CA1297373C - Tracheal tube for laser surgery - Google Patents

Abstract

Abstract A cuffed tracheal tube for use in intubation of a trachea of a patient during laser surgery involving the head or neck of the patient, includes a flexible aluminum conduit, and an expandable cuff carried at one end of the conduit and including a body of sponge-like material enclosed within a cover filled with water which saturates the sponge-like body while expanding the cuff to provide a seal between the tracheal tube and the trachea of the patient. The flexible aluminum conduit and the water saturated cuff define a heat dispersion medium for absorbing laser energy engaging the tracheal tube.

Description

~:~'7373 Background of the Invention The present invention relates to tracheal tubes and, more particularly7 to tracheal tubes for use in laser surgery.
As is well kno~n in the art, tracheal tubes are commonly inserted into a person's trachea for various purposes.
One such purpose is to provide a means for administering a general anesthetic. Such tubes usually are provided with a ~ tracheal cuff to insure a tracheal seal, both to prevent loss ; of administered gas and to prevent aspiration of body fluids.
10 Thus, tracheal tubes commonly in use, are provided with a cuff at one end of the tube, which is expandable out~ardly into engagement with the inner wall of the trachea. Cuffed tracheal tubes as known in the art, include those having cuffs or balloons made of latex rubber, plastic, silicone,etc. The cuff is mounted on the main tube and is usually attached to surround the tube in communication with an inflation line. When being inserted into the trachea, the cuff is in uninflated or deflated condition. After the intubation device has been inserted into the trachea, the cuff is inflated like a balloon, by feeding 20 air lnto the cuff to e~pand the cuff into engagement with the inner wall of the trachea to provide a seal thereagainstO
~ Another type of cuffed tracheal tube embodies a cover ; ~ filled with resilient materia~, with the cuff normally being disposed in expanded position and being collapsed by applying ~` a vacuum thereto during insertion or removal of the tube into or from the trachea, respectively.
The progress of laser technology has resulted in increased use of laser beams in surgical operationsO Laser beams - are characterized by high energy and power densities. Because 30 laser beams are light rays, they can be focused Yery precisely allowing them to be used for various types o~ surgery. Light ' ~ .

73'^d3 from a laser is focused by a lens system to a small spot of light of great intensity, producing strong heating, allowing vaporization of a small amount of virtually any substance, at locations within the body with minimal surgical invasiveness.
These factors permit laser surgery to be highly advantageous - in many situations in comparison to conventional surgical techniques.
In the case of surgery involving the head or neck area of the body, the laser beam may be directed in the proximity 10 of the trachea tube. Conventional trachea tubes are made of plastic, latex or rubber materials and, as such, when used during laser surgery involving the head or neck portion of a patient, such tubes are likely to be ignited by the high intensity laser beam striking the tube resulting in the generation of heat, flame and toxic fumes within the patient's trachea. Because anesthetic gases are administered together with oxygen in high concentration under positive pressure, conventional tracheal tubes are not safe for use during laser surgery of the head and neck. Tracheal tube ignition may result not only in burning of the patient's 20 tracheal and bronchial tree, but also may result in the inhalation of toxic fumes resulting from such burning. To overcome such problems, it has been common practice to wrap the tube portion of the tracheal tube ~lith an aluminum foil or tape to shield the tube from the laser beam. However, because the cuff portion of the tube must be capable of expansion, it is impractical to wrap the cuff in aluminum foil or tape. Thus the cuff portion, which provides the requisite seal between the tracheal tube and the trachea , remains vulnerable to damage by the laser beam. Although striking an air filled cuff with 30a laser beam is less likely to result in a fire~ it will res~
in cuff deflation. The res~ ting loss of the tracheal ~eal often ~'73'73 requires removal of the tracheal tube and replacement with an intact unit. A similar situation results when the laser beam penetrates the air inflation line to the cuff. A limited degree of protection for the cuff has been achieved by placing cotton soaked in saline or water around the cuff after insertion of the cuff and expansion of the tube to maintain a moist surface about the expanded cuffo However, this approach has not proven entirely satisfactory.
Another attempt at providing a tracheal tube for use 10 during laser surgery lnvolves the use of a laminated silicone tube having an outer coating impregnated with aluminum flakes.
However, such a structure offers only limited protection.
Additionally, such a structure utilitzes an air inflated cuff to provide the requisite seal. Although this approach provides a degree of protection from the laser beam, such tubes are known to have ignited. Further, should the cuff be penetrated by the laser beam, the cuff deflates and the seal between the tracheal tube and the patient's trachea is lost. An uncuf~ed metal tube is Norton tube available for use during laser surgery but has ~20not proven to be satisfactory since it lacks a cuff and has limited flexibility to conform to the patient's airway.
Summary of the Invention It is the object of the present invention to provide an Oimproved tracheal tube.
Another object of the invention is to provide a tracheal tube assembly for use in head and neck surgery and which is safe for use during laser surgery of the head and neck, by providing a flexible metal tube interior to serve as a heat dispenser or heat sink for dispersion of the laser energy.
Yet another object Or the invention is to provide a ~cuffed tracheal tube assembly which maintains its seal between ~31737~

