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Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Independent aspirating tubes involve delay in
their use as compared to aspirating canals in the wall of the
endoscopic tube; but there are special cases in which an independent
tube is invaluable. Three forms are used by the author. The velvet
eye cannot traumatize the mucosa (Fig. 9). To hold a foreign body by
suction, a squarely cut off end is necessary. For use through the
tracheotomic wound without a bronchoscope a malleable tube (Fig. 10)
[FIG. 9.--The author's protected-aperture endoscopic aspirating tube
for aspiration of pharyngeal secretions during direct laryngoscopy and
endotracheobronchial secretions at bronchoscopy, also for draining
retropharyngeal abscesses. The laryngoscopes are obtainable with
drainage canals, but for most purposes the independent aspirating tube
shown above is more satisfactory. The tubes are made in 20 30, 40, and
60 cm. lengths. An aperture on both sides prevents drawing in the
mucosa. It can be used for insufflation of ether if desired. An
aspirating tube of the same design, but having a squarely cut off end,
is sometimes useful for removing secretions lying close to a foreign
body; for removing papillomata; and even for withdrawing foreign
bodies of a soft surface consistency. It is not often that the foreign
bodies can be thus withdrawn through the glottis, but closely fitting
foreign bodies can at least be withdrawn to a higher level at which
ample forceps spaces will permit application of forceps. Such
aspirating tubes, however, are not so safe to use as the protected,
double aperture tubes.]
[FIG. 10.--The author's malleable tracheotomic aspirating tube for
removal of secretions, exudates, crusts, etc., from the
tracheobronchial tree through the tracheotomic wound without a
bronchoscope. The tube is made of copper so that it can be bent to any
curve, and the copper wire stylet prevents kinking. The stylet is
removed before using the tube for aspiration.]
 Aspirators.--The various electric aspirators so universally
used in throat operations should be utilized to withdraw secretions in
the tubes fitted with drainage canals. They, however, have the
disadvantages of not being easily transported, and of occasionally
being out of order. The hand aspirator shown in Fig. 11 is, therefore,
a necessary part of the instrumental equipment. It never fails to
work, is portable, and affords both positive and negative pressures.
The positive pressure is sometimes useful in clearing the drainage
canal of any particles of food, tissue, clots, or secretion which may
obstruct it; and it also serves to fill the stomach or esophagus with
air when the ballooning procedure is used. The mechanical aspirator
(Fig. 12) is highly efficient and is the one used in the Bronchoscopic
Clinic. The positive pressure will quickly clear obstructed drainage
canals, and may be used while the esophagoscope is in situ, by simply
detaching the minus pressure tube and attaching the plus pressure. In
the lungs, however, high plus pressures are so dangerous that the
pressure valve must be lowered.
[Fig. 11--Portable aspirator for endoscopy with additional tube
connected with the plus pressure side for use in case of occlusion of
the drainage canal. This aspirator has the advantage of great power
with portability. Where portability is not required the electrically
operated aspirator is better.]
[FIG. 12.--Robinson mechanical aspirator adapted for bronchoscopic and
esophagoscopic aspiration by the author. The positive pressure is used
for clearing obstructed drainage canals and tubes.]
[FIG. 13.--Apparatus for insufflation of ether or chloroform during
bronchoscopy, for those who may desire to use general anesthesia. The
mechanical methods of intratracheal insufflation anesthesia
subsequently developed by Meltzer and Auer, Elsberg, Geo. P. Muller
and others have rightly superseded this apparatus for all general