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Medical ArticlesDiabetesThere 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... Fever Typhoid Treat as under Fever, Gastric, and Fever. In addition, great c... Gangrene See Cancer in Foot. ... The Tired Emphasis "I AM so tired, so tired--I go to bed tired, I get up... After Pains See Child-bearing. ... Illustrations 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... Talismans 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 ... Acetic Acid For use in our treatment we recommend Coutts' Acetic Acid. It ... Alcohol This, in various forms, as brandy, whiskey, rum, wine, cordial... Hives See Rash. ... Weakness 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 EndoscopyCategory: 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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