CUIRASS RESPIRATOR FOR ENDOSCOPY

WHERE multiple anasthetic techniques are commonly in use for the same surgical procedure, it generally means that none is completely satisfactory. Anzesthesia for respiratory tract endoscopy is an example. The hope of obtaining more perfect conditions for both the patient and operator is our aim in introducing a new method. Endoscopy of the tracheo-bronchial tree demands :-a narcotised and completely relaxed patient throughout the operation; adequate oxygenation without interfering with the smooth progress of the examination; and rapid recovery of muscle tone, of the cough reflex and of consciousness. There are few investigations more distressing to the average patient than a bronchoscopy performed under local analgesia. Yet it is unwise to produce unconsciousness when there is the risk of a quantity of blood or pus flooding the bronchial tree, causing anoxia, possibly asphyxia or at least spreading the infective process. The use of intravenous pethidinel, reassurance and adequate topical analgesia represents a marked improvement on older methods. However, in wet cases, such as those with bronchiectasis, where the peripheral parts of the bronchial tree are involved in a chronic inflammatory process, it is often impossible to obtain adequate local analgesia. The coughing which sometimes occurs is distressing to the patient, inconvenient to the operator, and requires large doses of pethidine for suppression. Large doses of pethidine are also necessary for those patients who are highly nervous and uncooperative, and at the end of the examination lethedrone may be needed to reverse the profoundly depressed respiration. Thus, conditions under local analgesia can be far from ideal. Many patients in chest wards express great relief when told that they are to be bronchoscoped under general, rather than local analgesia; they might, however, be less enthusiastic if they knew that such a procedure was exposing them to additional risks. It is therefore essential to devise a general anzesthetic technique which is as free from risk as the use of local analgesia. Perfect conditions for both patient and surgeon can be produced with a light general anasthetic and profound relaxation, provided that adequate ventilation can be maintained throughout the investigation, and muscle tone and consciousness restored as soon as required.