10-이은형

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1 대한응급의학회지제 26 권제 6 호 Volume 26, Number 6, December, 2015 원 저 Airway 비숙련자에서매킨토시후두경과일회용후두경을이용한기관삽관의비교 : 마네킹연구 순천향대학교응급의학교실, 순천향대학교중앙의료원의학통계상담실 1 이은형 최재형 훈 조영순 이정원 이보라 1 Comparison of Tracheal Intubation Using the Macintosh Laryngoscope Versus the Disposable Laryngoscope by Inexperienced Personnel: A Manikin Study Eun Hyeong Lee, M.D., Jae Hyung Choi, M.D., Hoon Lim, M.D., Young Soon Cho, M.D., Jung Won Lee, M.D., Bora Lee, M.S. 1 책임저자 : 최재형경기도부천시원미구조마루로 170 순천향대학교의과대학응급의학교실 Tel: 032) , Fax: 032) emracoon@gmail.com 접수일 : 2015년 6월 26일, 1차교정일 : 2015년 6월 30일게재승인일 : 2015년 10월 4일 Purpose: Disposable one piece laryngoscope (DOL), which probably carries a lower risk of infection than conventional reusable ones, is the only device which has received approval by the Korean Ministry of Food and Drug safety. In the current study, we evaluated the effectiveness and usefulness of the conventional Macintosh laryngoscope (MAC) and DOL in inexperienced personnel. Methods: A randomized crossover trial was designed. Ninety seven participants (Medical students, Paramedic students) were enrolled and performed endotracheal intubation with MAC and DOL in Manikin (SimMan Laedal Medical Corporation, Stravanger; Norway). Cormack- Lehane grade, the number of attempts, time required for intubation, and dental compression were measured to evaluate the effectiveness. The participants were given a questionnaire survey on the usefulness of laryngoscopes (easier to use, lightness, brightness, manageable to use, delivering power, safer for patients, intense to use). Results: Regarding the aspect of effectiveness, a significant difference in dental compression was observed between DOL and MAC (p=0.011). Others showed no significant differences. Regarding the aspect of usefulness, DOL was superior to MAC except in delivering power. Conclusion: The DOL appears to be a reasonable device for use in emergency airway management. It should be verified for effectiveness and usefulness of newly developed equipment in emergency airway management because it is directly related to life. Key Words: Disposable equipment, Laryngoscopes, Intubation, Airway management Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Department of Biostatistic Consulting, Soonchunhyang University Medical Center 1, Gyeonggido, Korea Article Summary What is already known in the previous study Disposable laryngoscope (DOL), which probably carries a lower risk of infection than conventional reusable ones, is the only device which has received approval from the Korean Ministry of Food and Drug safety. What is new in the current study Regarding the aspect of effectiveness, a significant difference in dental compression was observed between DOL and Macintosh laryngoscope (MAC). Others showed no significant differences. Regarding the aspect of usefulness, DOL was superior to MAC except in delivering power. The disposable laryngoscopes appear to be a reasonable device for use in emergency airway management. 서 응급상황에서효과적인기관내삽관성공여부는환자의예후에많은영향을미칠수있으며, 직접후두경은기관내 론 563

564 / 대한응급의학회지 : 제 26 권제 6 호 2015 삽관시가장많이사용되는기구이다 1,2). 최근연구에의하면삽관에실패하여외과적기도관리가필요했던경우는 0.4%~1.2% 로보고되었다 3-5). 따라서기관내삽관시사용되는후두경의실효성과효용성은환자의기도관리에영향을줄수있는매우중요한요소이다.

