BACKGROUND: Many parameters are being used today to assess difficulty of intubation. This study was done to determine the validity of a new device, the Lee Thyromental Ruler (LTR), in the prediction of degree of difficult intubation. METHODS: A prospective, single-blinded cross sectional study was used. 187 patients scheduled for elective surgery under general endotracheal anesthesia were enrolled in the study. All residents of the Department of Anesthesiology of the Veterans Memorial Medical Center were taught how to use the LTR. Preoperative assessments were done on each patient using the following stepwise evaluation plan: (1) thyromental distance measurement in terms of fingerbreadths, (2) airway asseSsment using the Mallampati classification, (3) assessment of range of neck flexion and extension, and (4) thyromental distance measurement using the LTR. These were correlated with the number of attempts to intubate and the degree of glottic exposure during laryngoscopy by Cormack and Lehane as measures for difficulty of intubation RESULTS: The study showed that TMD by LTR using 5.3 cm had higher sensitivity (90 percent) and specificity (83.6 percent) than TMD by fingerbreadth for prediction of degree of difficulty of intubation as measured by the number of attempts to intubate. There was no significant difference in the number of attempts among patients distributed according to Mallampati classification and range of neck flexion and extension. Only the Mallampati classification showed a significant difference among the distribution of subjects according to the Cormack and Lehane grading of glottic exposure during laryngoscopy. CONCLUSION: The Lee Thyromental Ruler is therefore a more valid measure of the thyromental distance as compared to use of fingerbreadths. It is inexpensive, reliable, easy to use and its design allows its use in patients with different anatomical variations. It would thus aid in the prediction of difficult intubation and avoid the complications associated with multiple intubation attempts and failed intubation. (Author)
Human ; INTUBATION ; ANESTHESIA ; ENDOTRACHEAL ; SURGERY ; ELECTIVE, ANESTHESIOLOGY

Many authors have reported that the most frequent etiology of pneumothorax under general endotracheal anesthesia is high intratracheal pressure, and that bullae and certain pathologic lesions of the lung are predisposing factors for pneumothorax. We have experienced a case of sudden unilateral tension pneumothorax immedipediately following induction of anesthesia in a patient whose chest P-A X-ray revealed a stabilized old-tuberculotic lesion in the right upper lung field. We report this, case with a review of the literature of pneumothorax, especially pertaining to etlology and clinical clinical manifestations.
Anesthesia* ; Anesthesia, Endotracheal ; Causality ; Humans ; Lung ; Pneumothorax* ; Thorax

BACKGROUND: This study undertook to compare the effect-site concentration of remifentanil for prevention of hemodynamic responses to endotracheal intubation, employing the single-lumen tracheal tube and the double-lumen bronchial tube during total intravenous anesthesia. METHODS: Based on the nature of the surgery, 38 patients undergoing general anesthesia were assigned either to the single-lumen tube group or the double-lumen tube group. Anesthesia was induced by a target controlled infusion of propofol, with an effect-site concentration of 4 µg/ml. Remifentanil was then administered to the first patient in each group, with an effect-site concentration of 3.5 ng/ml. Subsequent concentration of remifentanil was determined by hemodynamic responses of the previous patient to intubation, based on the up-and-down method. RESULTS: The effect-site concentrations of remifentanil for prevention of hemodynamic responses to endotracheal intubation in 50% of patients (EC₅₀) were 2.8 ng/ml (95% CI, 2.0–3.7 ng/ml) in the single-lumen tube group, and 2.9 ng/ml (95% CI, 2.5–3.2 ng/ml) in the double-lumen tube group. No significant difference was observed between the two groups. CONCLUSIONS: The effect-site concentration of remifentanil for prevention of hemodynamic responses to endotracheal intubation did not differ during total intravenous anesthesia, using either the single-lumen tracheal tube or the double-lumen bronchial tube.
Anesthesia ; Anesthesia, Endotracheal ; Anesthesia, General ; Anesthesia, Intravenous ; Hemodynamics* ; Humans ; Intubation* ; Intubation, Intratracheal ; Methods ; Propofol

The authors have been experienced a case of laryngeal granuloma following endotracheal anesthesia which is rare in children and have used two different method of general anesthesia for resection of granuloma. These two methods are; 1) using endotracheal tube insertion for general anesthesia. 2) applying general anesthesia via under mask. Comparing with two different methods of general anesthesia, we come to the conclusion that the former is more reliable for clinical anesthesia because of supplying continuous positive pressure with oxygen and anesthetics in spite of poor operation field.
Anesthesia ; Anesthesia, Endotracheal ; Anesthesia, General* ; Anesthetics ; Child ; Granuloma* ; Granuloma, Laryngeal* ; Humans ; Masks ; Methods ; Oxygen

