A New and Simple Method for Ventilating Patients Undergoing Bronchoscopy

Carden, Edward; Trapp, W.G.; Oulton, J. L.

doi:10.1097/00000542-197010000-00021

Cited by 25 publications

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“…9 Carden, Trapp and Oulton described a modification of the original device in which oxygen was injected through the sidearm of the bronchoscope with little or no air entrainment. 16 Subsequent comparison of this system with the Sanders device has confirmed that the sidearm system delivers much higher oxygen concentrations and therefore, results in high 2 O a P concentrations without producing hypercapnia and respiratory acidosis. 14 This system may also be used to deliver a premixed nitrous oxide-oxygen gas mixture.…”

Section: (3) Rigid Bronchoscope Using the Venturi Principlementioning

confidence: 92%

Anaesthesia for telescopic procedures in the thorax

Plummer

Hartley

Vaughan

1998

British Journal of Anaesthesia

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Over the past decade, there has been an increase in endoscopic procedures within the thorax for diagnostic and therapeutic purposes. Each has its indications, techniques and complications. However, the one common denominator is that there is always the possibility that thoracotomy may be necessary. Occasionally, particularly if considerable haemorrhage occurs, thoracotomy may be required immediately. Consequently, the clinical examination and investigations should be orientated to this possibility. The medical and theatre staff should be prepared for, and trained to deal with, such an eventuality. GENERAL PREOPERATIVE CONSIDERATIONS Patients should undergo a complete evaluation for a full posterolateral thoracotomy. The goal is to define all of the problems and to ascertain if the patient is in the best possible condition. Factors known to increase the risk for patients undergoing thoracic surgery include cigarette smoking, advanced age, coronary artery disease, preoperative weight loss, obesity, poor pulmonary function and duration of anaesthesia. 47 Cardiac risk is determined by the severity of coronary artery disease, presence of cardiac arrhythmias, left ventricular dysfunction, age and associated medical conditions such as hypoxaemia, diabetes and renal insufficiency. 28 An exercise stress test should be performed as patients with ischaemia are at a higher risk of perioperative cardiac complications and death when undergoing major operations such as pneumonectomy. 22 Consideration should be given to cardiac catheterization and, if appropriate, coronary artery bypass grafting before major lung resection. However, it is not known if this is true for patients undergoing thoracoscopic pulmonary resection. The preoperative evaluation of the respiratory system involves taking a history, physical examination, exercise tolerance, routine laboratory tests, including arterial blood-gas tensions, radiography and pulmonary function tests. Patients who show an increase in peak expiratory flow rate by 15% or more after administration of bronchodilators should receive perioperative bronchodilators. A forced vital capacity (FVC) of at least three times the tidal volume is necessary for an effective cough and a value of less than 50% of predicted is an indicator of increased risk of

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