2 564 / 대한응급의학회지 : 제 26 권제 6 호 2015 삽관시가장많이사용되는기구이다 1,2). 최근연구에의하면삽관에실패하여외과적기도관리가필요했던경우는 0.4%~1.2% 로보고되었다 3-5). 따라서기관내삽관시사용되는후두경의실효성과효용성은환자의기도관리에영향을줄수있는매우중요한요소이다. 또한직접후두경은기관내삽관시환자의점막, 타액, 혈액등에직접접촉하는침습적인장비로서병원감염의주요원인으로지적되고있으며프리온과아포등의경우현실적으로멸균이어려운것으로보고되었다 6-10). 일회용후두경의경우에도접는과정에서후두경날이손잡이에닿아오염될수있으며플라스틱재질인경우날이휘거나시야가좋지않은경우가보고되었다 11). 이에비해최근국내에서최초로의료기기허가 2등급을승인받은손잡이-날일체형일회용후두경은날이접히지않아감염의위험성이낮고, 휘지않는경성재질이어서시야확보에이점이있을것으로예상된다 (Fig. 1). 하지만실제삽관성공률등의실효성과사용자중심의효용성이증명되지않아이에대한연구가필요할것으로생각된다. 이에저자들은앞서언급한일회용후두경에대한실효성과효용성을알아보고자하였으며, 기존의매킨토시후두경의익숙함에서오는주관적인영향을배제하기위하여실제기관내삽관경험이없는임상실습학생을대상으로연구를진행하였다. 대상과방법응급실에서실습중인학생 ( 의학과, 응급구조학과 ) 97명 을대상으로하였으며사전에연구에대한정보를제공하고동의를구하였다. 연구를시작하기전에참가자들에게일회용후두경과매킨토시후두경에대해설명한후이론및실습을통한기관내삽관실기교육을실시하였다. 97명모두일회용후두경과매킨토시후두경을사용하여기관내삽관을하도록하였다. 두장비를연속적으로사용해서발생할수있는연습효과를최소화하기위해무작위교차배정을시행, 먼저사용할후두경종류에따라두군을결정하였다. 무작위교차배정은컴퓨터를이용한난수표를이용하였다. 본연구는연구대상병원의임상연구심의위원회 (Institutional Review Board, IRB) 의심의 (IRB File No ) 를승인받았다. 삽관대상은 Laerdal사의시뮬레이션교육용 SimMan 마네킹 (Laerdal Medical Corporation, Stravanger; Norway) 이었으며, 일회용후두경은 4번사이즈의일체형플라스틱경성후두경 (Disposable Laryngoscope, Zhuhai Ushare Medical Inc.; Guang Dong, China), 재사용후두경은 4번사이즈의매킨토시후두경 (Welch Allyn fiber optic blades #69213 and handles #60813, Welch Allyn; NY, USA) 을이용하였다 (Fig. 1). 일회용후두경은매교육마다새것을사용했으며매킨토시후두경의배터리는 5회사용이후일회용배터리로교체하였다. 매킨토시후두경과일회용후두경에대한실효성을비교하기위하여참가자들의시야확보정도, 삽관성공시간, 삽관시도횟수, 삽관과정중발생한치아손상을조사하였다. 시야확보정도를표기하기위해 Comack과 Lehane Fig. 1. Disposable one-piece laryngoscope and macintosh laryngoscope. Left: Disposable one-piece laryngoscope (MHPD-201, Zhuhai Ushare Medical Inc.; Guang Dong, China), Right: Macintosh laryngoscope (Welch Allyn fiber optic blades #69213 and handles #60813, Welch Allyn; NY, USA)

3 이은형외 : 비숙련자에서매킨토시후두경과일회용후두경을이용한기관삽관의비교 : 마네킹연구 / 565 분류법을사용하여성문이모두보이면등급 1, 성문의후면만보이면등급 2, 후두개만보이면등급 3, 후두개나성문이보이지않으면등급 4로분류하였다 12). 삽관성공은앰부주머니를이용해튜브를통해마네킹의폐로공기를불어넣어마네킹의폐팽창여부로판정하였다. 삽관 1회시도는구강에서후두경을빼는경우로정의하였으며, 시도횟수에는제한을두지않았다. 삽관성공시간은초 (sec) 로표기하였으며, 삽관에성공할경우후두경날이앞니를통과하는시간부터후두경날이마네킹에서나오는시간까지를측정하였다. 삽관시도횟수는삽관에성공할때까지의시도횟수로정의하였다. 삽관도중환자의치아손상은마네킹치아에서딸깍소리가난경우로정의하였다. 