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Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

No dyspneic patient should be given a general

anesthetic; because any patient dyspneic enough to need a tracheotomy

for dyspnea is depending largely upon the action of the accessory

respiratory muscles. When this action is stopped by beginning

unconsciousness, respiration ceases. If the trachea is not immediately

opened, artificial respiration instituted, and oxygen insufflated, the

patient dies on the table. Skin infi
tration along the line of

incision with a very weak cocaine solution (1/10 of 1 per cent),

apothesine (2 per cent), novocaine, Schleich's fluid or other local

anesthetic, suffices to render the operation painless. The deeper

structures have little sensation and do not require infiltration. It

has been advocated that an interannular injection of cocaine solution

with a hypodermic syringe be done just prior to incision of the

trachea for the purpose of preventing cough after the incision of the

trachea and the insertion of the cannula. It would seem, however, that

this introduces the risk of aspiration pneumonia and pulmonary

abscess, by permitting the aspiration and clotting of blood in small

bronchi, followed by subsequent breaking down of the clots. As the

author has so often said, The cough reflex is the watch dog of the

lungs, and if not drugged asleep by local or general anesthesia can

safely be relied upon to prevent all possibility of the blood or the

pus which nearly always is present in acute or chronic conditions

calling for tracheotomy, being aspirated into the deeper air-passages.

Cocaine in any form, by any method, and in any dosage, is dangerous in

very young children.