Management of unanticipated difficult airway in a patient with well-visualized vocal cords using video laryngoscopy- A case report -

Background@#Difficult airway occurs due to anatomical abnormalities of the airway that can be predicted through airway assessments; however, abnormalities beyond the vocal cord can be clinically asymptomatic and undetected until intubation failure to advance the endotracheal tube.Case: We present a case of an unanticipated difficult airway in a stuporous 80-year-old female with a recent history of intracerebral hemorrhage and prolonged intubation. She required emergency ventriculo-peritoneal shunt surgery due to the progression of her hydrocephalus. Under anesthesia, facemask ventilation was easy and video laryngoscopy provided a full view of the glottis; however, endotracheal tube (ETT) entry failed. We suspected stenosis beyond the vocal cord, and a smaller diameter ETT was inserted and maintained for airway management during emergency surgery. Postoperative neck computed tomography findings revealed laryngotracheal stenosis (LTS). @*Conclusions@#Anesthesiologists should be aware that LTS may be asymptomatic and consider difficult airway guidelines in patients with history of prolonged endotracheal intubation.

Fat Myringoplasty Trimmed with CO2 Laser / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fat myringoplasty is a simple and safe method for repairing tympanic membrane perforation. The purpose of this study was to investigate the effect of fat myringoplasty accompanied by CO2 laser treatment for the trimming of perforation. MATERIALS AND METHOD: Twenty-one patients diagnosed with the following tympanic membrane perforations were used: 1) Traumatic perforation, 2) Chronic otitis media without active inflammation, 3) Re-perforation after middle ear surgery. The procedure was performed at OPD under local anesthesia while operating a microscope that was adapted to the CO2 laser. RESULTS: The overall success rate was 81 percent (17/21). CONCLUSION: Fat myringoplasty can be recommended for repairing tympanic membrane perforation in traumatic, chronic otitis media and re-perforation after middle ear surgery. Fat myringoplasty was simple and effective on only small perforations (

Effects of Laser Myringotomy on the Treatment of Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otitis media, with effusion has been known to require long term medical treatment. When medical treatment fails, myringotomy with or without ventilation tube insertion needs to be performed, but the duration of middle ear ventilation with myringotomy is very limited. The insertion of ventilation tubes may also cause some complications, and may require general anesthesia when performing at a young age. The purpose of this report is to see if myringotomy using CO laser can be used as an effective tool in the treatment of otitis media with effusion. MATERIALS AND METHODS: We retrospectively studied 66 ears of patients who went through myringotomy using CO laser between March, 1998 and May, 1999. We analyzed myringotomy size, patency time, recurrence and cost effectiveness. RESULTS: The average size of myringotorny was 2.1 mm in diameter. It remained patent for as long as 1.9 weeks in average. All myringotomy sites were healed without persistent perforations. Average recurrence rate and time were 27% and 3.2months, respectively. The medical treatment is expensive and needs more frequent follow-ups, but laser treatment is cheaper and requires less frequent follow-ups. CONCLUSIONS: CO laser myringotomy is a safe and cost effective procedure which can be done easily at the office in most of the cases.