Surgery – Specula – Laryngoscope
Reexamination Certificate
1999-03-09
2001-06-26
Cohen, Lee (Department: 3739)
Surgery
Specula
Laryngoscope
C600S190000, C600S185000, C600S146000
Reexamination Certificate
active
06251069
ABSTRACT:
FIELD OF THE INVENTION
This invention generally relates to examining or viewing devices and techniques used in the management of the upper airway.
BRIEF DESCRIPTION OF THE PRIOR ART
Endotracheal intubation is a medical procedure, that secures a patient's airway through placement of a tube in the patient's trachea in order to facilitate either spontaneous or controlled gas exchange.
Endotracheal intubation is routinely carried out in operating rooms after induction of anesthesia or in emergencies, and is usually achieved without great difficulty under direct vision provided by a laryngoscope.
The laryngoscope is a medical instrument used to expose the patient's vocal cords which narrow the uppermost end the trachea, i.e. the larynx.
Direct laryngoscopy is usually performed with a laryngoscope having a rigid straight blade (known as a Miller type blade), or a rigid curved blade (known as a Macintosh type blade). The most commonly used technique consists of the following steps:
(i) Flexion of the patient's neck and extension of his (or her) head in order to achieve alignment of the oral, pharyngeal and laryngeal axis,
(ii) Opening of the patient's mouth and introduction of the rigid blade into the right side of the oropharynx with care to avoid the teeth,
(iii) Displacement of the tongue to the left and up into the foot of the pharynx by the blade's flange,
(iv) Insertion of the tip of the blade into the vallecula,
(v) Elevation of the handle up and away from the patient in a plane perpendicular in his (or her) mandible and exposure of the vocal cords,
(vi) Insertion of the endotracheal tube through the exposed vocal cords.
However it is sometimes impossible to view the larynx by using the “traditional” direct laryngoscopy even in a patient with no (or very subtle) physical signs of difficult upper airway management.
Conditions associated with a difficult endotracheal intubation include obesity trauma (laryngeal fracture, mandibular or maxillary fracture, inhalation burn, cervical spine injury, temporomandibular joint dislocation), inadequate neck extension (rheumatoid arthritis, ankylosing spondylitis, halo traction), anatomic variations (micrognathia, prognathism, large tongue, arched palate, short neck prominent upper incisors), presence of a foreign body in the upper airway congenital anomalies (Pierre-Robin's syndrome, Treacher Collins' syndrome, laryngeal atresia, Goldenhar's syndrome, craniofacial dysostosis), infections (submandibular abscess, peritonsilar abscess, epiglottitis) and tumors (cystic hygroma, hemangioma, hematoma).
Patients with a potentially difficult intubation are frequently intubated awake and through the nose blindly or via fiberoptic endoscopy in order to maintain the protective reflexes against aspiration until the upper airway is secured.
The fiberoptic bronchoscope is a tubular instrument which utilizes flexible fiberoptic bundles to transmit light and visual images during examination of the upper and lower airways. It also contains one longitudinal channel extending from the rearward end to the tip through which oxygen can be insufflated and suction can be applied, and a lever at the proximal end to manoeuvre its tip.
There are several instruments and alternative techniques used in order to facilitate the management of the difficult airway.
Some of the instruments that can be used for laryngoscopy and endotracheal intubation are disclosed by the following patents:
1. Phillips, U.S. Pat. No. 3,856,001 discloses a rigid laryngoscope blade with a straight and a curved portion containing a longitudinal channel which forms an endotracheal tube passage. A light source is secured on one side of the blade (at the forward end of the straight portion) and aimed inwardly and downwardly. The light source is connected via electrical wires to a power source located in the handle.
2. Bullard, U.S. Pat. No. 4,086,919 discloses a rigid fiberoptic laryngoscope having a curved blade with a proximal connection member for connection to a laryngoscope handle and an eyepiece extending outwardly from the blade's proximal end. Fiberoptic bundles extend along the longitudinal axis of the blade up to the blade's distal end. An endotracheal tube can be passed alongside the fiberoptic bundle into the larynx and trachea.
3. Lowell, U.S. Pat. No. 4,306,547 discloses a rigid fiberoptic laryngoscope with a forwardly extended blade and a tube supporting channel. Fiberoptic bundles extend longitudinally along the top wall and terminate at the distal end of the channel. These bundles are proximally connected to a light source and a viewing assembly.
4. Fletcher, U.S. Pat. No. 4,329,983 discloses a guide instrument for endotracheal tubes which consists of a flexible bar that is inserted into the endotracheal tube and a flexible line extending along the bar which can be manipulated to flex the bar in a “bowed fashion” against the endotracheal tube so that the tube can be urged forwardly toward the trachea and away from the esophagus. This device can be used along with direct laryngoscopy in order to intubate an anteriorly located larynx.
5. Roberts, U.S. Pat. No. 4,384,570 discloses a rigid laryngoscope comprising an elongated blade shaped to fit into the oral pharynx of a patient and a handle consisting of a rigid section attached to one end of the blade, a movable section attached to the handle's rigid section and adapted to pivot about an axis being both substantially perpendicular to the length of the rigid handle section and extending in substantially the same direction as the length of the blade and means for locking the movable handle section during laryngoscopy. The use of this laryngoscope may decrease the risk of upper airway trauma when compared with the traditional laryngoscopic technique.
6. Baumann, U.S. Pat. No. 4,573,451 discloses a rigid laryngoscope blade with a bendable tip which can be actuated by operable means preferably located at the proximal end of the blade. This blade can be suitable to patients in which the traditional laryngoscopic procedures do not adequately expose the patient's larynx.
7. Frankel, U.S. Pat. No. 4,793,327 discloses a blind intubation instrument, which has an airway opening device, which is inserted into the patient's mouth and adjusted to a fixed position to hold the mouth open while an automated intubation guide is inserted for guiding an endotracheal tube into the trachea. The guide is fed into the mouth through an opening of the airway opening device, through which an endotracheal tube is fed into the mouth as well. The guide also has an adaptor or track which allows blind manipulation of the distal part of the endotracheal tube in order to achieve its insertion into the trachea after which the guide is withdrawn and the airway opening device removed from the mouth.
8. Wu, U.S. Pat. No. 4,982,729 discloses a rigid fiberoptic laryngoscope having an integral handle and a curved blade with fiberoptic bundles extending longitudinally along the blade and terminating at its tip. A releasably attachable (to the blade) bivalve element forms a passage for threading an endotracheal tube through the distal part of the blade.
9. Choi, U.S. Pat. No. 5,003,962 discloses an improved double angle blade or spatula which has three segments lengthwise. The proximal end of the blade is coupled so that it extends outward “L-fashion” from the end of the handle. The blade is then bent inwardly through a first and second bend toward the principal axis of the handle forming two acute angles of 20 and 30 degrees at the first and second bend respectively. The first bend is formed on the blade at about halfway between its proximal end and its tip and the second bend is formed at the distal third of the distal half of the blade. The principal object of this modified blade is to improve the difficult airway management.
10. Mac Allister, U.S. Pat. No. 5,016,614 discloses an endotracheal intubation instrument with a handle and a mechanism for retaining an endotracheal tube on an elongated obturato
Balas Constantinos
Mentzelopoulos Spyros
Cohen Lee
Dubno Herbert
Ram Jocelyn
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