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The Healing Crisis And Retracing

Certain unpleasant somatics that occur while fasting (or whil...

Affection Of The Brain

When the _brain_ is affected, the patient suddenly complains ...

Esophageal Foreign Body

After initial choking and gagging, or without these, there m...

The Effort Of Digestion

Digestion is a huge, unappreciated task, unappreciated becaus...

Lues Of The Esophagus

Esophageal syphilis is a rather rare affection, and may show ...

Enlargement Or Ossification Of The Heart

Treat these two affections in the same way. Take the A D curr...

Contraindications To Esophagoscopy

In the presence of aneurysm, advanced organic disease, exten...

Giddiness And Trembling

This comes very often as the result of loss of nerve power in ...

Amaurosis Paralysis Of The Optic Nerve

Use B D current, moderate force, three or four times, and the...

Suppression Of The Menses Amenorrhoea

For sudden suppression from taking cold, as by wetting the ...

A Summing Up

GIVE up resentment, give up unhealthy resistance. ...

Chloroform Or Ether (inhaled)

Fresh air. Pull tongue forward, and begin artificial respirati...

Cold Settled

A cold is often easily overcome. At other times it "sits down,...

Technic For General Anesthesia

For esophagoscopy and gastroscopy, if general anesthesia is ...

Brain Exercise

Proper exercise for the brain is most important. But this is n...



...

Paralysis

Take the B D current, medium force. If the paralysis be in a ...

Cardiac Drugs

Whether any drug should be used which acts directly on the he...

Problems

THERE are very few persons who have not I had the experience ...

Indications

Esophagoscopy is demanded in every case in which a foreign b...



Preparation Of The Patient For Peroral Endoscopy





Category: ANESTHESIA FOR PERORAL ENDOSCOPY
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The suggestions of the author in the earlier volumes in regard to
preparation of the patient, as for any operation, by a bath, laxative,
etc., and especially by special cleansing of the mouth with 25 per
cent alcohol, have received general endorsement. Care should be taken
not to set up undue reaction by vigorous scrubbing of gums
unaccustomed to it. Artificial dentures should be removed. Even if no
anesthetic is to be used, the patient should be fasted for five hours
if possible, even for direct laryngoscopy in order to forestall
vomiting. Except in emergency cases every patient should be gone over
by an internist for organic disease in any form. If an endolaryngeal
operation is needed by a nephritic, preparatory treatment may prevent
laryngeal edema or other complications. Hemophilia should be thought
of. It is quite common for the first symptom of an aortic aneurysm to
be an impaired power to swallow, or the lodgment of a bolus of meat or
other foreign body. If aneurysm is present and esophagoscopy is
necessary, as it always is in foreign body cases, to be fore-warned
is to be forearmed. Pulmonary tuberculosis is often unsuspected in
very young children. There is great danger from tracheal pressure by
an esophageal diverticulum or dilatation distended with food; or the
food maybe regurgitated and aspirated into the larynx and trachea.
Therefore, in all esophageal cases the esophagus should be emptied by
regurgitation induced by titillating the fauces with the finger after
swallowing a tumblerful of water, pressure on the neck, etc. Aspiration
will succeed in some cases. In others it is absolutely necessary to
remove food with the esophagoscope. If the aspirating tube becomes
clogged by solid food, the method of swab aspiration mentioned under
bronchoscopy will succeed. Of course there is usually no cough to aid,
but the involuntary abdominal and thoracic compression helps. Should a
patient arrive in a serious state of water-hunger, as part of the
preparation the patient must be given water by hypodermoclysis and
enteroclysis, and if necessary the endoscopy, except in dyspneic
cases, must be delayed until the danger of water-starvation is past.

As pointed out by Ellen J. Patterson the size of the thymus gland
should be studied before an esophagoscopy is done on a child.

Every patient should be examined by indirect, mirror laryngoscopy as a
preliminary to peroral endoscopy for any purpose whatsoever. This
becomes doubly necessary in cases that are to be anesthetized.





Next: Anesthesia For Peroral Endoscopy

Previous: Direction Of The Esophagus



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