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Syngnathia 환자의 기도관리 : Airway management for Syngnathia

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Authors

김현정; 염광원; 이종호

Issue Date
1998-07
Publisher
대한구강악안면외과학회
Citation
대한구강악안면외과학회지 24 323,1998
Keywords
syngnathiaairwayintubation
Abstract
Syngnathia(maxillomandidular fusion) is a rare congenital anomaly involving soft
tissue bony adhesions between the maxilla and mandible. Bony fusion, as in this case, is
extremely rare and to the time, no specific anesthetic management has been reported.
In our case, physical examinition of the 130-day infant patient(weight 5.5㎏) with
syngnathia revealed apparent left side fusion between maxilla and mandible. The opening
between upper and lower gingiva was limited to 10㎜ on the right side. Left choanal
atresia, microstomia, low set ears and blue sclera were also detected.
When patient arrived at the OR.5ℓ/min oxygen was administered using nasal prong
with end-tidal CO2 monnitoring cannula though mough. Glycopyrrolate
0.1mg and ketamine 5㎎ were administered intravenously. A solution of 2% lidocaine 2㎖
and 0.1% phenylephrine 1㎖ was used to topicalize the right nostril. Subanesthetic
doses(2∼3mg) of ketamine were used to provide sedation while maintaining spontaneous
ventilation. Warm, softed I.D. 3.5㎜ preformed nasotracheal tube was inserted via the
rigrht nostril with a 3.2㎜ O.D. fiberoptic bronchoscope. After that vecuronium and
dexamethasone were given intravenously. The Infant had been anesthetized uneventfully
with isoflurane.
Fiberoptic nasotracheal intubation under spontaneous ventilation using low doses of
ketamine offers a safe and non-invasive technique compared with tracheostomy or blind
nasotracheal intubtion. To increase safey, oxygen should be given via nasal or oral
routes and adequate monitoring, especially capnography and pulse oxymeter, should be
performed.
ISSN
1225-1585
Language
Korean
URI
https://hdl.handle.net/10371/74329
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