Fig. 277. Instruments for Bronchoscopy. Bronchoscopes: A, Killian’s; B, Jackson’s; C, Bruening’s. D, Instruments for extraction. E, Handle (Watson Williams’s).
Operations (see also [p. 481]). As regards the anæsthetic, chloroform is preferable in children, but in adults cocaine may suffice. The operations are best performed in a room which can be made dark.
Fig. 278. Instruments for Bronchoscopy. A, Aspirator for mucus; B, Sponge-holder; C, Hooks.
Tracheoscopy. The preliminary stages are similar to those of direct laryngoscopy. If the larynx be found normal, a smaller tube can be passed through the tube-spatula between the vocal cords, and the spatula can then be divided and removed in separate halves. In Bruening’s instrument the inner tubes are so constructed that they can be pushed through the outer tube and made to project like a telescope to any desired distance. In this way the subglottic region and trachea can be explored.
Upper bronchoscopy. The tubes are passed through the mouth, and the inner one is projected until the bifurcation of the trachea is visible. In order to avoid injury to the tissues, the operation should be performed entirely by sight and with great care. Three cases have been recorded where tracheotomy was needed for the relief of dyspnœa caused by œdema of the larynx which had followed traumatism.
The tube having been passed, cocaine (10%) is applied to the bifurcation of the trachea, and mucus is removed by sponging or by an aspirator. If the secretion be excessive, the foot of the table should be raised so that the mucus drains away from the part to be explored.