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Airway Management in the Patients of Expected Difficult Intubation -A Case Report-

대한치과마취과학회지 2010년 10권 2호 p.190 ~ 196
오세리, 이진한,
소속 상세정보
오세리 ( O Se-Ri ) - 원광대학교 치과대학 구강악안면외과학교실
이진한 ( Lee Jin-Han ) - 원광대학교 치과대학 치과보철학교실

Abstract


Difficult airway management including difficult intubation, difficult ventilation and difficult mask ventilation is a life threatening issue during anesthesia care. A 23-year-old woman with Treacher Collins syndrome was scheduled for distraction osteogenesis. She had hypoplasia of mandible and malar bone, bilateral deformities of auricles with partial deafness and antimongoloid slant of the palpebral fissures. A 56-year-old woman with mandibular hypoplasia due to childhood trauma was scheduled for distraction osteogenesis. She had a history of difficult intubation. We anticipated a difficult intubation and ventilation. Fiberoptic bronchoscopic guided awake intubation was selected for anesthesia induction. After intravenous injection of midazolam and remifentanil, 10% lidocaine pump spray on the pharyngolarynx with a direct laryngoscope and on the nasal canal. However fiberoptic bronchoscopic guided awake intubation was failed due to severe gag reflex. After intravenous injection of propofol and remifentanil using the target controlled infusion (TCI), mask ventilation was easily performed and, after intravenous injection of vecuronium, fiberoptic bronchoscopic guided intubation was easily performed using a wire reinforced endotracheal tube. The operation was completed successfully without any adverse events.

키워드

Difficult Intubation; Fiberoptic guided Intubation; Treacher Collins syndrome; Mandibular hypoplasia

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