CH710358A1 - Flexible intubating laryngoscope. - Google Patents

Abstract

In an intubation laryngoscope according to the invention, comprising a handle, an intubation spatula with a plurality of joint sections (5) and an actuating device with a tension element for adjusting the blade curvature or spatula angle, wherein the tension element is fastened in the region of the tip (3) of the intubation spatula, it is provided that the intubation spatula has a bendable spatula body with a cavity (7) and a gapless upper side (8), on whose underside (10) a guide (11) is formed; wherein the intubation spatula further comprises a deflectable spatula tongue (6) which is movably guided along the guide (11) in the longitudinal direction of the intubation spatula and forms a gap-free underside (9) of the intubation spatula.

Description

Technical area

The present invention relates to an intubation laryngoscope comprising an intubation spatula and a handle.

Technical background

The endotracheal intubation, that is the introduction of a respiratory tube into the trachea of a patient, is usually carried out in anesthesia, intensive care or emergency medicine by means of a direct laryngoscopy. By means of a conventional intubation laryngoscope, for example according to Miller or Macintosh (US Pat. No. 2,354,471), a direct view through the mouth is made to the vocal cords, so that the respiratory tube can be inserted into the trachea under direct view of the larynx between the two vocal cords.

For anatomical reasons or even pathological changes in the oral, maxillary or facial area, however, a direct laryngoscopic visualization of the vocal cords is not possible in all patients. This means that during direct laryngoscopy either only the posterior part of the vocal cords or the arytenoid cartilages or the epiglottis tip or no larynx structures at all can be recognized. This makes the insertion of the breathing tube through the vocal cords difficult or even impossible. In such a situation, so-called endoscopic laryngoscopes or video laryngoscopes are increasingly being used today for indirect visualization of the vocal cords.

Various devices are known from US 5,800,344, US 5,827,178, US 2013,057,767 and WO 9,944,490, in which the view by means of video camera or fiber optics of the intubation spatula tip on one on the laryngoscope handle or bedside attached monitor is transmitted. The endoscopic view of the intubation spatula tip is proven superior to the direct laryngoscopic view and often allows to establish a view of the vocal cords even in difficult direct laryngoscopic visual conditions and thus safely advance the breathing tube under endoscopic view in the trachea. The endoscopic transmission of the view from the laryngoscope tip to a screen during endotracheal intubation is likewise advantageous for training, demonstration, monitoring and, if appropriate recording, also for documentation purposes (Weiss, M. et al., Anesthesiology 1998, V89, No 3A: SSE9).

Since the introduction of endoscopic as well as the so-called video laryngoscopes devices have been developed with a variety of spatula shapes. In general, you can distinguish the following 3 groups: 1. Normal = conventionally shaped (Miller, Macintosh) laryngoscope spatula 2. Angled or highly curved laryngoscope spatula 3. Highly curved laryngoscope blade with guide channel

The introduction of angled in the middle of the laryngoscope blade or strongly curved shapes has meant that although the visualization of the vocal cords is very simple, but the insertion of the breathing tube to the angle of the angled intubation spatula or an excessive laryngoscope Bend around making it difficult. Therefore, i.a. curved intubation spatula with guide channel designed to better guide the tube in front of the glottis.

In principle, a normally shaped intubation spatula (Miller, Macintosh) with an endoscopic transmission of the view from the spatula tip offers an improvement in the viewing angle of 40 ° to 50 ° with respect to the direct laryngoscopic view. This normally suffices for an unexpectedly difficult intubation in order to visualize the vocal cords and then to guide the tube safely along the normally shaped intubation spatula into the trachea (Weiss, et al.

The introduction of angled or excessively curved spatulas has made insertion of the tube difficult and, consequently, additional aids such as curved or bendable or controllable guidewires (intubation stylets) in the ventilator tube have become necessary. Similarly, injuries to the oracular structures have been described using highly angled laryngoscopes.

Angled laryngoscopes or highly curved video laryngoscopes are certainly advantageous in known anatomically difficult intubation conditions, but may complicate intubation in routine intubation of the normally intubated patient.

From the above considerations, an endoscopic intubation laryngoscope is desirable in which the curvature or angle of the intubation spatula would be adaptable to the situation. This would allow to intubate the patient without guide aids in normal intubation conditions or with only slight visual limitations with normal shaped Intubationsspateln and adjust the curvature or the angle of the intubation spatula as necessary in difficult conditions.

Laryngoscopes with a movable Intubationsspatel are known. For example, US Pat. No. 4,573,451 shows an intubation spatula which has a joint in the area of the tip. The tip of the intubation spatula can be adjusted by means of a flexible or flexible pressure element and fixed by means of engaging ratchet parts. However, in US 4,573,451, only the tip is movable, and when the tip is bent back, there is a risk of trapping epithelial layers of the patient in the articular site.

