Effectiveness of applying continuous positive airway pressure in a patient with paradoxical vocal fold movement after endotracheal extubation: a case report / 대한마취과학회지

Paradoxical vocal fold movement (PVFM) is an uncommon upper airway disorder defined as paradoxical adduction of the vocal folds during inspiration. The etiology and treatment of PVFM are unclear. The physician should manage this condition because of the possibility of near complete airway obstruction in severe case of PVFM. We report a case of successful airway management in a patient with PVFM by applying continuous positive airway pressure (CPAP). In this case, PVFM was detected after removing an endotracheal tube from a 67-year-old male who underwent excision of a laryngeal mass. The patient recovered without complications in 1 day with support by CPAP.

Lethal coronary air embolism caused by the removal of a double-lumen hemodialysis catheter: a case report / 대한마취과학회지

Coronary air embolism is a rare event. We report a case in which an acute myocardial infarction occurred in the region supplied by the right coronary artery after the removal of a double-lumen hemodialysis catheter. Emergent coronary angiography revealed air bubbles obstructing the mid-segment of the right coronary artery with slow flow phenomenon distally. The patient expired due to myocardial infarction.

A Case of Laryngeal Web Injury during Intubation in Pediatric Patient / 계명의대학술지

Laryngeal web is a rare congenital disease, and its incidence has been estimated to be 1 in 10,000 live births. A 4-year-old female child with laryngeal web was scheduled for laryngeal web removal. Smooth intubation without causing damages to the laryngeal web is important during induction. Also, it is very important to select the appropriate tube size during pediatric anesthesia. There is lack of a registered cuffed micro-laryngeal surgery (MLS) tube 3.5 mm inner diameter (ID) in Korea, and also our hospital did not have an uncuffed MLS tube 4.0 mm ID. Therefore we could not select the appropriate size of the laser tube. The patient's laryngeal web was slightly injured during intubation. We report a case of laryngeal web injury caused by intubation for laryngeal web removal and wish to state that there is lack of a registered laser tube in the size, such as a cuffed MLS tube 3.5 mm ID.

The simultaneous application of positive-end expiratory pressure with the Trendelenburg position minimizes respiratory fluctuations in internal jugular vein size / 대한마취과학회지

BACKGROUND: The respiratory cycle alters the size of the right internal jugular vein (RIJV). We assessed the changes in RIJV size during the respiratory cycle in patients under positive pressure ventilation. Moreover, we examined the effects of positive-end expiratory pressure (PEEP) and the Trendelenburg position on respiratory fluctuations. METHODS: A prospective study of 24 patients undergoing general endotracheal anesthesia was performed. Images of the RIJV were obtained in the supine position with no PEEP (baseline, S0) and after applying three different maneuvers in random order: (1) a PEEP of 10 cmH2O (S10), (2) a 10degrees Trendelenburg tilt position (T0), and (3) a 10degrees Trendelenburg tilt position combined with a PEEP of 10 cmH2O (T10). Using the images when the area was smallest and largest, cross-sectional area (CSA), anteroposterior diameter, and transverse diameter were measured. RESULTS: All maneuvers minimized the fluctuation in RIJV size (all P = 0.0004). During the respiratory cycle, the smallest CSA compared to the largest CSA at S0, S10, T0, and T10 decreased by 28.3 8.5, 8.0, and 4.4%, respectively. Furthermore, compared to S0, a 10degrees Trendelenburg tilt position with a PEEP of 10 cmH2O significantly increased the CSA in the largest areas by 83.8% and in the smallest areas by 169.4%. CONCLUSIONS: A 10degrees Trendelenburg tilt position combined with a PEEP of 10 cmH2O not only increases the size of the RIJV but also reduces fluctuation by the respiratory cycle.