General Anesthesia in Bronchoesophagology, A Review of Its Use in 4,000 Endoscopic Procedures Over a Ten Year Period

¹ The Department of Medicine, University of Manitoba, and the Department of Medicine and Endoscopy, Deer Lodge Veterans' Hospital, Winnipeg General Hospital, Children's Hospital of Winnipeg and Manitoba Clinic.

This report includes 4,212 bronchoesophagological procedures under general anesthesia in a 10 year period.

Intravenous pentothal was given in 3,624 instances, and ether in 616.

Local anesthesia pentothal and a muscle relaxant (a curare-like drug) was the preferred method in adults. The relaxant drug was omitted in some elderly and debilitated persons. Preoperatively morphine or pantopon was given, usually combined with atropine or scopolamine. pantocaine was used as the topical agent until February 1952 after which time 5 per cent cyclaine was substituted. Flaxedil was also substituted for curare at this time.

Pentothal gives a pleasant induction, prevents and counteracts reactions from local agents, rarely produces postoperative nausea or vomiting, and if properly gauged the patient is usually reacting before leaving the operating room. It may be repeated many times without apprehension by the patient. It is not inflammable.

Pentothal and the relaxant must be given separately, induction must not be hurried and the patient must be at the proper depth of anesthesia and relaxation before attempting to introduce the endoscopic instrument.

Pentothal and curare are dangerous in asthmatics. The only death in this series occurred in an asthmatic person who had received these drugs.

Ether is the safest anesthetic for infants and was used routinely for children under ten. It is preferable in adults with severe emphysema, or asthma or tenaceous secretions. It may be used with pentothal as an induction agent either rectally or intravenously.