Implementation and Outcomes of a Difficult Airway Code Team Composed of Anesthesiologists in a Korean Tertiary Hospital: A Retrospective Analysis of a Prospective Registry

정희준,Choi Ji Won,Kim Duk Kyung,Lee Sang Hyun,Lee Soo Yeon 대한의학회 2022 Journal of Korean medical science Vol.37 No.3

Background: In 2017, we established an airway call (AC) team composed of anesthesiologists to improve emergency airway management outside the operating room. In this retrospective analysis of prospectively collected data from the airway registry, we describe the characteristics of patients attended to and practices by the AC team during the first 4 years of implementation. Methods: All AC team activations in which an airway intervention was performed by the AC team between June 2017 and May 2021 were analyzed. Results: In all, 359 events were analyzed. Activation was more common outside of working hours (62.1%) and from the intensive care unit (85.0%); 36.2% of AC activations were due to known or anticipated difficult airway, most commonly because of acquired airway anomalies (n = 49), followed by airway edema or bleeding (n = 32) and very young age (≤ 1 years; n = 30). In 71.3% of the cases, successful intubation was performed by the AC team at the first attempt. However, three or more attempts were performed in 33 cases. The most common device used for successful intubation was the videolaryngoscope (59.7%). Tracheal intubation by the AC team failed in nine patients, who then required surgical airway insertion by otolaryngologists. However, there were no airway-related deaths. Conclusions: When coupled with appropriate assistance from an otolaryngologist AC system, an AC team composed of anesthesiologists could be an efficient way to provide safe airway management outside the operating room.

마네킹을 이용한 어려운 기도에서 부지 기관 내 삽관의 효과

심규식,방성환,안희정 사단법인 한국응급구조학회 2020 한국응급구조학회지 Vol.24 No.2

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.

Cervical collar makes difficult airway: a simulation study using the LEMON criteria

Moonsu Yuk,Woonhyung Yeo,Kangeui Lee,고정인,Taejin Park 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.1

Objective Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway. Methods This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application. Results The mean inter-incisor distance significantly decreased from 4.3 to 2.6 cm (P<0.001). Fifty-seven participants classified as I and II were newly classified as III and IV according to the modified Mallampati classification after cervical collar application (16% to 91%). The angles of neck extension significantly decreased from 44° to 22° after cervical collar application (P<0.001). Before cervical collar application, our simulations predicted that 14 of 76 participants (18%) would have a difficult airway, whereas after cervical collar application, 76 of 76 (100%) were predicted to have a difficult airway. Conclusion All values for the LEMON criteria (mouth opening, modified Mallampati classification, and neck extension) worsened significantly after cervical collar application. Additionally, a difficult airway was predicted in all participants after cervical collar application.

소아 환자에서 성대위 기도 기구의 사용

정찬종 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.1

Supraglottic airway devices (SADs) have become prevalent inchildren because they avoid many of the adverse effects associatedwith endotracheal intubation. The laryngeal mask airway (LMA)Classic and the LMA Proseal have proven safe and efficacious forroutine cases in pediatric patients. The LMA Proseal provides abetter airway seal and protection against aspiration than the LMAClassic in children. Most SADs are designed for airway maintenanceduring routine anesthesia, but other roles include rescueairway after failed intubation, conduit to facilitate difficult intubationand as an adjunct device for special situations in or outside thehospital (e.g., neonatal resuscitation). Recently developed secondgenerationSADs, the i-gel and the LMA Supreme may be a suitablealternative for airway management when a single-use device withgastric access is needed in children. The Air-Q intubating laryngealairway may be feasible as a conduit for tracheal intubation forpediatric patients with a difficult airway. This review article discussesthe safety and efficacy of SADs in children.

혈관종으로 안면기형이 있는 환자의 전신마취 경험 -증례보고-

김동찬 ( Dong Chan Kim ),이지혜 ( Ji Hye Lee ),김정희 ( Jung Hee Kim ),이성녀 ( Sung Nyu Lee ),김덕규 ( Deokkyu Kim ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.1

기도관리의 어려움은 마취와 관련된 중요 합병증의 원인 중에 하나이다. 어려운 기도 (difficult airway)에서 기도확보가 늦어지거나 실패한다면 환자는 사망까지 초래될 수 있다. 만약 어려운 기도가 의심된다면 각성 상태 기 관내삽관이나 외과적 기도확보가 추천된다. 저자들은 고관절과 대퇴부의 농양에 대한 수 술이 필요한 52세의 남자 환자에서 안면에 심 한 변형을 유발한 혈관종 때문에 어려운 기도 관리를 경험하였기에 이를 보고하는 바이다. Difficult airway is one of the most important causes of major anesthesia-related complications. If an airway is suspected to be difficult, awake endotracheal intubation or surgical airway were recommended. We report a case that a 52-year-old male underwent a surgery for the abscess of hip and thigh, and he had facial anomaly due to no definite treatment for hemangioma, which is cause of difficult airway.

