Unilateral hypoglossal nerve palsy after endotracheal intubation for general anesthesia in a difficult airway patient: A case report

Hypoglossal nerve palsy after general anesthesia is an exceptionally rare complication, which has varied etiology. We present a case of unilateral hypoglossal nerve palsy resulting from repeated airway intervention for general anesthesia. A 57-year-old woman was scheduled to undergo modified radical mastectomy. During endotracheal intubation, the patient had Cormack's grade III-a severe airway condition. After the first intubation attempt failed, the intubation was attempted a second time using a stylet inside the endotracheal tube with cricoid pressure; this attempt was successful. In the evening of the operation day, the patient complained of dysarthria and dysphagia. Physical examination revealed deviation of the tongue to the right, which may have been caused by traumatic hypoglossal nerve injury. This case reviews the pathophysiology, prevention, and management of hypoglossal nerve palsy.

Arytenoid dislocation after uneventful endotracheal intubation: a case report / 대한마취과학회지

Arytenoid dislocation is an unusual complication of endotracheal intubation. We reported a case of a 48-year-old female with arytenoid dislocation after uneventful endotracheal intubation, which was successfully treated with arytenoid reduction. The patient complained of persistent hoarseness until the fourth day after an uneventful gynecologic surgery under general anesthesia. On laryngoscopic examination, paralyzed left vocal cord with minimal arytenoid movement was observed. An anteromedial dislocation of the left arytenoid cartilage was suspected and surgical reduction was performed by the laryngologist. The hoarseness was immediately resolved after surgical intervention. Anesthesiologists should be careful not to cause laryngeal trauma in anesthetized patients. In addition, early diagnosis and prompt surgical reduction are essential for a better prognosis for arytenoid dislocation.

A study of lower facial change according to facial type when virtually vertical dimension increases / 대한치과보철학회지

PURPOSE: The aim of this study was to evaluate the effect of increased vertical dimension of occlusion on lower facial changes by facial type. MATERIALS AND METHODS: Lateral cephalograms from 261 patients were obtained and classified by sagittal (Class I, II, and III) and vertical (hypodivergent, normodivergent, and hyperdivergent) facial patterns. Retrusive displacement of soft tissue Pogonion and downward displacement of soft tissue Menton were measured in each group after 2 mm of vertical dimension of occlusion was increased at the lower central incisor using a virtual simulation program. The ratio of both displacements was calculated in all groups. The statistical analysis was done by 2-way ANOVA and Post hoc was done by Tukey test (5% level of significance). RESULTS: Retrusive displacement of soft tissue Pogonion in Class III group was statistically different compared to Class I and II, and in vertical facial groups all 3 groups were significantly different (P<.05). Downward displacement of soft tissue Menton showed statistically significant difference between all sagittal groups and vertical groups (P<.05). The ratio of both displacements showed statistically significant difference in all sagittal groups and vertical groups (P<.05), and Class II hyperdivergent group had the highest value. CONCLUSION: Lower facial change was statically significant according to the facial type when vertical dimension of occlusion increased. Class II hyperdivergent facial type showed the highest ratio after increase in vertical dimension of occlusion.

Vital Sign Change after Placement in the Prone Position in an Obese Patient: A case report / 대한마취과학회지

When performing spine surgery, placement of the patient in the prone position with longitudinal padding is most frequently utilized.However, hemodynamics could be compromised by compression of the internal organs, particularly if surgery is being conducted on an morbidly obese patient or on a patient with a soft frame.An increase in the intraabdominal and intrathoracic pressure might cause a perfusion defect of major venous return, a decrease in cardiac output and a defect in pulmonary ventilation and venous congestion within the spinal canal.Accordingly, serious alteration of vital signs or significant expected consequences can occur.We briefly report a case of life-threatening hemodynamic change after placement in the prone position of a morbidly obese patient during general anesthesia.Placing a risky patient on a semi-rigid, stable Wilson frame can be a promising alternative to avoid such intraoperative mishaps.

Randomized Study Comparing the Sniffing Position with the Neutral Position for Lightwand Intubation / 대한마취과학회지

BACKGROUND: The sniffing position is recommended for optimal glottic visualization under direct laryngoscopy. However, there is no study assessing whether sniffing position is superior to a neutral position during lightwand-guided intubation. This prospective, randomized study was performed to compare facilitation of lightwand-guided intubation between the sniffing and neutral positions. METHODS: The study included 180 patients with normal cervical spines requiring tracheal intubation for elective surgery. Patients were randomly allocated into two groups: neutral or sniffing position. Mallampati class, mouth opening distance, thyromental distance, and laryngeal view grade were measured. A lightwand railroaded with an endotracheal tube was bent 90degrees at 5 cm from the distal end for both groups. Time to intubation, success rate and intubation time for the first attempt, hydrodynamic changes, and BIS values were recorded. RESULTS: There were no significant differences in time to intubation, success rate and intubation time of the first trial, hydrodynamic changes, or BIS values between the two positions. CONCLUSIONS: Routine use of the sniffing position does not provide any advantage over the neutral position during lightwand-guided intubation.