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Canadian Journal of Anesthesia, Vol 8, 222-238, Copyright © 1961 by Canadian Anesthesiologists' Society

Remote Control General Anaesthesia and Bronchographic Technique in Infants and Children

GUY FORTIN M.D.1, ANDRÉ MACKAY M.D.1, GILLES LORANGE M.D.1, HUGUES TURNIER M.D.1, and ROGER MATHIEU PH.D.1

1 Department of Anaesthesia, the Chest Clinic, and Radiological Physics Laboratory, Notre Dame Hospital, Montreal, P.Q.

A brief review of the principles involved in various methods of bronchography for infants and children under local and general anaesthesia is presented. The dangers involved and technical difficulties of performing bronchography without an endotracheal tube are discussed. Current methods of bronchography which include endotracheal intubation as part of the procedure are described and analysed.

The requirements for the performance of successful bronchography are stated. It is pointed out that oversimplification of anaesthetic technique exposes the patient to a dangerous hazard and leads to poor results. The use of explosive anaesthetic agents such as ether in the vicinity of an X-ray machine is considered a dangerous practice.

The radiation hazard during bronchography under general anaesthesia is discussed and a special anaesthetic apparatus with remote controls providing protection for the hands of the anaesthetist from the direct X-ray beam is described.

Details concerning the combined inhalation (non-rebreathing) and insufflation anaesthetic techniques involved are given. The principle of a common working airway shared by the anaesthetist and the endoscopist is adapted to the technique.

Recommendations pertaining to pre-anaesthetic preparation of the patient are given.

Induction of anaesthesia in the child is never attempted under duress. The danger involved in spraying the upper respiratory tract with a local anaesthetic agent in infants and children is stressed.

Maintenance of anaesthesia is accomplished with a non-explosive mixture of fluothane, nitrous oxide, and oxygen. Since coughing causes alveolar filling with the contrast agent, the patient is completely curarized to avoid a source of anoxia and obliteration of bronchial detail. Controlled respiration throughout the procedure is an essential part of the preliminary selective bronchographic technique described.

Dionosyl is the contrast medium selected. This dye produces a uniform coating and clings to the bronchial mucosa. There is no necessity to flood the bronchial lumen to obtain radiological results of good quality. When properly used, in limited amounts, controlled respiration will not cause Dionosyl to be blown into the alveoli.

Recommendations pertaining to the immediate post-anaesthetic care of the patient are given.

A report on a clinical study is included.

Note:

Presented at the annual meeting of the Canadian Anaesthetists' Society, Quebec Division, Royal Victoria Hospital, Montreal, P.Q., Feb. 6, 1960, and as an exhibit at the Second World Congress of Anaesthesiologists, Toronto, September 4–10, 1960.






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Copyright © 1961 by the Canadian Anesthesiologists' Society.