the trachea and the tracheal tube in the event the cuff or the cuff inflation line is penetrated by a laser beam.
A further object of the invention is to provide a cuffed tracheal tube assembly including a cuff portion which provides a heat barrier or heat dispersion medium for absorbing laser energy.
These and other objects are achieved by the present invention which provides a tracheal tube assembly for use in intubation of the trachea of a patient during laser surgery involving the head or neck of the patient, its tracheal tube assembly comprising a tube having a flexible metal conduit shielded by a silicone sheath or coating, with the tube having a proximal end and a distal end, and an expandable cuff carried by said tube near the distal end thereof. The tube includes an inflation line operative connected to the cuff for contracting and expanding the cuff. The cuff is adapted for establishing a seal between the tube and the trachea of the patient. The cuff includes a body portion of sponge-like material, and a cover with the body being enclosed within the cover. The cuff is ; ZO filled with a liquid through thè inflation line which saturates the body portion of the cuff while expanding the cuff and cover into engagement with the inner wall o~ the trachea of the patient to form a seal between the tube and the tracheal wall. The liquid saturated cuff provides a heat barrier or heat sink or dispersion medium for absorbing the laser energy engaging the cuff.
The present invention consists of certain novel features and a combination of parts hereinafter fully described llustrated in the accompanying drawings, and particuIarly ` 30 pointed out in the appended claims, it being understood that various changes in the details may be made without departing ' ~29i737~
from the spiri-t, or sacrificing any of the advan-tages of the present invention.
_ief Description of the Drawinqs For the purpose of facilita-ting an unders-tanding of the invention, there is illustrated in the accompanying drawings a preferred embodiment, from an inspec-tion of which, when considered in connection with -the following description, the invention, its construction and operation, and many of its advantages should be readily understood and appreciated.
FIG. 1 is a side sectional view of a cuffed tracheal tube assembly embodying the principles of the present invention, and showing the cuff disposed in its collapsed condition;
FIG. 2 is a fragmentary, side elevational view of the -tracheal tube assembly shown in FIG. 1 illustrating the cuff in -the expanded position or sealing condition and with a water or saline filled syringe illustrated for expanding -the cuff to the sealing position;
FIG. 3 is a sectional view taken along line 3-3 of FIG.
l;
FIG. 4 is a sectional view taken along line 4-4 of FIG.

FIG. 5 is a sectional view taken along line S-5 of FIG.

2; and FIG. 6 is a fragmentary eleva-tional v.iew of the tracheal tube assernbly shown in FIG. 2, showing -the cuff disposed in sealing engagement with a trachea, shown diagrammatically.
scription of a Preferred Embodiment Referring to FIG. 1 of the drawings, the -tracheal tube assembly 10 provided by the present invention embodies an elongated tube 11 having an inflatable cuff 12, mounted on one end portion thereof, with an inflation line 13 communicating :~L2~1~73~3 with and extending into the cuff to facilitate deflation and inflation of the cuff, as will hereinafter be described in greater detail. The tracheal tube assembly 10 may be of any suitable construction and is for the purpose of feeding oxygen or the like, into and out of the respiratory tract of a patient , during surgery, and in particular during laser surgery involving the head or neck of the patient.
The use of lasers as a means of performing surgery within the body is increasing dramatically. One type of laser lO is based upon carbon dioxide, has wide range of uses for surgery i-because it lS selectively absorbed by water, a component of all tissue, and because it makes incisions with minimial damage to surrounding tissue. ~hen the tracheal tube assembly 10 is used as an endotracheal tube assembly, the elongated tube 11 is comprised of fle~ible metal conduit 11A shielded or enclosed within a silicone sheath 15. The metal conduit 11A is of a flexible me~al preferably aluminum, or other metal, metal alloy, etc. having a density corresponding to that of aluminum or a density less than that of aluminum.
The tube assembly ,~ has a distal end 16 for insertion into the trachea of a patient, and a proximal end 17 on which a connector 18 is mounted for connecting the tracheal tube assembly 10 to a suitable source of anesthetic gas, o~gen, or the like~ or, when mechanical ventilation of a respiratory tract is to be carried out, to a ventilating machine, or the like.
'~;, The tube assembly ~-1 may be of any suitable length, such tubes commonly being in the nature of nine to fourteen inches in length, when used as an endotracheal tube. The flexible metal conduit 1lA is enclosed within the silicone sheath 15 and movable ; 30 relative to the sheath 15 upon flexure of the conduit 11A. s' Rèferring now to FIGS. 1 and 2, the cuff portion 12 ,~ .

