surgery
• /
• 제26권4호
• /
• pp.260-265
• /
• 1993

Twelve patients underwent surgical correction of total anomalous pulmonary venous connection[TAPVC] between Sep. 1989 and May 1993. There were 9 boys and 3 girls whose ages ranged from 10 days to 17 month [median 1.2 month]. Six patients were less than 1 month of age at operation. The anomalous drainage was supracardiac in 6, cardiac in 2, infracardiac in 2, and mixed in 2. There were 3 early death, and its mortality rate was 25%. There were no operative mortality after Sep. 1991. Age at operation, presence of preoperative pulmonary venous obstruction, preoperative assisted ventilation and type of anomaly did not affect early mortality. Late pulmonary venous obstruction was developed in 4 patients between 1 month to 4 month after operation. Among these patients, 2 were died and one was reoperated and well, and the other one was not operated because of patient`s refusal. We conclude that late pulmonary venous obstruction is fatal and its early detection and correction is important for improving late survival.

• Tuberculosis and Respiratory Diseases
• /
• 제48권2호
• /
• pp.268-273
• /
• 2000

A 32-year-old woman complaining of cough, sputum, and chest discomfort for the past ten days was admitted to the hospital. The radiologic findings were transradiant left lung with reduced number and size of vessels, mediastinal shifting to the right at expiration, matched ventilation-perfusion defect on ventilation-perfusion scan, and diffuse hypoplasia of the left pulmonary artery and i1s branches on the pulmonary angiography. We describe a case of unilateral hyperlucent lung by main bronchus obstruction in a patient who presents a clinical picture suggestive of the Swyer-James syndrome.

• Tuberculosis and Respiratory Diseases
• /
• 제77권4호
• /
• pp.193-196
• /
• 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in lifethreatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

• 대한두경부종양학회지
• /
• 제34권2호
• /
• pp.77-80
• /
• 2018

Subglottic cysts have been reported as a relatively rare problem of pediatrics who have a history of premature birth and period of intubation. They may cause significant upper airway obstruction and many cases require tracheostomy to airway management. Endoscopic marsupialization by microinstruments or laser has been standard primary treatment but a high recurrence rate has been reported. A 19-month-old child presented with stridor who has history of ventilation via an endotracheal intubation in the newborn period for 7 days. Radiologic examinations were performed for aggravated dyspnea symptom and subglottic cystic mass was found, then it was marsupialized at operation room and tracheostomy was done at the same time. After decannulation of tracheostomy tube, there is no recurrence of cyst nor upper airway obstruction for 29 months. We report this case with a review of literature.

• 대한두개안면성형외과학회지
• /
• 제9권2호
• /
• pp.77-80
• /
• 2008

Purpose: The majority of nasal fractures have been treated by closed reduction. And they were manipulated under local anesthesia or general anesthesia. Under the local anesthesia, patients can feel the pain and fear, so general anesthesia through the endotracheal intubation became popularized recently to treat the nasal fracture. But it has still the drawbacks of postanesthetic complication. Therefore, under the mask ventilation anesthesia using oral airway, we tried to manipulate the nasal fracture. Methods: From July 2007 to November 2007, we worked with fifty patients that were manipulated the nasal fracture. Fifty patients were divided into two groups, general anesthesia with the endotracheal intubation group(n=25) and the mask ventilation using oral airway group(n=25). We checked up the anesthesia time, postanesthetic complication, postoperative aesthetic & functional problem of nose in two groups. Results: In total operation time and sore throat frequency among the postoperative anesthetic complications, there was statistically significant difference between the mask ventilation group and the endotracheal intubation group(p<0.05). But there was no difference statistically in nausea frequency(p>0.05). And no patients complained of postoperative nasal complication such as septal deviation, septal perforation, nasal obstruction and hump nose in two groups. Conclusion: Through the mask ventilation using oral airway, we could reach satisfactory results in the anesthetic time and postanesthetic complication.

• Journal of Chest Surgery
• /
• 제26권8호
• /
• pp.664-666
• /
• 1993

A technique for insertion of a long silicone T-tube in patient with critical stenosis and high-risk resection and primary anastomosis of long segment of the distal trachea is presented. It was not easy to insert a long T-tube by existing methods because of flexibility of a T-tube and tightness of stenosis. So we used a silastic endotracheal tube and guiding wire as stylet of a T-tube. During insertion, ventilation was normally maintained through the lumen of endotracheal tube. This provided rapid relief from airway obstruction and asphyxation and is a easy, safe and effective method to restore patency of the major airways.

