A method of administering topical anaesthesia for flexible airway endoscopy
Bibliographic record
Abstract
We have found that a modified epidural catheter inserted through the suction port of the fibreoptic endoscope is an effective method of accurately introducing local anaesthetic drugs to provide topical anaesthesia for flexible airway endoscopy. The distal end of a 16-gauge epidural catheter is cut to remove the side holes and is then threaded through the suction port of an endoscope (in our practice we use an Olympus LF-2). It is advanced until the cut end of the epidural catheter is flush with the distal end of the endoscope. The proximal end of the catheter is then attached to its connector in the usual manner and this is in turn attached to two three-way taps arranged in series. A 1-ml syringe containing local anaesthetic is fitted to the side port of the distal three-way tap via a nonreturn valve. The side port of the proximal three-way tap is left open to air and a 2-ml syringe is attached to the other port via a nonreturn valve. The plunger of the 2-ml syringe is removed and replaced with a length of oxygen tubing connected to an oxygen supply at a flow of 1 l.min−1 ( Fig. 10). Local anaesthetic solution is delivered to the airway via the endoscope with the help of an assistant who occludes the open port of the proximal three-way tap whilst simultaneously injecting 0.1–0.2-ml aliquots of local anaesthetic via the port of the other three-way tap ( Fig. 11). A 1-ml syringe is needed to overcome the high pressure generated by the gas flow. Injection produces a fine jet of local anaesthetic, which can be precisely targeted at areas of mucosa at up to 5 cm distance from the tip of the endoscope. The direction of spray of local anaesthetic is controlled by movement of the tip of the fibreoptic endoscope. This allows the airway ahead of the advancing endoscope to be accurately anaesthetised under direct vision. This technique is more time consuming than the usual spray-as-you-go method but the fine spray produces less coughing and gagging. We find this device most useful for producing airway anaesthesia if coughing has to be minimised or if sedation is contraindicated, thus placing strenuous demands on the local anaesthetic technique.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".