Partial Obstruction of an Armored Endotracheal Tube during a Carotid Endarterectomy due to Tracheal Deviation in a Pnemonectomized Patient / 대한마취과학회지

Endotracheal tube obstruction during anesthesia can have many causes. Hyperinflation of the remaining lung after a pneumonectomy can severely displace the trachea, and attachment of an endotracheal tube tip to the wall of a deviated trachea may also cause severe airway obstruction. The right lung of the patient was removed 3 years ago due to lung cancer. Compensatory hyperinflation of the left lung and severe right-sided tracheal deviation was seen on a chest X-ray. An armored endotracheal tube without Murphy's eye was used. Two hours after beginning the operation, peak airway pressure and PETCO2 began to increase gradually. A wheezing-like sound was heard. Bronchospasm was suspected, but signs of a spasm were not relieved by medications. The signs completely disappeared after pulling the tube 2 cm proximal. The position of the tube should be confirmed by fiberoptic bronchoscopy or chest X-ray after intubation when the trachea is deviated.

Difficult Endotracheal Intubation by Airway Trauma / 대한마취과학회지

We report a case of unsuspected difficult intubation in an adult due to anatomical abnormalities caused by a thermal burn injury on the right anterior pillar of the pharynx. After induction of anesthesia, vocal cords and epiglottis were not seen and the right half of the pharyngeal cavity was obstructed by a narrowed palatoglossal arch on the laryngoscopic view. Endotracheal intubation trials failed by oral and nasal routes. The laryngeal mask airway could not be passed into the narrowed oropharynx. We awaked the patient and took the patient's past history precisely and an otolaryngologic evaluation was taken. We found that at the age of six, the patient experienced a thermal burn injury on the right anterior pillar of the pharynx by heated iron and anatomical deformities by scar contracture formed thereafter. The next day a partial palatoglossal resection was done in sitting position under local anesthesia and then endotracheal intubation by direct laryngoscopy could be completed successfully.

Superior Vena Caval and Airway Obstruction on Induction of Anesthesia in a Patient with Anterior Mediastinal Mass: A Case Report / 대한마취과학회지

Mediastinal masses may cause life-threatening complications such as major airways obstruction, superior vena caval obstruction, and cardiac compression during general anesthesia. We present a case in which superior vena caval and airway obstruction developed at induction of anesthesia in a patient with an anterior mediastinal mass. Shortly after induction of anesthesia in the supine position, the patient became difficult to ventilate and blood began to flow upward into the IV line. The patient was immediately turned to the right lateral position and allowed to breathe spontaneously. The ventilation of patient was improved significantly and cyanosis of the face and upper extremities disappeared. We think that general anesthesia should be avoided if at all possible in patients with mediastinal mass and alternative methods of diagnosis and management are discussed.

Effect of Saline-Filled or Viscous Lidocaine-Filled Cuff on the Laser-Induced Polyvinyl Chloride Endotracheal Tube Fires and Tidal Volume / 대한마취과학회지

BACKGROUND: There have been a lot of methods that prevent catatrophic airway fires during laser surgery, but none of them can protect endotracheal tube cuff exposed directly to laser beam. This study was performed to know the preventive effect of viscous lidocaine-filled cuffs on laser-induced combustion, and to know how long we can maintain positive pressure ventilation if laser beam broke out cuff perforation. METHODS: Transparent acrylic trachea attached to artificaial lung was intubated with 8.0 ID polyvinylchloride endotracheal tube. Cuff was filled with 8ml of saline or saline and viscous lidocaine mixture with 2:1 or 4:1 ratio. Positive pressure ventilation with air in tidal volume of 500 ml was begun. The laser output was set to 10 watt/sec in the continuous mode with beam diameter of 1 mm. Laser beam was directed perpendicularly at the part of the cuff protruding between endotracheal tube shaft and acrylic trachea, and laser emission was continued until the cuff was perforated or combusted. RESULTS: There was no case of laser-induced fires. After the perforation of cuff, the tidal volume was slowly decreased in 2:1 mixture of saline and viscous lidocaine filled cuff compared to others (P<0.05). CONCLUSION: 2:1 mixture of saline and viscous lidocaine may be used as an efficient inflating material of endotracheal tube cuffs on laser airway surgery.

The Effect of Cuff Volume of Laryngeal Mask Airway on Cuff Pressure and Ventilation / 대한마취과학회지

BACKGROUND: The cuff inflation of laryngeal mask airway (LMA) with excessive volume of air may injure soft tissue and nerves around hypopharynx because of high cuff pressure. But it is not well known about adequate cuff volume of LMA. The cuff inflation of LMA in hypopharynx accomodate pharynx, so various injection volume may differ in sealing effect. This may influence ventilation. This study was proposed to investigate the effect of cuff volume on cuff pressure and ventilation when LMA inserted. METHODS: Fifteen male patients were inserted with #4 LMA, fifteen female patients were inserted #3 LMA. For male patients, 10, 20, 30 and 40 ml of air were injected into cuff of LMA and 10, 15, 20 and 25 ml for female patients. Cuff pressure, minute ventilation and airway pressure were randomly measured. RESULTS: Volume of injected into cuff and cuff pressure of LMA were closly related. But minute ventilation and airway pressure were not related with injected air volume of LMA. CONCLUSION: Excessive volume of air injected to LMA cuff was not beneficial to ventilation. So minimal sealing cuff volume under maximal recommended volume of LMA may reduce the incidence of complications associated with high cuff pressure.