하악골 부분절제술을 받은 환자에서 발생한 기도 관리 실패
Failed Airway Management in a Patient with Wound Hematoma After Partial Mandibulectomy and Reconstruction with Free Flap
김석곤, 송재격, 강봉진, 김철환, 최규운,
소속 상세정보
김석곤 ( Kim Seok-Kon ) - 단국대학교 의과대학 마취통증의학교실
송재격 ( Song Jae-Gyok ) - 단국대학교 의과대학 마취통증의학교실
강봉진 ( Kang Bong-Jin ) - 단국대학교 의과대학 마취통증의학교실
김철환 ( Kim Cheol-Whan ) - 단국대학교 치과대학 구강악안면외과학교실
최규운 ( Choi Gyu-Woon ) - 단국대학교 의과대학 마취통증의학교실
KMID : 0980220130130030127
Abstract
We experienced failed airway management in a patient who had partial mandibulectomy and reconstruction with free-flap. 40 year-old man (height: 164 cm, body weight: 59 kg) with malignant melanoma on #38 tooth area of mandibular body was scheduled for partial mandibulectomy and reconstruction with free flap. Approximately fifteen-hours after surgery, the patient was extubated without complication. Seven hours after extubation, we experienced respiratory failure andfailed airway managementdue to airway edema and neck. We failed orotracheal intubation with direct laryngoscopy andlaryngeal mask airway, thus we tried tracheostomy but the patient was hypoxic state for more than 30 minutes. The patient had got hypoxic brain damage in whole cerebral cortex and basal ganglia. We should have the policy of airway management of the patients who have massive oro-maxillo-facial surgery and all medical personnel who treat these patients should be educated the policy and airway management methods.
키워드
Difficult airway; Hypoxemia; Nasotracheal intubation; Tracheostomy; Wound hematoma
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