Rules For Insertion Of The Catheter For Insufflation Anesthesia

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).