The use of indirect indices of myocardial oxygen consumption in evaluating angina pectoris.

B ronchofiberoscopy for examination of the tracheobronchial tree has considerable advantages over conventional rigid bronchoscopy, not the least of which is ease of insertion into a lightly sedated patient. Introduction of the bronchofiber-scope via a sterile nasopharyngeal airway facilitates its passage, prevents its contamination by nasal secretions and protects the nasal mucosa from trauma (Wanner A, Zighelboim A, Sackner MA: Nasopharyngeal airway: a facilitated access to the trachea.tion of the flexible bronchofiberscope via the trans-nasal approach permits access to airways in the upper lobes even to subsegmental bronchi. In over 800 examinations in patients aged 11 to 96 years, performed by our group, there has been no mortality and no significant morbidity. Mild broncho-spasm has occurred in about 1 percent of patients during exploration of the tracheobronchial tree, but it has never been severe enough to warrant discon-tinuance of the procedure. In so far as patient acceptance is concerned, endotracheal intubation in a conscious patient as a conduit for the broncho-fiberscope clearly has no advantage over rigid bronchoscopy. Although the intubation of conscious subjects has been advocated as beneficial for the training of resident physicians, we believe that the resident staff should first learn intubation on man-nikins and later on unconscious patients. Intubation of alert patients should be reserved for personnel with more experience than can usually be obtained by an intern or resident. Even in the best hands, intubation with an endotracheal tube carries signs-cant morbidity which we have not observed with transnasal passage of the bronchofiberscope. In 3 percent of postoperative patients, hoarseness develops as a result of the act of intubation and the position of the endotracheal tube during the procedure (Jaffe BF: Postoperative hoarseness. Am J Surg 123:432-436, 1972). The tip of the laryngo-scopic blade may produce mild trauma or arytenoid dislocation. Forceful intubation may produce vocal cord laceration, vocal edema and hemorrhage. During the intubation, movement of the head from side to side can produce pressure on one cord and then the other. Too large a tube can damage the larynx. "Bucking" of the patient with inadequate local anesthesia results in forceful spasm of the vocal cords around the endotracheal tube which leads to vocal cord edema. In addition to this potential morbidity, the presence of an endotracheal tube in susceptible individuals may precipitate an asthmatic attack (Schnider SM, Papper EM: Anesthesia for the asthmatic patient. Anesthesiology 22: 886-892, 1961). It appears to us that …