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Dental complications associated with neonatal intubation in preterm infants
Kim, Ik-Hwan,Kang, Chung-Min,Song, Je Seon,Lee, Jae-Ho The Korean Dental Society of Anesthsiology 2019 Journal of Dental Anesthesia and Pain Medicine Vol.19 No.5
This paper describes the potential oral complications in preterm infants who have undergone orotracheal intubation. Neonatal intubation may have adverse effects on the developing deciduous teeth, oral soft tissues, and even the permanent teeth. However, endotracheal intubation may be essential for the survival of premature infants, owing to incomplete tracheal development. Excessive pressure to the oral tissue must be avoided, in cases where orotracheal intubation is inevitable. Moreover, the potential oral complications must be considered when neonatal intubation is performed for the patient's survival, and subsequent reevaluation and proper oral health care are needed.
치과치료를 위한 전신마취 환자 중 기관삽관이 어려운 환자에서 구강카메라를 이용한 증례
송영균,김승오,Song, Young-Gyun,Kim, Seung-Oh 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.1
Dental treatment under general anesthesia is considered a good way for behavioral control in disabled patients. General anesthesia for disabled patients sometimes requires difficult airway management. In this case, intra-oral camera is great helpful to intubation. Originally, the intra-oral camera is designed to facilitate diagnosis dental disease. The intra-oral camera is very efficient on intubation. Laryngeal photo taken by Intra-oral camera can be good guide for difficult intubation. In this report, an 11-year-old boy with chromosomal anomaly received dental care under general anesthesia. And he had a potentially difficult airway. We achieved nasotracheal intubation successfully with intra-oral camera.
Gupta Nishkarsh,Gupta Anju,Sarma Riniki,Batra Atul,Madan Karan 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.5
Background: Nasotracheal intubation (NTI) is commonly performed in oromaxillofacial surgeries. We did this meta-analysis to ascertain whether use of video laryngoscopy (VL) provided better NTI characteristics as compared to direct laryngoscopy (DL) in patients undergoing oromaxillofacial surgeries. Methods: We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oromaxillofacial surgery. The primary outcome was time to intubation. Secondary outcomes included the first attempt success, overall success, incidence of nasal bleeding, Cormack and Lehane grade, and maneuvers required. Results: Of the 456 studies identified following a systematic search, 10 were included. Meta- analysis showed a significantly lower time to tracheal intubation favoring VL (mean difference: –9.04, 95% CI [–12.71, –5.36], P < 0.001; I2 = 59%). VL was also associated with a greater first attempt success (relative risk [RR]: 1.10, 95% CI [1.04, 1.16], P = 0.001). Maneuvers to facilitate intubation were less with VL (RR: 0.22, 95% CI [0.10, 0.51], P < 0.001). There was no difference in overall intubation success (RR: 1.04, 95% CI [0.98, 1.10], P = 0.17). The incidence of bleeding did not differ between the DL and VL groups (RR: 0.59, 95% CI [0.32, 1.08], P = 0.09). Conclusions: Evidence as per this meta-analysis suggests VL leads to a shorter time to NTI, a greater first attempt success rate, and reduced need for maneuvers when compared to DL. The present study supports use of VL as a first line device for NTI in oral-maxillofacial surgeries in experienced hands.
Submental intubation: alternative short-term airway management in maxillofacial trauma
Ravi Raja Kumar,Suresh Vyloppilli,Shermil Sayd,Annamala Thangavelu,Benny Joseph,Auswaf Ahsan 대한구강악안면외과학회 2016 대한구강악안면외과학회지 Vol.42 No.3
Objectives: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.
Air leakage due to the cuff hanging on the vocal cords during nasotracheal intubation: a case report
유승화,감명환,박세웅,김현정,서광석 대한치과마취과학회 2023 Journal of Dental Anesthesia and Pain Medicine Vol.23 No.1
Nasotracheal intubation is commonly performed under general anesthesia in oral and maxillofacial surgery. For the convenience of surgery, nasal Ring-Adair-Elwyn (RAE) tubes are mainly used. Because the nasal RAE tubes were bent in an “L” shape, the insertion depth was limited. Particularly, it is necessary to accurately determine the appropriate depth of the RAE tubes in children. Several types of nasal RAE tubes are used in the medical market, which vary in material and length. We performed endotracheal intubation using a nasal RAE tube for double-jaw surgery, but air leakage persisted even when the air pressure in the cuff was increased. When checked with a laryngoscope, it was confirmed that the tube was pushed out, and the cuff was caught on the vocal cords, causing air leakage. Since inserting the tube deeply did not solve the problem, replacing it with a nasal RAE tube (PolarTM, Preformed Tracheal Tube, Smith Medical, Inc., USA) did not cause air leakage; thus, we reported this case.
Nasotracheal intubation in pediatrics: a narrative review
김지은,전수영 대한치과마취과학회 2024 Journal of Dental Anesthesia and Pain Medicine Vol.24 No.2
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.
유승화,박경남,감명환 대한치과마취과학회 2024 Journal of Dental Anesthesia and Pain Medicine Vol.24 No.1
The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.
상악골 Le Fort I 골절 환자에서 경구 기관 내 삽관 하에서의 악간고정 및 정복: 증례보고
최은주,이석련,Choi, Eun-Joo,Lee, Seok-Ryun 대한치과마취과학회 2014 Journal of Dental Anesthesia and Pain Medicine Vol.14 No.4
In order to reduce jaw fracture accompanied by basal skull or nasal fracture, submental intubation could be generally performed. Albeit submental intubation has been widely accepted, it could develop complications such as nerve injury, glandular duct injury, and orocutaneous fistula. Here, we suggest oral intubation for overcoming complications and providing more stable surgical environment in emergency case. Under oral intubation maintaining in retromolar triangle and buccal corridor space, intermaxillary fixation was successfully underwent in 38-years-old female patient with Le Fort I fracture accompanied by pneumocephalus.
The evaluation of a scoring system in airway management after oral cancer surgery
Lee, Ho-Jin,Kim, Jin-Wook,Choi, So-Young,Kim, Chin-Soo,Kwon, Tae-Geon,Paeng, Jun-Youg Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-
Background: The purpose of this retrospective study was to investigate the usefulness of tracheostomy scoring system in the decision of postoperative airway management in oral cancer patients. Materials and methods: A total of 104 patients were reviewed in this retrospective study, who underwent radical resection with or without neck dissection and free flap reconstruction due to oral cancer. The patients were classified into three groups according to the timing of the extubation; extubated groups (n = 51), overnight intubation group (n = 45), and tracheostomy group (n = 8). Cameron's score was used to evaluate the relation between the state of the patient's airway and the type of the operation. Results: Tracheostomy was performed in eight patients (8/104, 7.7 %). A total of 22 patients (21.2 %) had more than 5 points of which 17 patients (77.3 %) did not have a tracheostomy and any postoperative emergency airway problems. The tracheostomy scores were significantly different among the three groups. Hospital stay showed a significant correlation with the tracheostomy score. Conclusions: The scoring system did not quite agree with the airway management of the authors' clinic; however, it can be one of the clinical factors predicting the degree of the postoperative airway obstruction and surgical aggressiveness for recovery. The further studies are needed for clinically more reliable scoring systems.