A case of sudden cardiac arrest due to misplaced tracheostomy cannula was reviewed. The genera1 condition of the patient was febrile, dyspneic and acutely ill. Emergency tracheostomy was performed under ketamine-halothane endotracheal anesthesia. Sudden cardiac arrest was noticed when a metal cannula was inserted through the tracheostomy site by the surgeon after the tracheostomy. Immediate closed chest cardiac massage was performed successfully.
Anesthesia, Endotracheal ; Catheters* ; Death, Sudden, Cardiac ; Diphtheria* ; Emergencies ; Heart Arrest* ; Heart Massage ; Humans ; Thorax ; Tracheostomy*

At Orthopaedic Department of Kyung Hee University Hospital, we performed 50 total knee replacement in 32 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1987. We studied these cases and compared the results of total knee replacement surgery in preoperative ambulatory patients(group I ) with those in preoperative non-ambulatory patients(group II ). 1. Preoperatively, 19 patients were able to walk, and 13 patients were unable to walk. 2. 7 patients of bilateral TKR(36.8%) were included in group I, and 11 patients (86.9%) in group II. 3. The improvement of range of motion after TKR was greater in group II (34 degrees) and in group I, average postoperative range of motion was similar to the average preoperative ROM. 4. Flexion contracture was more markedly improved in group II. 5. In group I, the average preoperative knee rating score by Hospital for Special Surgery rating system was 38.8 and improved to 93.4 postoperatively. In group II, the average preoperative knee rating score was 27.4 and improved to 85.7 postoperatively. 6. Postoperatively most of the patients were able to walk without support except one cases of infection(group I ) and the other who had severe rheumatoid involvements in other joints (group II ). 7. Preoperative evaluation for involvements of cervical spine and surrounding soft tissue structure was necessary endotracheal anesthesia. 8. There was 2 cases of complications in group I, and 4 cases in group II.
Anesthesia, Endotracheal ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Contracture ; Humans ; Joints ; Knee ; Range of Motion, Articular ; Spine

The effect of various drugs on the incidence and severity of hypertension, tachycardia and emergence phenomena associated with ketamine anesthesia were investigated in many studies. Lorazepam is a psychotropic agent of the benzodiazepine class. similar in action to, but more potent than, diazepam. This study was carried out to investigate the efficiency of the ketamine I.V. drip technique under endotracheal intubation with a combination of nitrous oxide, oxygen, muscle relaxant and controlled ventilation. The only contraindications to the use of this technique were hypertension, a history of cerebrovascular disease or psychotic upset. Eighteen patients, ranging in age from 20 to 60 years, were premedicated with I.M. atropine sulfate and oral lorazepam (2mg/kg) administration. Anesthesia was induced with 1.5~2,0mg/kg ketamine and 0.03~0.04mg/kg alcuronium, before intubation. Anesthesia was maintained by dripping 0. l% ketamine in 5% dextrose in water, with N2O and 02, The average dosage of ketamine was l. 685mg/kg for induction and 0.011mg/kg/min for maintenance during operations with a duration of from 55 to 275 minutes. Alcuronium is a non-depolarizing muscle relaxant and a derivative of C-toxiferine l. It has a little ganglionic blocking effect. The increase of blood pressure after endotracheal intubation was not significant. The incidence of complications of anesthesia was increased blood pressure 16. 7% (20mmHg above preop. value), tachycardia 38. 9% , dreams 5. 6 % and hallucination 5. 6%. Also oral premedication with lorazepam provided significant anterograde amnesia in all patients. It may be concluded that a combination of oral premedication by lorazepam and ketamine I.V. drip anesthesia with N2,O, O2 and alcuronium, followed by endotracheal intubation, can be used relatively satisfactorily in explo-laparatory operations in which muscle relaxation is needed.
Alcuronium ; Amnesia, Anterograde ; Anesthesia ; Anesthesia, Endotracheal* ; Atropine ; Benzodiazepines ; Blood Pressure ; Cerebrovascular Disorders ; Clinical Study* ; Diazepam ; Dreams ; Ganglion Cysts ; Glucose ; Hallucinations ; Humans ; Hypertension ; Incidence ; Intubation ; Intubation, Intratracheal ; Ketamine ; Lorazepam ; Muscle Relaxation ; Nitrous Oxide ; Oxygen ; Premedication ; Tachycardia ; Ventilation ; Water