모든실험은정확한평가를위해비디오판독으로재확인하였다. 두후두경에대한효용성을비교하기위하여전반적인편의성, 경량감, 주관적인밝기, 조작편이성, 힘의전달감, 주관적인안전성, 선호도를설문지형식으로조사하였다. 연속형변수의경우평균과표준편차또는중앙값과사분위수범위 (Interquartile range, IQR) 로나타내었고, 범주형변수또는순위형변수의경우, 빈도와백분율 (%) 로제시하였다. 이용한후두경에따른비교를하기위하여연속형변수의경우쌍별비교 (paired t-test) 또는윌콕슨의부호순위검정 (Wilcoxon s signed rank test), 범주형변수의경우피셔의정확한검정 (Fisher s exact test) 또는코크란-아미티지추세검정 (Cochran-Armitage trend test) 을수행하였다. 모든통계적인분석은 SPSS (version 14.0; SPSS, Inc, Chicago, Ill) 와 R (version 3.1.3, The R Foundation for Statistical Computing, Vienna, Austria) 을이용하였으며, 유의수준 0.05보다작은유의확률을보이는경우통계적으로의미있는것으로간주하였다. 결과본실험에총 97명의참여자가실험에참가하였으며, 남자가 45명 (46%) 이었으며나이는 23.45±1.74세였다. 두군간성별과나이에차이는없었다 (Table 1). Comack과 Lehane 분류에서일회용후두경을이용한경우 1, 2등급이각각36%, 52% 이고, 3, 4등급이각각 11%, 0% 였으며, 매킨토시후두경의경우 1, 2 등급이각각 38%, 54% 이고, 3,4등급이각각 6%, 1% 로통계적으로유의한차이가없었다 (p=0.573). 삽관시도횟수는일회용후두경에서 1회가 86%, 2회가 8%, 3회이상이 6% 였으며, 매킨토시후두경에서 1회가 81%, 2회가 12%, 3회이상이 6% 였으며, 통계적으로유의한차이가없었다 (p=0.638). 삽관성공시간은일회용후두경에서 18.29±9.81초, 매킨토시후두경에서 18.4± 8.89초였으며통계적으로유의한차이가없었다 (p=0.896). 삽관중치아손상이발생하지않은경우는일회용후두경에서 87%, 매킨토시후두경에서 82% 였고 1 회의치아손상이발생한경우는일회용후두경에서 3%, 매킨토시후두경에서 13% 였고 2회이상치아손상이발생한경우는일회용후두경에서 10%, 매킨토시후두경에서 4% 였으며통계적으로유의한차이를보였다 (p=0.011). 최대삽관시도횟수는일회용후두경에서 5회, 매킨토시후두경에서 4회였으며삽관에실패한경우는없었다. 먼저이용한후두경에따른결과에서는삽관중치아손상을제외한수행능관련수치는두후두경간에유의한차이를보이지않았다. 매킨토시후두경을먼저이용한후일회용후두경을사용한군에서삽관중치아손상이통계적으로의미있게감소하였다 (Table 2). 효용성관련설문에서는먼저사용한후두경에따라서통계적으로유의한차이가없었다. 시술자들이느끼는효용성에대한설문조사에서전반적인편의성, 경량감, 주관적인밝기, 조작편이성, 주관적인안전성및선호도에서일회용후두경이더높은비율을차지했다. 힘의전달감에서는매킨토시후두경이더높은비율을차지했다. 모든설문문항에서, 먼저사용한후두경에따른선호도는통계적으로유의한차이가없었다 (Fig. 2). 고찰본연구는기관내삽관에미숙한학생을대상으로하여발생할수있는윤리적문제를고려하고삽관난이도를표준화하기위해마네킹을이용하여진행하였다 13). Rassam 등 14) 의연구에서는매킨토시후두경과여러종류의일회용후두경날그리고일체형구조의일회용후두경한종류에대한주관적인효용성과소요시간을비교평 Table 1. Demographic characteristic per group. Variable Disposable First (N=50) Macintosh (N=47) Total (N=97) Comparison (p-value) Age (year), mean±sd 23.56± ± ± Sex, n (%) Male 23 (46) 22 (46.81) 45 (46.39) 1 Female 27 (54) 25 (53.19) 52 (53.61) p-values were calculated by Student s t-test assuming unequal variance for age and chi-square test for sex.