~2~3~3 includes a water impervious cover 19 and a cuff body 20 disposed within the cover 19, FIGS. 1 and 5. Both the cuff body 20 and the cuff cover 19 are disposed around a portion of the tube assembly 1;1 in spaced relation to~the ends 16 and 17 thereof.
In. practice) the cuff portion 12 is normally disposed -substantially closer to the end 16 of the tube 11 than to the end 17 thereof, such as, for example, being spaced from the end 16 a distance in the nature of one-half to three-fourths of an inch on a tube having an overall length of fourteen inches.
OHowever~-the cuff portion 12 may be disposed at any suitable location along the tube assembly 11, the particular location thereof depending upon the intended use of the tracheal tube 10. For example, normally, when end 16 of the tube assembly 11 is to be inserted into the windpipe or trachea only, the cuff : portion 12 preferably will normally be spaced a relatively short /, distance from the distal end 16, such as, for example, the aforementioned one-half to three-fourths of an inch. However, if the tracheal tube 11 is to be inserted further than into the l;
trachea9 such as, for example, into the bronchia, the cuff 20portion 12 preferably would be spaced a greater distance from the distal end 16 so that it would remain in the trachea when the distal end 16 was inserted into the bronchia.
The cuff cover 1g is flexible and may be made of ~y ~:. suitable material such as, for example, latex rubber, suitable .~ plastic sheet material, such as, polyvinylchloride~ or the like, or s:ilicone.rubber The cover 19 is generally tubular in form, and the end portions 21 and 22 thereof are hermetically sealed to the outer surface of the sheath encased tube assembly 11 by, S
suitable means, such a~, for example, being vulcanized thereto 300r by a suitable eement such as rubber cement, or the like.
It is apparent that the body 20 of the cuff portion 12 could : 7 ~;2973'73 be mounted on the conduit 11A and this assembly co~ d be encased within a silicone sheatht rather than the conduit 11A being separately encased within the silicone sheath 15, with the cuff 12 being hermetically sealed thereto.
The cuff body 20 affords a resilient mass which fills the cuff cover 19 between the end portions 21 and 22 thereof and, when the tracheal tuber10 is disposed in normal inoperative position outside the trachea, and is effective to yieldingly hold the cover 19 in the expanded position. The cuff body 20 lO is made of a sponge-like resilient materi~ having a multitude of open cells or interstices spread therethrough, such as, for example, sponge rubber or a suitable resilient plastic material, such as, for example, foamed polyurethane, or the like.
As shown in the drawings, an inflation line 13 extends ; along the tube assembly 11 and is encased within the sheath 15 1 and operatively connected to the cuff portion 12 for operative contracting and expanding of the cuff portion. Inflation line 13 has one end 2~ communicating with the cuff portion 12 and ; a free end 27 which projects outwardly from the sheath 15 at 20 the proximal end 17 of the tube assembly 11. End 27 of the line 13 defines a cylindrical end member 28 defining an inlet port Z
for the inflation line 13. A cylindrical plug 30 is carried by a flexible strap 31 and adapted for insertion into the end of the cylindrical member 28 to seal the port.
Referring to FIGS. 1, 2, 4 and 5, the inflation line :
13 extends through the end portion 21 of the cuff coYer 19 and is hermetically sealed thereto by the hermetic seal which connects the cover 19 to the tube assembly 11. With this construction, it will be seen that when the inflation lins 13 30is open to the at~osphere at the end portion 27 thereof, and the tracheal tube 10 is disposed outside of a trachea, the cuf~

