General anesthesia in bronchoesophagology, a review of its use in 4,000 endoscopic procedures over a ten year period.

It is well recognized that local anesthesia is used by most endoscopists on this continent and in England. It is the method of choice recommended in all text books dealing with bronchoesophagology and diseases of the chest;16 Jackson and Jackson,’ in 1934 stated, “General anesthesia is never used in our Clinic for endoscopic procedures.” In recent years, however, with continuing improvements in methods and drugs used in general anesthesia, this method has gained some increase in favor, particularly in esophagoscopy and is even recommended for beginners in esophagology, by Jackson,2 in 1950. Holinger7-8 also suggests its use in certain instances. Although local anesthesia has proved to be extremely valuable in endoscopy it has limitations and dangers. Some of these have been referred to by Thomas and Fenton,9 Weisel and Tella,’#{176}and Lierle.1’ While serving overseas in a 600 bed hospital, the author did bronchoscopies and esophagoscopies under local anesthesia, as previously taught and practiced. However, our anesthetist, the late Dr. A. St. C. Rumball,12 was responsible for my initial interest in general anesthesia for endoscopic procedures. We used pentothal anesthesia (sodium thiopentone) many times, but as many others have found,’3 we also observed that pentothal alone or in conjunction with local anesthesia was not satisfactory. We encountered many cases of laryngospasm and the patients had to be in a dangerously deep stage of anesthesia before they were sufficiently relaxed, particularly for bronchoscopies. We found that ether even without preliminary local gave excellent relaxation, but as these patients were all active, young, and usually healthy men, ether anesthesia was too time consuming in a busy military hospital. We eventually abandoned the idea, but happily fate brought us together again in Winnipeg, following hostilities, when we were both appointed to the staff of Deer Lodge Veterans’ Hospital at the beginning of January, 1946. We eventually developed a method mutually satisfactory to both of us. The paper published by Cassels and Holinger,7 in 1946 on “Points of Mutual Interest in Bronchology and Anesthesiology” brings back many fond memories and adequately describes our associations of that time. Our experience at Deer Lodge was confined to adults but at the same time the author was appointed to the staff of the Winnipeg General Hospital, and a little later to the Children’s Hospital of Winnipeg, so that ample opportunity was provided to use