4 566 / 대한응급의학회지 : 제 26 권제 6 호 2015 가하였는데, 일체형후두경이모든면에서불량한것으로나타났다. 이결과는이연구에서사용된일체형후두경의조명과모양등구조적인특성으로인한것으로생각되며, 본연구에서사용된일회용후두경의경우에는충분히밝은발광다이오드 (LED, Light-Emitting Diode) 조명이사용되었으며모양역시매킨토시후두경과흡사하여시야와소요시간에유의한차이를보이지않은것으로생각된다. 또한 Rassam 등 14) 의연구에서는마네킹에가해진힘의최대수치를객관적으로측정하였으며, 일회용후두경을사용한경우매킨토시후두경에서보다더높은힘이가해진것으로나타났다. 이는삽관에더많은힘이필요했다는의미로해석할수있다. 본연구에서는주관적인힘의전달감을설문형식으로만평가했으며일회용후두경에서더불량한것으로나타났다. 이는참여자가일회용후두경을사용한삽관시더많은힘이필요했다고느낀것으로해석할수있다. 그외의주관적인조작편이성에서는일회용후두경이더우수하다고응답하였다. 삽관시전달되는힘은외상등의합병증과관련될가능성이있어추후객관적인연구가필요할것으로생각된다. 일회용후두경은재사용후두경에비해가볍고휴대성이뛰어나다는장점이있다. 이는일회용후두경이병원에서 뿐만아니라병원전단계나재난상황에서적용될수있다는것을의미한다. 그러나병원전단계, 수술실에서의전신마취등다양한상황에서의성공률, 소요시간등의실제실효성면에서도일회용플라스틱후두경날이재사용금속후두경날에비하여불량하다는보고가있었다 15-20). 이는이전연구에서사용되었던후두경날의모양, 재질, 밝기그리고일체형이아닌구조차이등에의한것으로생각된다. 본연구에서는시야, 삽관성공시간의경우후두경간에차이가없었는데, 이는본연구에서의일회용후두경날형태가매킨토시와흡사하고휘지않으며밝기또한충분하기때문인것으로생각된다. 추후병원전단계나수술방등에서의일체형후두경을이용한추가연구가필요할것으로생각된다. 통계적으로는유의하지않았으나먼저교육받은후두경의종류와무관하게나중에사용한후두경에서삽관시도횟수가감소하였으나이는연습효과에의한것으로생각된다. 효용성과관련된설문은참가자의주관을반영하기때문에먼저사용한후두경에따라다른결과가나올수있다. 하지만본연구에서는유의한차이가보이지않았다. 추후실제환자대상, 숙련자를대상으로하는추가연구가필요할것으로생각된다. Fig. 2. Usefulness of laryngoscope. Inexperienced personnel did a questionnaire survey on the usefulness of laryngoscopes (easier to use, lightness, brightness, manageable to use, delivering power, safer for patients, intense to use).

5 이은형외 : 비숙련자에서매킨토시후두경과일회용후두경을이용한기관삽관의비교 : 마네킹연구 / 567 Table 2. Comparison of objective evaluation (Visibility, Trial count, Time to success for intubation, Complication count) per groups according to laryngoscope trained first. Disposable First (N=50) Macintosh First (N=47) Total (N=97) Variable Disposable Macintosh p Disposable Macintosh p Disposable Macintosh p Visibility (C-L grade ), n (%) 1 17 (34) 16 (32) (38.3)0 21 (44.68) (36.08) 37 (38.14) (52) 28 (56) 25 (53.19) 25 (53.19) 51 (52.58) 53 (54.64) 3 07 (14) 5 (10) 04 (08.51) 01 (02.13) 11 (11.34) 06 (06.19) 4 00 (00) 01 (02) 0 (0) 0 (0) 0 (0) 01 (01.03) Trial count for intubation, n (%) 1 41 (82) 45 (90) (89.36) 34 (72.34) (85.57) 79 (81.44) (10) 04 (08) 03 (06.38) 08 (17.02) 08 (08.25) 12 (12.37) 3 04 (08) 01 (02) 02 (04.26) 05 (10.64) 06 (06.18) 06 (06.18) Time to success for intubation (sec), mean±sd 18.85± ± ± ± ± ± No. of complication, n (%) 0 45 (90) 47 (94) (82.98) 33 (70.21) (86.6)0 80 (82.47) (02) 03 (06) 02 (04.26) 10 (21.28) 03 (3.09)0 13 (13.4) (08) 00 (00) 06 (12.76) 04 (08.52) 10 (10.3)0 04 (04.12) p-values were calculated by cochran-armitage trend test or Wilcoxon s signed rank test as appropriate. Comack-Lehane grade 삽관중치아손상과관련된합병증의경우두후두경간에통계적으로유의한차이를보였다. 일회용후두경에서합병증이발생하지않은비율이높았으나 2회이상합병증이발생한비율역시높아이에대한추가적인연구가필요할것으로생각된다. 