~73'~3 body 20 is effective to yieldingly hold the cuff cover 19 in the outwardly expanded posi-tion. To facili-tate insertion of the tracheal tube assembly 10 into the trachea of a patient, a vacuum is provided at t~le free end portion 27 of the inflation line 13, as by use of a syringe 38 or other means. In this way, air or fluid may be withdrawn from within the cuff cover 19 through the inflation line 13 to thereby afforcl a partial vacuum within the cuff 12 to cause it to collapse to the posi-tion as shown in FIG. 1. The withdrawal of air or fluid from within the cuff cover 19 is substankially uniform throughout the entire area between thé end portions 21 and 22 thereof so as to effect a relatively uniform substantially complete collapse of all portions of -the cuff cover.
An index line 34 may be provided on the silicone sheath 15 on the side of the sheath where -the inflation line 13 is located -to aid the medical personnel during insertion of the tracheal tube assembly 10 in locating the inflation tube 13 diametrically opposed to the point where the laser surgery is to be performed. This minimizes the chance that the laser beam could be directed to impinge the inflation line 13.
The plug 30 is of such size that it may be manualLy inser-ted into and removed from the member Z8 on line 13. With this cons-truction, after a partial vacuum has been applied to the cuff porti.on 12 to thereby move it into a collapsed position, such as shown in FIG. 1, the plug 30 may be manually inserted into the member 28 to thereby close the e.nd 27 of the tube 13 and thereby retain -the vacuum in the cuff 12 during manipula-tion of the tracheal tube assembly 10.
Referring now to FIGS. 2 and 6, to expand the cuff portion 12 to provide the requisite seal between -the tracheal tube assembly 10 and the trachea 40 of the patient, a liquid ~ ~r w 3 ~ 3 is injected in-to the interior of the cuff portion 12 through the inElation line 13 using a syringe 38 shown in FrG. 2, the tip of which is inserted into the open end 27 of the inflation line 13 before allowing the cuff to expand. To accomplish this, the plug 30 is removed from the member 2~ while the member is held in a collapsed state. The liquid filled syringe is attached to the member 28 and the li~uid is injected. The liquid, for ex-ample, may be water or a saline solution. The li~uid saturates the cuff body 20 of the cuff portion 12 and expands the cuff body 20 to its expanded position to expand the cuff portion 12 to its full expanded position, as shown in FIG. 6, wherein the cuff portion 12 engages the inner wall 41 of the patient's -tra-chea 40. Once expanded, the plug 30 may be reinserted into the member 28 to retain the liquid within the cuff portion 12.
As indica-ted, the tracheal tube assembly 10 is par-ticularly suited for use in laser surgery involving the neck or throat of a patient. In such an application, the laser beam generated by a laser, represented by block 48 in FIG. 6, may be directed in the proximity of the tracheal tube assembly 10 which is located in the trachea of the patient. The tube assembly 11, which is comprised of an aluminum metal conduit llA and silicone sheath 15 is impervious to a laser beam generated by surgical carbon dioxide lasers. That is, when a laser beam impinges -the -tube assembly 11, the aluminum metal conduit llA will disperse the energy of the laser beam, thereby preven-ting the laser beam from penetrating through the tube 11 and from preventing a flame situation to occur within the tube with its attendant generation of toxic fumes. Moreover, if the laser beam impinges the cuff portion 12, and penetrates the outer covering 19, cuff body 2Q
may be penetrated as shown in FIG. 6, a seal will be maintained between the cuff portion 12 and the patient's trachea. A seal ~ 10 ' will be maintained even if infla-tion line 13 is penetrated. The water or sal,ine saturated cuff portion 12 disperses the energy of -the laser and prevents a fl.ame or ignition situation from occurring with its a-ttendant generation of toxic fumes.
It is believed that either -the water or the saline solution in the space be~ween the cuff cover 19 and the cuff body 20 or the water or saline solution in contact throughout the cuff body 20 provides a degree of protection for the cuff body from the laser because the liquid absorbs the energy thereof and acts as a heat sink ~laterial. This results in a dispersion of the heat within the cuff portion 12 -thereby preventing a flame or igni-tion situation of the cuff body 12 even through the cuff cover 19 may be penetrated by the laser beam. In a similar manner, the fle~ible aluminum conduit llA, as shown in ~IG. 4, is com-prised of ring segments llB flexibly jointed together which provide flexibility to the conduit, disperses heat resulting from the laser beam impinging on the tube assembly 11 during laser surgery. ~he heat transfer characteristics of the alumi-num condui-t llA enables it -to effectively resist penetration by the laser beam.
In addition, it will be seen that the presen-t invention af-fords a novel and practical tracheal tube which is particularly well adap-ted for use in laser surgery and which is laser p.^oof in -that the tracheal tube absorbs energy generated by a sur~ical laser sufficiently as to preclude flaming of the tube or cuff, and the cuff construction is such as to enable a seal between the trachea and tube to be maintained even should the cuff be penetra-ted by a laser beam.

