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Preparation Of The Patient For Peroral Endoscopy

Sources: 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.