과거연구된바에의하면의료진이주관적으로생각하는효용성면에서도플라스틱재질의일회용후두경날은재사용금속후두경날에비해시야가불량하고휘는경우가있어실효성이떨어질것이라는인식이있었다 14,21,22). 본연구에서는일체형후두경이더밝고가벼웠으며다루기쉬웠다고인식했으며, 선호도역시더높은것으로나타났다. 최근연구에따르면 3개월간플라스틱재질의일회용후두경에대한학습후일회용후두경사용량이실제로증가했으며실효성면에서도차이가없다는방향으로인식이바뀌었다 21). 이는기존의금속후두경에익숙했던의료진들에게일회용후두경에대한어색함과막연한불신이있었던것으로생각할수있다. 본연구에서참가자들이환자에게더안전할것으로생각한것역시일회용후두경이었으며, 위생적이고금속에비해환자에게손상을적게입힐것같다는점등이이유로거론되었다. 실제 Rowley 등 23) 의연구에서의료진들은본인의가족에게기관내삽관을하게된다면일회용후두경을사용하겠다고응답한경우가대부분이었다. 본연구에서직접적으로연구한부분은아니지만, 후두경은인체의점막에직접접촉하는의료기구로감염전파의가능성이있는기구이다. 대한민국보건복지부와미국질병관리본부가고시한의료기관사용기구및물품소독지침에따르면후두경날은준위험기구 (semi-critical instrument) 로분류되어높은수준의소독혹은멸균이요구되고, 손잡이는비위험기구 (noncritical instrument) 로분류되어중간수준의소독이요구되고있다 8,24-26). 하지만최근까지도후두경에대한표준화된감염관리지침이없으며, 후두경생산업체및병원마다제시하는소독방법이서로다른것으로보고되었다 8,27,28). 비위험기구로분류된손잡이의머리부분은삽관과정에서환자의구강에직접닿을수있으며, 손잡이면은후두경날을접는경우날에접촉해오염될수있고, 그부위를만진의료진의손을오염시킬수있어감염경로가될수있다 9,29). 또한손잡이면은마찰력을높이기위한격자형요철이가공되어있어세척을어렵게하며, 이는혈액이나세균등의잔존률을상승시키는것으로알려져있다 9,29,30). 이를극복하기위해기관내삽관시후두경날에피복을입히는방법과일회용후두경날을사용하는방법이제시되어왔다. 하지만피복의경우사용도중파손되거나씌우고벗기는과정에서오염될수있으며, 일회용후두경날의경우에도접는과정에서손잡이로부터오염될수있어결과적으로후두경소독과정은생략할수없었다 11). 그러나국내에

6 568 / 대한응급의학회지 : 제 26 권제 6 호 2015 서의재사용후두경의오염실태와감염사례는아직연구된바가없어이에대한연구가필요하며, 이를통한표준화된감염관리지침개발이필요할것이다. 일체형구조의일회용후두경의경우손잡이와날모두멸균상태이며접는과정이없어의료진의손이나손잡이로부터의오염가능성이낮아감염관리의측면에서매킨토시후두경보다유리할것으로생각된다. 현재국내대부분의병원에서사용하는재사용금속후두경은식품의약품안전처분류에따르면허가등급 1등급으로관찰용으로신고된상태이다. 이경우안정성시험이나심사없이도신고하는경우판매와유통이가능하다. 이에반해본연구에서사용된일회용후두경은기관내관의삽입과배치를지원하는일회용장비로 2등급심사를통과한유일한직접후두경이다. 응급환자에서의기도관리는생명과직접적인관련이있기때문에향후에도기도관리장비에대한안정성, 실효성, 효용성등의검증이필요하다고생각된다. 기존의재사용후두경날과는다르게일회용후두경의경우후두경날의크기와종류가 4가지로한정되어있다는단점이있다. 추후더다양한일회용후두경에대한검증과도입이필요할것으로생각된다. 또한일회용후두경의사용확대를위해서는실제환자에대한다양한추가연구와비용문제의해결이필요할것이다. 본연구에는몇가지의제한점이있다. 첫째, 기관내삽관경험이없는학생을참가자로하였다는점이다. 비숙련자에서는이전에사용하던장비의익숙함에서오는정보비뚤림 (Information bias) 이최소화될수있지만전문적인견해와실효성에대한평가는어려웠을것으로생각된다. 하지만사전에이론과실습을통한교육을실시하여이러한제한점을극복하려고노력하였다. 둘째, 마네킹을대상으로하였으며어려운기도등의변수를구현하지않아실제임상상황과차이가있을수있다. 셋째, 한가지종류의일회용후두경만을실험대상으로하였다는점이다. 하지만현재국내에서심사를통과하여정식으로유통되는일회용후두경은한종류밖에없어적절한비교대상을정할수없었다. 결론연구결과에서일회용후두경과매킨토시후두경간에시야확보정도, 삽관시도횟수, 삽관성공시간등대부분의실효성면에서차이가보이지않았으며시술자들이느끼는효용성면에서도일회용후두경이전반적으로더우수했다. 따라서감염예방차원에서더유리한일회용후두경의사용이권장된다. 참고문헌 01. Malan CA, Scholz A, Wilkes AR, Hampson MA, Hall JE. Minimum and optimum light requirements for laryngoscopy in paediatric anaesthesia: a manikin study. Anaesthesia ;63: Anderson KJ, Bhandal N. The effect of single use of laryngoscopic equipment on illumination for tracheal intubation. Anaesthesia. 