어려운 기도관리의 최신지견 - anesthesia.or.kr

1 107 87 , . , . , , . 1970 34% 1990 14% , . 85% . , . , . , , , , , , 2008 [1].

2 2003 [2] (dif-ficult airway) . , . a) , , , b) ( , , , , ) , , .. , . 87 108 Table 1.

3 (interincisor) (thyromental) (maxillary incisors) Mallampati class II 3 cm 3 (6 cm) Table 2. 1. : 2. 3. : (stylet), , (light wand), (forceps) 4. : ILMA Proseal LMA, C-trach5. 6. (retrograde) 7. : Combitube, , (transtracheal) 8.

4 , Table 1 .. , ( ), , . , Mallampati , , , . CT MRI . , .. CT MRI . 1. , , . Table 2.

5 2. , , .. 2003 (Fig. 1) , 109 Fig. 1. 2003 . 87 110 Table 4. Nebulizers entire airwayTopical sprays and gels upper airwayTranstracheal injection larynx and trachea Spray as you go larynx and tracheaNerve blocks distribution of the nerve supplyCombinations of the aboveTable 3. [3]Supraglottic airway device insertionDirect laryngoscopy and intubationBlind nasal intubationRetrograde intubationFlexible fiberoptic laryngoscopy and intubationRigid indirect optical devices and intubation.

6 Rocuronium sugammadex . 3. , preoxygenation , . 4. 3 . 5. Sellick . 6. , . 7. , . 8. , Combitube . 9. , . , . , , (Table 3).

7 , , (Table 4) .. , , .. , . , , .. , . ( , ) . , .. combitube, (TTJV) (rigid bronchoscope) Table 5 . TTJV.

8 111 Table 5. 1. (light wand) (Gliedscope, McGrath, Pentax AWSS ) (blades) ( ) 2. 2 (transtracheal jet ventilation) - (esophageal tracheal combitube) CobraPLA (Cobra perilalyngeal airway), Laryngeal tube Cookgas Air-Q airway (emphysema) .. kit . TTJV.

9 , , . , , . , , , .. 1.. , American Society of Anesthesiologists Task Force on Management of the difficult airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: Henderson J. Airway Management in the Adult, Miller's anesthesia . Edited by Ronald D.

10 Miller, Lars I. Eriksson, Lee A. Fleisher JPW-K, William L. Young, Elsevier Inc, 87 Table 1. Time ScheduleWeekEducational program1 2 3 4 5 6 7 8 Introduction, FOB grip, FOB and monitor instruction, cleansing and keeping of FOB, simulation training with mannequinNasal inspection, Oral inspection with OvassapianOral intubation (with or without Ovassapian)Oral intubation without OvassapianNasal intubation, confirm intubation tube position, confirm double lumen tube positionFOB guided intubation through ILMA/LMA, Airtraq and etc., reverse angle intubationLobar broncus selection, tube change with FOB Awake intubation, spray as you go, nerve block, leadership training in difficult airway management.