• Clinical and Experimental Pediatrics
• /
• 제48권4호
• /
• pp.401-405
• /
• 2005

목 적 : 급성 호흡부전증, 호흡중추장애, 신경근 질환 등으로 인한 만성 호흡부전 환자들이 가정용 인공 호흡기의 도입으로 가정에서 기계 환기를 받을 수 있게 되어 생명을 연장시키고, 삶의 질을 향상시킬 수 있어 그 사용하는 예가 증가하고 있다. 그러나 이에 대한 임상자료가 거의 없어 저자들은 인공 호흡기를 장착한 환아들을 대상으로 임상실태를 조사하였다. 방 법 : 1997년부터 2003년까지 서울아산병원 소아 중환자실에 입원 후 가정용 인공 호흡기를 장착한 21명의 환아들을 대상으로 하여 후향적으로 의무기록을 분석하고 전화면담을 시행하였다. 결 과 : 대상 환아들은 21명으로 남아 15명, 여아 6명이었다. 인공 호흡기를 장착하였을 때 중간 연령은 31개월(범위 : 2-150개월)이었으며, 호흡기를 장착한 중간 기간은 25개월(범위 : 2-68개월)이었다. 환아들의 원인 질환으로는 호흡중추장애를 포함한 신경근 질환이 16례, 급성 호흡곤란을 포함한 폐질환이 4례, 유전성 대사질환이 1례였다. 인공 호흡기 양식은 압력 조절 양식이 16례(76%), 용적 조절 양식이 5례(24%), 산소가 필요한 경우는 13례(62%)였고, 인공 호흡기를 조금이라도 이탈할 수 있었던 경우는 3례(14%)였다. 기계고장은 19개월마다 1회 발생하였고, 인공 호흡기 장착 후 평균 입원 횟수는 매년 1.7회, 그 원인으로는 폐렴(68%)이 가장 많았다. 추적 관찰한 결과 사망한 환아는 9명(43%)이었고, 사망원인은 기관지 튜브 폐쇄가 4례였다. 인공 호흡기 대여, 산소발생기, 영양식, 진찰 및 치료비용 등을 포함한 모든 의료비용은 월간 평균 111만원이었다. 결 론 : 최근 가정용 인공 호흡기 사용이 증가하고 있으며, 사망원인으로 기관지 튜브 폐쇄가 많아 주의 및 관리를 필요로 하고 인공 호흡기를 장착한 가정에 경제적 어려움이 있어 사회적 관심과 제도적 지원이 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
• /
• 제44권3호
• /
• pp.574-582
• /
• 1997

연구배경 : 정상인에서는 운동부하시 증가되는 환기량의 요구를 초기에는 상시호흡량의 증가로 후기에는 호흡수의 증가로 충족시키며, 호흡수 증가에 따라 유발되는 호흡주기의 감소를 보상하기 위해 흡기책임비율이 50% 이상까지 증가하는 것으로 알려져 있다. 반면 만성기도폐쇄 환자에서는 환기능력의 감소와 생리적 사강 호흡의 증가로 인해 최대운동부하시 얕고 빠른 호흡양상을 보인다고 알려져 있지만 책임비율의 변화에 대해서는 연구가 많지 않고 이와 기도폐쇄정도와의 관련성에 대해서는 보고가 없는 실정이다. 방 법 : 12명의 만성기도폐쇄 환자와 10명의 정상인을 대조로 점진적 최대운동부하검사를 실시하였다. 결과 분석은 안정시에서 최대운동부하시점까지의 시간을 100%로 하여 rest, 20%, 40%, 60%, 80%, max 등% control duration으로 분획한 후 각 시점에서 1분 환기량, 상시호흡량, 호흡수, 생리적 사강비율, 흡기책임비율 등의 지표를 양군 간에 비교하였다. 결 과 : 1분환기량과 상시호흡량의 안정시에서 최대운동시까지의 변화는 양군 간에 유의한 차이가 관찰되었으나 호흡수는 유의한 차이를 나타내지 않았다. 생리적사강 비율은 정상대조군에 비해 만성기도폐쇄군에서 그 감소가 유의하게 낮았다. 흡기책임비율은 정상대조군에서 $38.4{\pm}3.0%$에서 $48.6{\pm}4.5%$로 증가한 반면 만성기도폐쇄군에서는 $40.5{\pm}2.2%$에서 $42.6{\pm}3.5%$로 별 변화가 없어 양군간에 유의한 변화의 차이가 있음을 확인할 수 있었고 이러한 흡기책임비율의 변화는 기도폐쇄정도 (FEV1%)와 유의한 상관관계가 있음을 확인할 수 있었다. (r=0.8151, p<0.05). 결 론 : 이상의 결과에서 만성기도폐쇄 환자는 최대운동부하시 정상에서 관찰되는 흡기책임비율의 증가가 발생하지 않으며 이는 기도폐쇄의 정도와 유의한 상관성을 갖고 있음을 확인할 수 있었다.

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