2002;57: Kim SH, Kim EC, Choi YH, Kim YM, Oh YM, Choi HJ, et al. The Parameters Affecting the Success Rate for Endotracheal Intubation in Emergency Department: Multicenter Trial using Korean Emergency Airway Management Registry. J Korean Soc Emerg Med. 2008; 19: Levitan RM, Rosenblatt B, Meiner EM, Reilly PM, Hollander JE. Alternating day emergency medicine and anesthesia resident responsibility for management of the trauma airway: a study of laryngoscopy performance and intubation success. Ann Emerg Med. 2004;43: Tayal VS, Riggs RW, Marx JA, Tomaszewski CA, Schneider RE. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med. 1999;6: Hall JR. Blood contamination of anesthesia equipment and monitoring equipment. Anesth Analg. 1994;78: Morell RC, Ririe D, James RL, Crews DA, Huffstetler K. A survey of laryngoscope contamination at a university and a community hospital. Anesthesiology. 1994;80: Muscarella LF. Reassessment of the risk of healthcareacquired infection during rigid laryngoscopy. J Hosp Infect. 2008;68: Williams D, Dingley J, Jones C, Berry N. Contamination of laryngoscope handles. J Hosp Infect. 2010;74: Lowman W, Venter L, Scribante J. Bacterial contamination of re-usable laryngoscope blades during the course of daily anaesthetic practice. S Afr Med J. 2013;103: Anderson K, Gambhir S, Glavin R, Kinsella J. The use of an anaesthetic simulator to assess single-use laryngoscopy equipment. Int J Qual Health Care. 2006;18: Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. New York: McGraw-Hill; p Tan BH, Liu EH, Lim RT, Liow LM, Goy RW. Ease of intubation with the Glidescope or Airway scope by novice operators in simulated easy and difficult airways-a manikin study. Anaesthesia. 2009;64: Rassam S, Wilkes AR, Hall JE, Mecklenburgh JS. A comparison of 20 laryngoscope blades using an intubating manikin: visual analogue scores and forces exerted during

7 이은형외 : 비숙련자에서매킨토시후두경과일회용후두경을이용한기관삽관의비교 : 마네킹연구 / 569 laryngoscopy. Aneaesthesia. 2005;60: Jabre P, Leroux B, Brohon S, Penet C, Lockey D, Adnet F, et al. A comparison of plastic single-use with metallic reusable laryngoscope blades for out-of-hospital tracheal intubation. Ann Emerg Med. 2007;50: Shahriari A, Khooshideh M, Enayaty H. Comparison of successful intubation with two different blades of laryngoscope: single-use and reusable. J Res Med Sci. 2007; 12: Amour J, Le Manach YL, Borel M, Lenfant F, Nicolas- Robin A, Carillion A, et al. Comparison of single-use and reusable metal laryngoscope blades for orotracheal intubation during rapid sequence induction of anesthesia: a multicenter cluster randomized study.?anesthesiology. 