Prediction of difficult intubation in patients with postburn sternomental contractures: modified onah class / 대한마취과학회지

BACKGROUND: Postburn sternomental contractures cause various changes in mouth, oral cavity, pharynx, larynx and related structures. Although there are many methods to predict difficult intubation, the modified Mallampati test (mMT) and the El-Ganzouri multivariate risk index (EGRI) are popular tests. The authors wanted to compare modified Onah class with these 2 tests and also explored the possibility that Onah class could be an adequate independent predictor for difficult intubation. METHODS: One hundred and nine patients, aged 18 to 60 years of age, scheduled for elective surgery for reconstruction of postburn sternomental contractures were divided according to the modified Onah class. We made assessments prior to general anesthesia with respect to mouth opening, thyromental distance, mMT, neck movement, ability to prognath, body weight, and history of difficult tracheal intubation. The accuracy, specificity, positive and negative predictive values were calculated from the data of the 3 tests, and as the 3 tests were compared with patient's laryngoscopic view grade according to Cormack and Lehane criteria by using the Chi-square test. RESULTS: The incidence of Cormack and Lehane grade III, IV was 39.4%. Onah class showed significantly higher accuracy, specificity, and positive predictive value than mMT and EGRI. There were significant correlations between modified Onah class 2b, 3 and the Cormack and Lehane grade III, IV. CONCLUSIONS: Application of modified Onah class for preoperative prediction of the degree of difficulty with laryngeal visualization can reduce the frequency of both an unanticipated failure to visualize laryngeal structures as well as potential unnecessary interventions related to over-prediction of airway difficulty in patients with postburn sternomental contractures.

Suggestions for Improving Doctor's Opinion for the National Long-term Care Insurance

Applicants for care services offered by the National Long-term Care Insurance are required to submit a written docu- ment of assessments performed by a physician.These documents are used as a secondary source to determine the level of long-term care required by the applicant. Though necessary, physicians have not received evaluation or fee-dback regarding this process. We surveyed doctors, members of committees for long-term care level assessment, and long-term care team staff of the national health insurance corporation. What was considered useful information differed among the three groups. Integrating the feedback from these groups, we suggested improvements that could be made to this assessment process.

Retropharyngeal Laceration during Nasotracheal Intubation: A case report / 대한마취과학회지

Nasotracheal intubation is a useful airway management technique for head, neck, and dental surgery. However, the risks associated with this technique include the possibility of damaging the nasal mucosa and related structures including the epistaxis, pharyngolaryngeal mucosal injury, bleeding, avulsion of the turbinate, nasal polyps, sinusitis, and bacteremia. Some of these symptoms occasionally result in fatal complications. A 26-year-old male, was scheduled to undergo surgery for malocclusion type 3 under general anesthesia with nasotracheal intubation. During the nasotracheal intubation, the tip of nasotracheal tube entered into the retropharyngeal space through the nasopharyngeal wall instead of oropharyngeal space, however no blood aspiration and retropharyngeal swelling occured. After surgery, the patient was treated with broad spectrum antibiotics and conservative management, and was completely cured without further complications.

Glossodynia as an Unusual Manifestation of Vitamin B12 Deficiency: A case report / 대한통증학회지

A 58-year old male patient, with a history of gastrectomy, came to our department for recently aggravated glossodynia. A delicate physical examination revealed gait ataxia and a positive Rhomberg test. He was diagnosed as having vitamin B12 deficiency using a combination of the laboratory results, such as macrocytic anemia. It was thought that the tongue pain might have been a main clinical manifestation of vitamin B12 deficiency.