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Claims (15)

The embodiments of the invention in which an exclusive property or privilege is claimed are defined as follows:

1. A tracheal tube assembly for use in intubation of the trachea of a patient during laser surgery involving the head or neck of the patient, said assembly comprising: a tube comprising a flexible metal conduit having a proximal end and a distal end, a silicone sheath encasing said metal conduit, with said metal conduit movable relative to said silicone sheath, an expandable cuff mounted on said tube near the distal end thereof and adapted for establishing a seal between said tube assembly and an inner wall of the trachea of the patient, an inflation line operatively connected to said cuff, means for filing said cuff by directing a liquid through said inflation line, said cuff including a body portion of sponge-like material and a cover, said body being enclosed within said cover and said cuff being filled with said liquid through said inflation line said water said body portion of said cuff thereby expanding said cuff into engagement with the inner wall of the trachea of the patient to form a seal between said tube assembly and the tracheal wall and defining a heat dispersion medium for absorbing laser energy impinging said cuff.

2. An assembly according to claim 1, wherein said liquid is water or saline solution.

3. An assembly according to claim 1, wherein said inflation line has a proximal end and a distal end, said distal end of said inflation line extending into said cuff, and said proximal end of said inflation line being adapted for connection to a source of said liquid to supply said liquid through said inflation line to the interior of said cuff.

4. An assembly according to claim 3, wherein the major portion of said inflation line between its proximal and distal ends extends along said flexible metal conduit and is encased within said sheath.

5. An assembly according to claim 4, wherein said flexible metal conduit comprises a plurality of ring segments interconnected with one another flexibly joined together.

6. An assembly according to clam 1, wherein said flexible metal conduit is made of aluminum.

7. An assembly according to claim 4, wherein tube includes indexing means for indicating the location of said inflation tube.

8. A tracheal tube assembly for use in intubation of the tracheal of a patient during laser surgery, said assembly comprising:
a tube comprising a flexible metal conduit having a proximal end and a distal end, a cuff mounted on said tube near the distal end thereof and adapted for establishing a seal between said tube assembly and the inner wall of the tracheal of the patient, said cuff including a body portion of sponge-like material and a cover therearound, means communicating with said cuff delivering liquid to said cuff for establishing a seal between said tube assembly and the inner wall of the trachea, said body portion being enclosed within said cover and said cuff being adapted to be filled with liquid which expands said cuff into engagement with the inner wall of the tracheal of the patient to form a seal between said tube assembly and the tracheal wall and to define a heat dispersion medium for absorbing laser energy impinging said cuff.

9. An assembly according to claim 8, wherein said fluid is water.

10. An assembly according to claim 8, further comprising an inflation line having a proximal end and a distal end, said distal end of said inflation line extending into said cuff, and said proximal end of said inflation line being adapted for connection to a source of said liquid to supply said liquid through said inflation tube to the interior of said cuff.

11. An assembly according to claim 8, wherein said liquid is water or saline solution.

12. An assembly according to claim 10, further comprising a sheath of pliable material encasing said flexible conduit and at least a portion of said inflation line extending along said flexible conduit and encased within said sheath.

13. An assembly according to claim 12, wherein said sheath is made of silicone material.

14. An assembly according to claim 10, wherein said flexible conduit is made of aluminum.

15. A tracheal tube for use in intubation of a patient during laser surgery comprising:
an elongated metal conduit tube having an outer surface, proximal end and distal end, a silicone sheath enclosing said conduit tube, with said conduit tube movable relative to said silicone sheath, a cuff mounted on said elongated tube adjacent to said distal end and in spaced relation to said proximal end, said cuff including a flexible tubular cover disposed on said elongated tube in surrounding relation thereto, and having its ends secured to said outer surface, and a resilient body portion mounted in said cover, said cuff being adapted to be filled with liquid to expand said cuff and saturate said body portion with said liquid, with said liquid saturated body portion defining a heat dispersion medium for absorbing laser energy engaging said cuff.