PubMed · 9248536
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M Lagerkranser. 1997. Difficult intubation.. https://doi.org/10.1111/j.1399-6576.1997.tb05504.x
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Its is the task of each medical specialty to develop guidelines for diagnosis and therapies. Examinations done by several specialties should follow a common consensus. A randomized survey at 70 German ENT departments investigated the current position of tracheobronchoscopy and esophagoscopy at each institution. Sixty questionnaires were evaluable. Altogether 8,295 tracheobronchoscopies and 10,404 esophagoscopies were performed. Thirty-six percent of all tracheobronchoscopies and 6% of all esophagoscopies were done with a flexible system. Approximately 58% of all tracheobronchoscopies and 55% of all esophagoscopies were performed for tumor staging. Complications during tracheobronchoscopy occurred in 0.8% of cases and in 0.58% of the esophagoscopies. Using these data an interdisciplinary quality assurance concept was developed for tracheobronchoscopy and esophagoscopy. Current experience has shown that a otolaryngologists in Germany mainly perform rigid tracheobronchoscopy and esophagoscopy. Although endoscopy is mostly done in cases with varied anatomic structures, complications are very rare and comparable to flexible techniques. Greater experience with flexible systems also is to be encouraged in ENT departments.
Although rigid esophagoscopy and tracheobronchoscopy have always been a domain of the ENT surgeon, the development of flexible endoscopes has increased diagnostic and therapeutic indications in clinical practice. Component elements of fiberendoscopes and CCD endoscopes are shown. Techniques in flexible bronchoscopy, flexible esophagoscopy and rhinolaryngoscopy are explained. General and special indications of fiberendoscopy are listed. Possibilities and limitations of flexible bronchoscopy are shown. Flexible techniques for removing foreign bodies of the esophagus and indications for mini-endoscopy are demonstrated. Experience has shown that flexible endoscopy has brought the diagnosis and therapy of tubular organs into a new perspective. Since flexible techniques do not replace rigid ones and complement each another, ENT surgeons must be trained in both techniques.
Since the first description by Ciaglia in 1985, percutaneous dilatational tracheostomy (PDT) has emerged worldwide to be a favored and frequently used technique for airway control. Advantages are the rapidity, simplicity and independence of the physician. These characteristics tempt clinicians to perform the procedure uncritically and thus produce complications. Based on our experiences with the technique and on a critical analysis of the literature the indications and optimal operative technique are discussed. Operative steps are illustrated and potential pitfalls (anatomic variations, injury to vital structures and bleeding) are defined. In our experience endoscopic control plays a crucial role in preventing intraoperative complications. ENT colleagues should know the technique because of their experience with tracheotomized patients and should offer their services to other disciplines.