As before mentioned, the lower air passages will not tolerate
dilatation; therefore, it is necessary never to use tubes larger than
the size of the passages to be examined. Four sizes are sufficient
for any possible case, from a newborn infant to the largest adult.
For infants under one year, the proper tube is the 4 mm. by 30 cm.;
the child's size, 5 mm. by 30 cm., is used for children aged from one
to five years. For children six years or over, the 7 mm. by 40 cm.
bronchoscope (the adolescent size) can be used unless the smaller
bronchi are to be explored. The adult bronchoscope measures 9 mm.
by 40 cm.
The author occasionally uses special sizes, 5 mm. x 45 cm., 6 mm. x 35
cm., 8 mm. x 40 cm.
_Esophagoscopes_.-The esophagoscope, like the bronchoscope, is a
hollow brass tube with beveled distal end containing a small
electric light. It differs from the bronchoscope in that it has no
perforations, and has a drainage canal on its upper surface, or next
to the light-carrier canal which opens within the distal end of the
tube. The exact size, position, and shape of the drainage outlets is
important on bronchoscopes, and to an even greater degree on
esophagoscopes. If the proximal edge of the drainage outlet is too
near the distal end of the endoscopic tube, the mucosa will be drawn
into the outlet, not only obstructing it, but, most important,
traumatizing the mucosa. If, for instance, the esophagoscope were to
be pushed upon with a fold thus anchored in the distal end, the
esophageal wall could easily be torn. To admit the largest sizes of
esophagoscopic bougies (Fig. 40), special esophagoscopes (Fig. 5) are
made with both light canal and drainage canal outside the lumen of the
tube, leaving the full area of luminal cross-section unencroached
upon. They can, of course, be used for all purposes, but the slightly
greater circumference is at times a disadvantage. The esophageal and
stomach secretions are much thinner than bronchial secretions, and, if
free from food, are readily aspirated through a comparatively small
canal. If the canal becomes obstructed during esophagoscopy, the
positive pressure tube of the aspirator is used to blow out the
obstruction. Two sizes of esophagoscopes are all that are required--7
mm. X 45 cm. for children, and 10 mm. X 53 cm. for adults (Fig. 3, A
and B); but various other sizes and lengths are used by the author for
special purposes.* Large esophagoscopes cause dangerous dyspnea in
children. If, it is desired to balloon the esophagus with air, the
window plug shown in Fig. 6, is inserted into the proximal end of the
esophagoscope, and air insufflated by means of the hand aspirator or
with a hand bulb. The window can be replaced by a rubber diaphragm
with a perforation for forceps if desired. It will be noted that none
of the endoscopic tubes are fitted with mandrins. They are to be
introduced under the direct guidance of the eye only. Mandrins are
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