Technic For General Anesthesia


Categories: ANESTHESIA FOR PERORAL ENDOSCOPY
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

For esophagoscopy and gastroscopy,

if general anesthesia is desired, ether may be started by the usual

method and continued by dropping upon folded gauze laid over the mouth

after the tube is introduced. Endo-tracheal administration of ether

is, however, far safer than peroral administration, for it overcomes

the danger of respiratory arrest from pressure of the esophagoscope,

foreign body, or both, on the trachea. Chloroform should not be used

for esophagoscopy or gastroscopy because of its depressant action on

the respiratory center.



For bronchoscopy, ether or chloroform may be started in the usual way

and continued by insufflating through the branch tube of the

bronchoscope by means of the apparatus shown in Fig. 13.



In case of paralysis of the larynx, even if only monolateral, a

general anesthetic if needed should be given by intratracheal

insufflation. If the apparatus for this is not available the patient

should be tracheotomized. Hence, every adult patient should be

examined with a throat mirror before general anesthesia for any

purpose, and the necessity becomes doubly imperative before goiter

operations. A number of fatalities have occurred from neglect of this

precaution.



Anesthetizing a tracheotomized patient is free from danger so long as

the cannula is kept free from secretion. Ether is dropped on gauze

laid over the tracheotomic cannula and the anesthesia watched in the

usual manner. If the laryngeal stenosis is not complete,

ether-saturated gauze is to be placed over the mouth as well as over

the tracheotomy tube.



Endo-tracheal anesthesia is by far the safest way for the

administration of ether for any purpose. By means of the silk-woven

catheter introduced into the trachea, ether-laden air from an

insufflation apparatus is piped down to the lungs continuously, and

the strong return-flow prevents blood and secretions from entering the

lower air-passages. The catheter should be of a size, relative to that

of the glottic chink, to permit a free return-flow. A number 24 French

is readily accommodated by the adult larynx and lies well out of the

way along the posterior wall of the larynx. Because of the little room

occupied by the insufflation catheter this method affords ideal

anesthesia for external laryngeal operations. Operations on the nose,

accessory sinuses and the pharynx, apt to be attended by considerable

bleeding, are rendered free from the danger of aspiration pneumonia by

endotracheal anesthesia. It is the safest anesthesia for goiter

operations. Endo-tracheal anesthesia has rendered needless the

intricate negative pressure chamber formerly required for thoracic

surgery, for by proper regulation of the pressure under which the

ether ladened air is delivered, a lung may be held in any desired

degree of expansion when the pleural cavity is opened. It is indicated

in operations of the head, neck, or thorax, in which there is danger

of respiratory arrest by centric inhibition or peripheral pressure; in

operations in which there is a possibility of excessive bleeding and

aspiration of blood or secretions; and in operations where it is

desired to keep the anesthetist away from the operating field. Various

forms of apparatus for the delivery of the ether-laden vapor are

supplied by instrument makers with explicit directions as to their

mechanical management.



We are concerned here mainly with the technic of the insertion of the

intratracheal tube. The larynx should be examined with the mirror,

preferably before the day of operation, for evidence of disease, and

incidentally to determine the size of the catheter to be introduced,

though the latter can be determined after the larynx is

laryngoscopically exposed. The following list of rules for the

introduction of the catheter will be of service (see Fig. 59).





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