피열 후두개 낭성 종물 환자의 기도 유지 및 마취관리 1례

김병주,김정원,신동엽,홍기혁 인제대학교 1995 仁濟醫學 Vol.16 No.4

마취과 의사는 어려운 기도나 실패한 기관삽관에 능숙하게 대처할 수 있어야 한다. 특히 구강내 종괴는 기도확보에 어려움을 야기한다. 저자들은 최근에 경험한 피열후두개 낭종을 가진 생후 1개월된 환아의 마취관리 1례를 문헌고찰과 함께 보고한다. The anesthesiologist must have full control of the patient's airway any time. But he may occasionally find himself in a very challenging and dangerous situation, where control of the airway is difficult. Difficulty or failurein intubation is, fortunately, relative rare. However, when failed in intubation, it is life-threatening. This case report describes perioperative management of difficult incubation, including careful perioperative evaluation of the upper airway and provision for a secure perioperative airway.

응급실에서 시행된 기도삽관의 현황과 난이도의 예측

정성필,임태호,장문준,김승호,이한식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : This study was designed to describe the current trends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. Methods : All patients who was taken endotracheal intubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. Results : During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except for 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%). Commonly used drugs were thiopental and vecuronium. The difficult intubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. Conclusion : At this institution, the majority of ED intubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult intubation in ED.

기도확보가 어려운 상황에서 Miller blade와 Macintosh blade를 이용한 기관내삽관의 비교 : 숙련되지 않은 인턴을 대상으로 한 마네킨 연구

이미림,김철태,이효철 사단법인 한국응급구조학회 2018 한국응급구조학회지 Vol.22 No.3

Purpose: The purpose of this study was to compare laryngoscopic views and ease of use and success of intubation, via the percentage of glottic opening (POGO) scale when using the Miller blade and Macintosh blade in paraglossal approach. Methods: Forty intern doctors were randomized for laryngoscopy to be performed in a crossover manner. They performed endotracheal intubation with Miller blade and Macintosh blade in two airway scenarios: normal airway and difficult airway with edema. We observed the rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, ease of intubation, and the POGO scale. Results: In the normal airway, there was no difference in intubation between the two endoscopes. In the difficult airway, the time for visualizing the glottis (7.80 versus 10.24 sec; p=.006), the time to tube passage (19.38 versus 23.03 sec; p=.038) and the time to complete endotracheal intubation (21.84 versus 28.54 sec; p=.022) with Miller blade was shorter than with Macintosh blade. The POGO scale(%) of the Miller blade was higher than that of the Macintosh blade’s (62.25 versus 56.32; p=.030). Conclusion: Compared to the Macintosh blade, Miller blade provided better visualization of the glottis and POGO scale, and faster time to completion of endotracheal intubation.

I-gel과 굴곡성 기관지경을 이용한 기관내 삽관 경험 -증례 보고-

임현경,최춘길,신혜란,이춘수,황성일,이성묵,송장호 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.2

Most anesthesiologists, at one point or another, are faced with a difficult airway. We came upon an unexpected difficult airway and a failed intubation using a direct laryngoscope and lightwand. At this point, we decided to insert an i-gel which is quick and simple. This allowed us to maintain oxygenation and ventilation. After checking for the location of the laryngeal inlet with a flexible fiber optic bronchoscope, a 5.5 mm internal diameter endotracheal tube was inserted into the trachea over the flexible fiber optic bronchoscope. Finally, a suitable a 7.0 mm internal diameter endotracheal tube was inserted using an exchange catheter technique. With respect to this case, we conclused that the i-gel is a very helpful device for endotracheal intubation in patients with difficult airways.

진단받지 않은 후두개와 후두개곡사이낭종으로 인한 어려운 기관 내 삽관

이정하(Jung Ha Lee),허봉하(Bong Ha Heo),윤대훈(Dae Hun Yun) 조선대학교 의학연구원 2020 The Medical Journal of Chosun University Vol.45 No.1

Laryngeal cyst in adults is a rare condition. However, if these cysts are unexpectedly discovered after anesthesia induction, an emergency situation immediately poses a life-threatening condition if proper airway management is not done. The authors report that in the case of difficult intubation tubes after anesthesia induction caused by laryngeal cyst, which was not diagnosed as asymptomatic, the oral intubation was successful without complication using the Clarus Video System (Clarus Medical, USA), an semi-rigid optical stylet. A 67-year-old male presented for laparoscopic radical prostatectomy. We discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet. Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral semi-rigid optical stylet-aided intubation. We experienced difficult intubation due to laryngeal cyst, which had no symptoms of respiratory closures before anesthesia, and in such cases it is believed that systematic preparation for “difficult airways” should be made to prevent hypoxic damage that can result from unexpected intubation failure.