• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.27 no.2
• /
• pp.122-125
• /
• 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.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.23 no.4
• /
• pp.179-192
• /
• 2023

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.

• Journal of Environmental Impact Assessment
• /
• v.20 no.2
• /
• pp.97-105
• /
• 2011

도시의 일상생활에서는 시가지의 바람이 나무, 집 등 낮은 건축물 군에 의해 방해되어 보통은 전원의 바람보다 풍속이 저감되는 경우가 많다. 이러한 기존의 바람 흐름이 있는 곳에 건축물이 세워지게 되면 기존의 풍환경은 크게 변화되어 풍속이 약한 곳과 강한 곳이 조성되어 이와 같은 바람이 지표부근의 구조물에 의해 받는 영향은 도시지역에서 강하게 나타나게 된다. 이는 교외나 시골지역은 상대적으로 도시지역에 비해 영향을 적게 받게 된다. 임의의 지역, 특히 도시지역의 경우 기존의 건물이 증축되거나 혹은 새로운 건물이 신축되면 이로 인하여 기존의 바람흐름이 달라지며 이는 인접건물들의 확보하고 있던 자연 환기력의 변화를 야기 시키는 원인이 되기도 한다. 이러한 현상은 건축물에 의해 자연 환기력이 바뀌게 되는 일종의 기존 환경으로 부터의 변화를 의미한다. 본 연구에서는 수치해석을 이용하여 이와 같이 건물의 주변 환경변화, 즉 신축, 증축 등과 같은 변화를 고려하여 그 영향을 예측/분석하였다. 그 결과로 건물의 자연환기력을 전면에서 바람에 의한 압력증가와 후면에서 바람의 흡입에 의한 압력감소로 인해 전면의 풍속에 의해 발생하는 동압보다 큰 압력차가 발생하고, 그로 인해 환기량이 발생하는 것을 알수 있다. 주변 변화에 의해서는 동일한 규모의 건물이 추가되는 경우에 기존의 경우에 비해 35~45%의 자연환기격이 감소되는 것으로 나타났다.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.16 no.4
• /
• pp.313-316
• /
• 2016

Airway obstruction in pediatric patients always poses a challenge for anesthesiologists. Beckwith-Wiedemann syndrome causes various abnormalities such as macroglossia and omphalocele. Patients with these abnormalities often need corrective surgeries. Management of difficult airway caused by conditions such as macroglossia in patients with this syndrome could be challenging. We encountered a case of difficult airway in an infant with Beckwith-Wiedemann syndrome. It was predicted that macroglossia might cause difficult ventilation, intubation, and extubation. Preoperative assessment and preparations for difficult airway should be considered.

• Journal of Yeungnam Medical Science
• /
• v.5 no.2
• /
• pp.213-219
• /
• 1988

In the geriatric patient with COPD, incidence of postoperative pulmonary complication is higher than young patient. Therefore, some anesthesiologists preferred spinal anesthesia to general anesthesia for surgery of the perineum, lower extrimities, and pelvic extra peritoneal organs. But, during spinal anesthesia, the same careful observation is requiered as during general anesthesia. We experienced a case of the convulsive seizure at about 1 hour after spinal anesthesia for open prostatectomy in a 76-year-old male patient wit COPD. It was suspected that his convulsive seizure be resulted from hypercapnea combined with hypoxia following upper airway obstruction. This patient was treated successfully by ultrashort acting barbiturate and controlled ventilation.

• Advances in pediatric surgery
• /
• v.11 no.2
• /
• pp.123-130
• /
• 2005

Gastric perforation of the newborn is a rare and life threatening problem. The pathogenesis of gastric perforation is not clear. Since ischemia is responsible for intestinal perforation, a similar mechanism may result in gastric perforation. Twelve patients with neonatal gastric perforation who were treated at the Department of Pediatric Surgery, Hanyang University Hospital from 1987 to 2002 were reviewed. Eight patients were male and four female. The age of perforation was 1 day to 8 days of life. Ten patients were operated upon and 2 patients were treated nonoperatively. The perforation site was located on the anterior wall along the greater curvature of the stomach in 8 patients and along the lessor curvature of the stomach in 2. The precipitating factors were prematurity, gastroschisis, mechanical ventilation, intestinal obstruction, cyanotic heart disease and indomethacine medication. In 5 cases the cause of perforation was not identified. The mortality rate was 25 % (3 of 12). Earlier recognition and treatment were thought to be crucial prognostic factors.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1983.05a
• /
• pp.5.4-6
• /
• 1983

