To the Editor.—I wish to offer my solution to the problem of "Spasm and Operative Cholangiography" as described by Chessick et al (Arch Surg 110:53, 1975).
Some 15 years ago in the role of "kibitzing" anesthesiologist, I placed 0.12 gm of nitroglycerin under the tongue of a patient who had a normal cholangiogram except that the dye did not pass into the duodenum. A short time later the roentgenogram was normal in all respects and dye had entered the intestine.
Since then I have used this technique many times to rule out spasm in otherwise normal cholangiograms. Earlier, cyclopropane was usually the anesthetic, but more recently halothane or enflurane have been used, so there was no question of spasm due to morphine-like analgesics.