부산대학교 도서관

In this case report we present successful airway management in a patient with predicted difficult airway using the Dificult Airway Society guidelines. Our patient presented with recurrence of severely reduced mouth opening due to post-traumatic bilateral temporomandibular ankylosis, and was scheduled for surgical resection of the mandibular articular processes. Awake fiberoptic intubation was planned. After light sedation and thorough topicalization of the nasal cavity the flexible optic bronchoscope was successfully navigated into the trachea with 'spray-as-you-go' technique and the endotracheal tube was railroaded over it. After a two-point check of the endotracheal tube placement the patient was put under anesthesia. The surgery was uneventful. Finally, a plan with surgeons for safe extubation was made and the patient was extubated uneventfully on the next day using the airway exchange catheter in the intensive care unit. Key words: Awake tracheal intubation; At-risk extubation; Dificult airway; Trismus U ovom prikazu slucaja opisujemo uspjesno zbrinjavanje disnoga puta u bolesnika s predvidenim otezanim disnim putom primjenjujuci smjernice koje je izdalo Dificult Airway Society. Bolesnik se prezentirao otezanim otvaranjem usta posljedicno obostranoj post-traumatskoj ankilozi temporomandibularnih zglobova. Planirana je budna fiberopticka intubacija za kirursku resekciju obaju mandibularnih zglobnih nastavaka. Nakon lagane sedacije i temeljite topikalizacije nosne supljine feksibilni opticki bronhoskop je uspjesno navigiran u traheju tehnikom spray-as-you-go te je endotrahealni tubus postavljen preko njega. Nakon dvostruke provjere polozaja endotrahealnog tubusa bolesnik je anestetiziran. Kirurski zahvat je protekao bez neocekivanih dogadaja. U dogovoru s operaterima primijenjen je plan za sigurnu ekstubaciju te je ona ucinjena bez neocekivanih dogadaja dan kasnije primjenom tzv. katetera 'izmjenjivaca' u jedinici intenzivnog lijecenja. Kljucne rijeci: Trahealna intubacija na budno; Rizicna ekstubacija; Otezani disni put; Trizmus
Introduction Temporomandibular joint (TMJ) ankylosis often occurs after misdiagnosis, delayed treatment, inadequate surgery, prolonged immobilization, or insufficient physiotherapy for intracapsular or subcondylar mandibular fractures. This condition is challenging to treat [...]