2010;112: Amour J, Marmion F, Birenbaum A, Nicolas-Robin A, Coriat P, Riou B, et al. Comparison of plastic single-use and metal reusable laryngoscope blades for orotracheal intubation during rapid sequence induction of anesthesia. Anesthesiology. 2006;104: Dos Santos FD, Schnakofsky R, Cascio A, Liu J, Merlin MA. Disposable stainless steel vs plastic laryngoscope blades among paramedics. Am J Emerg Med. 2011;29: Galinski M,Catineau J, Rayeh F, Muret J, Ciebiera JP, Plantevin F, et al. Laryngoscope plastic blades in scheduled general anesthesia patients: a comparative randomized study. J Clin Anesth. 2011;23: Machan MD, Monaghan WP, McDonough J, Hogan G. Emerging evidence in infection control: effecting change regarding use of disposable laryngoscope blades. AANA J. 2013;81: Twigg SJ, McCormick B, Cook TM. Randomized evaluation of the performance of single?use laryngoscopes in simulated easy and difficult intubation. Br J Anaesth. 2003;90: Rowley E, Dingwall R. The use of single-use devices in anaesthesia: balancing the risks to patient safety. Anaesthesia. 2007;62: Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing healthcare-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53: Available at: Accessed March 2, Ministry of Health & Welfare. Guidelines for medical instruments and material disinfection in healthcare facilities. Seoul: Author; 2010 Accessed March 2, 2015 Available at: 행정규칙 / 의료기관사용기구및물품소독지침. 27. Kim HY, Lee EJ, Jang EK, Park YA. A study for infection control standards for medical devices in NICU. J Korean Clin Nurs Res. 2010;16: Lee SO. A survey on hospital infection. J Korean Acad Nurs. 1993;23: Negri de Sousa AC, Levy CE, Freitas MI. Laryngoscope blades and handles as sources of cross-infection: an integrative review. J Hosp Infect. 2013;83: Esler MD, Baines LC, Wilkinson DJ, Langford RM. Decontamination of laryngoscopes: A survey of national practice. Anaesthesia. 1999;54:

570 / 대한응급의학회지 : 제 26 권제 6 호 2015 매킨토시후두경과일회용후두경의비교 성별 : 남자 / 여자, 나이 : 세 1. 매킨토시후두경을이용한기관삽관시시야는어땠나요? 1 Grade 1 2 Grade 2 3 Grade 3 4 Grade 4 2. 일회용후두경을이용한기관삽관시시야는어땠나요?

8 570 / 대한응급의학회지 : 제 26 권제 6 호 2015 매킨토시후두경과일회용후두경의비교 성별 : 남자 / 여자, 나이 : 세 1. 매킨토시후두경을이용한기관삽관시시야는어땠나요? 1 Grade 1 2 Grade 2 3 Grade 3 4 Grade 4 2. 일회용후두경을이용한기관삽관시시야는어땠나요? 1 Grade 1 2 Grade 2 3 Grade 3 4 Grade 4 3. 전반적으로사용하기에어느것이더좋았나요? 1 일회용후두경 2 차이가없다. 3매킨토시후두경 두후두경중더가벼운것은? 두후두경중더밝은것은? 두후두경중더다루기쉬운것은? 두후두경중삽관시힘을더잘받는것은? 두후두경중환자에게더안전하다고생각되는것은? 일회용후두경차이가없다. 매킨토시후두경 4. 본인이실제환자를대상으로사용한다면어느것을사용하고싶나요? 1매킨토시후두경 2 차이가없다. 3 일회용후두경 5. 기관삽관평가 먼저교육받은후두경종류기관삽관시도횟수 ( 회 ) 기관삽관성공시소요시간 ( 초 ) 기관삽관시합병증마네킹에서딸깍소리난횟수 일회용후두경 매킨토시후두경

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar