Categories: BRONCHOSCOPIC OXYGEN INSUFFLATION
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
1. The patient should be fully under the anesthetic by the open
method so as to get full relaxation of the muscles of the neck.
2. The patient's head must be in full extension with the vertex
firmly pushed down toward the feet of the patient, so as to throw the
neck upward and bring the occiput down as close as possible beneath
the cervical vertebrae.
3. No gag should be used, because the patient should be sufficiently
anesthetized not to need a gag, and because wide gagging defeats the
exposure of the larynx by jamming down the mandible.
4. The epiglottis must be identified before it is passed.
5. The speculum must pass sufficiently far below the tip of the
epiglottis so that the latter will not slip.
6. Too deep insertion must be avoided, as in this case the speculum
goes posterior to the cricoid, and the cricoid is lifted, exposing the
mouth of the esophagus, which is bewildering until sufficient
education of the eye enables the operator to recognize the landmarks.
7. The patient's head is lifted off the table by the spatular tip of
the laryngoscope. Actual lifting of the head will not be necessary if
the patient is fully relaxed; but the idea of lifting conveys the
proper conception of laryngeal exposure (Fig. 55).