A tracheostomy is performed to relieve an upper airway obstruction, to facilitate bronchial toilet, to decrease dead space, to assist ventilation and as an elective procedure in head and neck surgery. Many complications are associated with tracheostomy, both in the actual performance of the operation and in the postoperative management. Recently the authors report one case ; a two years old children got a severe burn on face and neck and received tracheostomy and have carried tracheostomy cannula for 10 years, at last the cannula was worn out and the 12 years old boy came to the hospital.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.19 no.4
• /
• pp.235-238
• /
• 2019

Corticobasal degeneration (CBD) is a rare neurodegenerative disease characterized by dystonia, cognitive deficits, and an asymmetric akinetic-rigid syndrome. Little information is available regarding anesthetic management for CBD patients. Our patient was a 55-year-old man with CBD complicated by central sleep apnea (CSA). Due to the risk of perioperative breathing instability associated with anesthetic use, a laryngeal mask airway was used during anesthesia with propofol. Spontaneous respiration was stable under general anesthesia. However, respiratory depression occurred following surgery, necessitating insertion of a nasopharyngeal airway. Since no respiratory depression had occurred during maintenance of the airway using the laryngeal mask, we suspected an upper airway obstruction caused by displacement of the tongue due to residual propofol. Residual anesthetics may cause postoperative respiratory depression in patients with CBD. Therefore, continuous postoperative monitoring of $SpO_2$ and preparations to support postoperative ventilation are necessary.

• Tuberculosis and Respiratory Diseases
• /
• v.46 no.5
• /
• pp.628-635
• /
• 1999

Background : Maximal expiratory flow rate is determined by the size of airway, elastic recoil pressure and the collapsibility of airway in the lung. The obstruction of expiratory flow is one of the major functional impairments of emphysema, which represents COPD. Nevertheless, expiratory narrowing of upper airway may be recruited as a mechanism for minimizing airway collapse, and maintaining lung volume and hyperinflation by an endogenous positive end-expiratory pressure in patients with airflow obstruction. We investigated the physiologic role of trachea in respiration in emphysema. Method : We included 20 patients diagnosed as emphysema by radiologic and physiologic criteria from January to August in 1997 at Seoul Municipal Boramae Hospital. Chest roentgenogram, high resolution computed tomography(HRCT), and pulmonary function tests including arterial blood gas analysis and body plethysmography were taken from each patient. Cross-sectional area of trachea was measured according to the respiratory cycle on the level of aortic arch by HRCT and calibrated with body surface area. We compared this corrected area with such parameters of pulmonary function tests as $PaCO_2$, $PaO_2$, airway resistance, lung compliance and so on. Results : Expiratory cross-sectional area of trachea had significant correlation with $PaCO_2$ (r=-0.61, p<0.05), $PaO_2$ (r=0.6, p<0.05), and minute ventilation (r=0.73, p<0.05), but inspiratory cross-sectional area did not (r=-0.22, p>0.05 with $PaCO_2$, r=0.26, p>0.05 with $PaO_2$, and r=0.44, p>0.05 with minute ventilation). Minute ventilation had significant correlation with tidal volume (r=0.45, p<0.05), but it had no significant correlation with respiratory frequency (r=-0.31, p>0.05). Cross-sectional area of trachea had no significant correlation with other parameters of pulmonary function including $FEV_1$, FVC, $FEV_1$/FVC, peak expiratory flow, residual volume, diffusing capacity, airway resistance, and lung compliance, whether the area was expiratory or inspiratory. Conclusion : Cross-sectional area of trachea narrowed during expiration in emphysema, and its expiratory area had significant correlation with $PaCO_2$, $PaO_2$, and minute ventilation.

• Archives of Plastic Surgery
• /
• v.39 no.6
• /
• pp.612-617
• /
• 2012

Background Packing after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone. Methods Nasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey. Results In the experimental group, the nasal respiration volume 1 day after surgery remained at $71.3%{\pm}6.84%$ on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group ($2.80{\pm}0.4$) was not significantly different from the control group ($2.88{\pm}0.33$). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience. Conclusions The nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.