A Review of Intubation Techniques in Anaesthetic Management of Temporomandibular Joint Ankylosis

Intubation of a patient with temporomandibular joint ankylosis is a challenge for every anaesthesiologist. Dependable anaesthetic technique is most desired by all anaesthesiologists. The purpose of the present article is to have a brief overview of temporomandibular joint ankylosis, its clinical features, management and to review literature demonstrating various intubation techniques available to an anaesthesiologist while managing patients with temporomandibular joint ankylosis.

Bronchial Cuff Inflation Technique for Proper Positioning of Double-lumen Endobronchial Tube / 대한마취과학회지

BACKGROUND: Accurate placement of double-lumen endobronchial tube(DLT) is essential for successful one-lung anesthesia. This study was performed to evaluate the effectiveness of bronchial cuff inflation technique for accurate placement of DLT. METHODS: One hundred and five patients undergoing elective thoracotomy which required the use of DLTs were studied. Following induction of anesthesia, the tip of the left-sided DLT was advanced just past the vocal cords, the stylet in the endobronchial lumen was removed and the tube was rotated 90 degrees counterclockwise. After rotation of DLT, the bronchial cuff was inflated with air(4-6 ml) and the tube was advanced until resistance to further passage was encountered. After deflating of the bronchial cuff, the tube was advanced 2 cm more distally. The fiberoptic bronchoscopy was then introduced into the tracheal lumen of the tube and the tube's position was evaluated. RESULTS: In the 100 patients out of 105 patients, the tube was inserted into the left side bronchus correctly. In the 77 patients(77 %) out of 100 patients, the position of DLTs was evaluated as ideally placed. In the 16 patients(16 %), the tube was evaluated as too deeply inserted into the appropriate bronchus and in the other 7 patients, the tube was too shallow. But only one patient needed repositioning. CONCLUSIONS: Bronchial cuff inflation technique may be useful for accurate placement of DLT for the one-lung anesthesia in the situation without fiberoptic bronchoscope.

The Analysis of Anesthetic Management of 156 Infants with Congenital Hypertrophic Pyloric Stenosis / 대한마취과학회지

Congenital hypertrophic pyloric stenosis is one of the most common gasttointestinal abnonnalities occurring in the first six months of life. Although the primary therapy for pyloric stenosis is surgical, it is essential to realize that pyloric stenosis is medical and not a surgical emergency. Preoperative preparation is the primary factor contributing to the low perioperative complication rates and the necessity to recognize fluid and electrolyte imbalance is the key to successful anesthetic management. The anesthetic records of 156 infants with congenital hypertrophic pyloric stenosis were reviewed. Seventy-six per cent of the infants were male(i.e., 3:1 male to female ratio). Surgical correction was undertaken between age of 2 and 3 weeks, and the average weight of the infants at the time of surgery was 3.74+/-0.68 kg. All the infants received general anesthesia for the surgical procedure and assist respiration through the laryngeal mask airway was applied increasingly from 1992. There were no perioperative deaths.

Comparative Study of Hemodynamic Changes and Complications following Lightwand of Laryngoscopic Intubation / 대한마취과학회지

The purpose of this randomized, prospective study was to compare the intubation time, hemodynamic effect and complication rates of orotracheal intubation performed by direct laryngoscopic or lighted stylet (lightwand) methods in the controlled settings of the operating room. After approval of clinical investigation committee and informed consent from patients, healthy ASA class 1 and 2 elective surgical patients were studied. On arrival to operating room, EKG, radial arterial cannulation to monitor blood pressure continously and neuromuscular monitoring device were applied to patients. Anesthesia was induced with fentanyl 3 ug/kg, thiopental 4 mg/kg and vecuronium 0.15 mg/kg to facilliate relaxation. Ventilation was controlled for 5 min by facemask with oxygen-isoflurane (1.2 vol%) or enflurane(1.7 vol%) before intubation. The patients were intubated randomly using either direct curved laryngoscope (DL, 37 patients) or lightwand (LW, 36 patients). The time to intubation (TTI) was recorded. The mean arterial pressure(MAP) and heart rate(HR) were recoreded every 30 sec after intubation for 5 min. The changes of MAP and HR after intubation were compared with pre-intubation value. After extubation, complications such as mucosal trauma and postoperative sore throat were recorded. The data were analyzed using either unpaired t-test or Chi-square analysis, where appropriate. There were no failed intuhation in either groups. There was no significant differences between the groups with respect to sex, age, weight, height, existence of nasogastric tube. The TTI was similar between groups(14.5+/-8.1 sec for LW, 16.8+/-9.5 sec for DL). There was no differences in incidence of trauma(19.4% for LW, 16.2% for DL) between groups. There were no statistically significant difference in the maximal increase in MAP(44% for LW, 55% for DL at 30 sec) and HR(25.6% for LW, 24.1% for DL at 30 sec) and during 5 min following intubation. In canclusion, even though the hemadynamic effect after intubation was not influenced by using LW, the results of this study indicate that the use of the LW is as useful, effective and safe method as using DL for oro-endotracheal intubation. Further study may prove that using the LW to be an effective alternative technique of intubation in patients with difficult airway.