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There are two more or less distinct stages of this serious tro...
Angina Pectoris Symptoms
The pain of true angina pectoris generally starts in the regi...
Treat as under Fever, Gastric, and Fever. In addition, great c...
See Cancer in Foot. ...
The Tired Emphasis
"I AM so tired, so tired--I go to bed tired, I get up...
See Child-bearing. ...
I shall give a couple of illustrations: In the winter of 1...
The Contagion Of Scarlatina Very Active
The _contagion_ of scarlatina is very active, and adheres for...
A talisman may be described as an emblematical object or im...
Cancer In Face
Treat as far as possible as recommended for breast cancer. ...
The Frightening Heart
Heart disease is one of the major causes of death among North...
Baths And Bathing
Bathing as a Means of Cleanliness. It has been said that one ...
For use in our treatment we recommend Coutts' Acetic Acid. It ...
This, in various forms, as brandy, whiskey, rum, wine, cordial...
See Rash. ...
Often there follows, after the cure of an inflammatory disease...
Inducing A Child To Open Its Mouth (author's Method)
The wounding of the child's mouth, gums, and lips, in the of...
The Electric Circuit
The Electric Circuit is made up of any thing and every thing ...
Positive And Negative Manifestations
Acute diseases are to be regarded as electrically positive, a...
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