Television bronchography.

Abstract

Bronchography under television control has proved to be an excellent and simple method of obtaining bronchograms at the Christ Hospital, Cincinnati, Ohio. It expedites and facilitates the handling of the patient and permits the operator to work in a lighted room rather than in the practically total darkness necessary for fluoroscopy. Not only is no dark adaptation needed, but the patient is much less apprehensive in the lighted room. Intubation of the trachea and bronchi can be carefully controlled, since the physician and his assistant can simultaneously watch the position of the tube on the television screen. Technicians can move about freely. The assistant easily controls the patient, as well as the amount of opaque material being injected. The use of television during bronchography is an excellent medium for instructing residents and other personnel. With a remote monitor, the procedure can be observed elsewhere in the hospital for teaching or other purposes. Premedication is paramount if one is to achieve good topical anesthesia of the tracheobronchial tree. One of the barbiturates, preferably pentobarbital, is given an hour and a half before the examination. In addition to this, morphine, 1/4 to 1/6 gr., combined with atropine, 1/100 gr., for its antisecretory and bronchodilatory effect, is administered approximately forty-five minutes before the procedure. Dihydrocodeinone bitartrate 1/2 gr. is given orally to suppress the cough reflex. The patient is brought to the radiology department on a stretcher. Four to five cubic centimeters of 1 per cent topical tetracaine is injected transtracheally, just above Burns' notch, and the patient is allowed to cough up this material. This technic produces good aerosolization of the tetracaine with resultant anesthesia of the tracheobronchial tree, the larynx, and the epiglottis. Additional anesthesia is carried out with a topical spray of 1 per cent tetracaine, in order to anesthetize the pharynx. Next, a small rubber (or plastic) catheter is led through the nares. With the head tilted backward, the chin tilted upward, and the tongue retracted forward, the tracheobronchial tree can be opened easily for introduction of the catheter into the larynx. Once this is done, an additional 2 to 3 c.c. of 1 per cent tetracaine is instilled into the tracheobronchial tree by positioning the patient so that the flow will be properly directed. This completes the anesthesia. The patient is next transferred to the x-ray table and a technician is assigned to control the catheter and instill the material being used to outline the tracheobronchial tree. With the lights on and the television camera functioning, the operator can then direct the catheter into the appropriate areas. With adequate positioning of the patient, the entire tracheobronchial tree can be clearly outlined. The middle lobe and lingula are visualized easily by tilting the table downward.