무증상의 후두개곡 낭종 환자에서 예기치 못한 어려운 기관내 삽관 1례 = Unanticipated Difficult Intubation in a Patient with an Asymptomatic Vallecular Cyst : A Case Report

다국어 초록 (Multilingual Abstract)

Although vallecular cyst is often asymptomatic and harmless to the patient, discovery of large vallecular cyst after induction of anesthesia is a potentially life-threatening problem for thepatient and provides for the anesthesiologist a challenge in airway management. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large vallecular cyst that was discovered during induction of general anesthesia. A 47-year-old man presented for elective laparoscopic colecystectomy due to GB polyp. He had normal mouth opening and neck extension; no mass or distortions of the tongue or neck were observed. Anesthesia and paralysis were induced with 80 ㎎ propofol, alfentanil 0.5 ㎎, midazolam 2.0 ㎎ and rocuromum 50 ㎎. It was noted that ventilation of the lungs via mask was difficult. Despite insertion of an oropharyngeal airway, ventilation proved to be more difficult. Intubation was attempted. Direct laryngoscopy (Macintosh 3 blade) revealed a 3-4 ㎝ tranlucent cyst arising from the left vallecula. The cyst completely obscured the view of epiglottis and vocal cords, preventing intubation despite multiple attempts by three anesthesiologists. StafF anesthesiologist was aspirated cyst using a 16-guage needle, syringe and 20 ㎖ of serous fluid were aspirated from cyst. The epiglottis and vocal cord were then exposed and tracheal intubation was performed easily with a size 7.0 cuffed oral tracheal tube. Anesthesia and the operation then proceeded uneventfully, following laparoscopic colecystectomy, an ENT surgeon removed the cyst.