Other solutions, such as those described in WO 9 311 700, CN 2 046 364, EP 2 679 144, WO 10 079 521, FR 2 821 736 and US 6 174 281 laryngoscopes, have a much more complicated and therefore costly mechanics For example, these laryngoscopes are not suitable as disposable laryngoscopes. WO 9 311 700 shows a laryngoscope in which a lower tongue of the intubation spatula is divided into several sections and can be deformed accordingly. The mechanics used here have a complicated multipart construction and are therefore not suitable for a disposable laryngoscope. EP 2 679 144 shows a laryngoscope with a plurality of displaceable cylindrical elements which push away a flexible lower leaf of an intubation spatula by advancing the elements away from an upper leaf and thus increase the curvature of the lower leaf. The curvature of the upper leaf remains unchanged. WO 10 079 521 shows a laryngoscope, in which the intubation spatula is provided with magnets and influenced by counter-magnets, in part outside the patient. FR 2 821 736 provides an intubation spatula consisting of a plurality of pivotably interconnected members which are pivotally actuated via a tension member. The tension element is anchored in a carriage on the side in the handle. The intubation spatula is preloaded with the strongest curvature. The curvature can be increased with the pulling element, which runs along an upper edge of the Intubationsspatels by the pivotally interconnected links in the upper region are pushed into each other. US Pat. No. 6,174,281 shows a laryngoscope with an intubation spatula made of a plurality of links, which are flexibly connected to one another on the underside by means of hinged connections. The intubation spatula can be actively deformed by means of a tension element which runs along the upper edge of the intubation spatula. The actuation takes place here by means of a hand lever which is articulated rotatably at the upper end of the handle.

Presentation of the invention

It has been shown that in most known laryngoscopes with movable Intubationsspatel either the top or bottom of the Intubationsspatels has separation points, where relative shifts or Verschwenkungen between the links occur and thus there is a risk to pinch mucous membrane layers of the patient. This can lead to traumatization of the patient. In addition, the known laryngoscopes with movable intubation spatula on a complicated and therefore costly mechanics, making these laryngoscopes are less suitable as disposable laryngoscopes.

It is therefore an object of the present invention to provide an intubation laryngoscope, which has a low risk of injury to the epithelial layers of the patient and at the same time has a simple and thus cost-effective structure.

This object is achieved by an intubation laryngoscope with the features of claim 1. The intubation laryngoscope is preferably made of plastic and comprises a handle, an intubation spatula with a plurality of joint portions and an actuator for adjusting the blade curvature. The Intubationsspatel comprises a bendable spatula body with a cavity and a gapless top, on the underside of a guide is formed. The intubation spatula further comprises a bendable spatula tongue, which is movably guided along the guide in the longitudinal direction of the intubation spatula and forms a gap-free underside of the intubation spatula.

In this way, the top of the intubating spatula (i.e., the convex side) may be formed with a uniform surface having no cuts, gaps, hinges, or other irregularities, e.g. would represent a risk of injury to the patient at a change in curvature. The same applies to the underside (i.e., the concave or handle-facing side) of the intubation spatula. With gapless so is meant that the top resp. Underside, for example, has no joint incisions, which can close depending on the blade curvature and thus could pinch tissue of the patient.

Preferred embodiments of the invention are specified in the dependent claims.

In one embodiment, the deflectable spatula body comprises a first spatula half shell and a second spatula half shell, which are connected to form the cavity and the gap-free upper side and which form at the bottom of the guide for the spatula tongue. The term half-shell should not be understood to mean that the two half-shells must be mirror-symmetrical.

The intubation spatula may be in its relaxed, i. be formed in the least or not curved or angled shape, straight, slightly curved or slightly angled. In particular, in a straight shape of the spatula body can be easily manufactured as a one-piece injection molded part without half shells.

Preferably, the deflectable spatula tongue forms the tension member by being connected at its proximal end to the actuator and transmits a force generated by the actuator directly to the spatula tip. Alternatively, the pulling element may further comprise a pull rope which either connects the proximal end of the spatula tongue to the actuator, or the pull rope is guided in the cavity and secured to the spatula tip. In the latter case, the spatula tongue would be held displaceably at the proximal end of the intubation spatula and shifts in the proximal direction with increasing spatula curvature relative to the two spatula half shells.

The joint portions of the Intubationsspatels may be formed by openings open towards the underside, preferably V-shaped incisions, in adjacent to the cavity side walls of the spatula body. The bendable spatula tongue resp. The tension element then covers these incisions as seen from the underside, so that a gap-free underside of the intubation spatula is formed. For this purpose, the spatula tongue preferably at least the width of the underside of the spatula body resp. of the assembled spatula shells. It can also be wider, so that it protrudes on one or both sides over the underside of the spatula body.

The shape of the incisions determines the shape of the spatula in the maximum bend / curvature. Thus, depending on the shape and distribution of the incisions different forms resulting in maximum tension can be effected. Also, only one incision would be conceivable, which would lead to a simple buckling of Intubationsspatels.

The bendable spatula tongue can with its distal end in the region of the spatula tip with the spatula body resp. be connected to the first and the second spatula half shell. A translatory movement of the spatula tongue causes the spatula tip to be pulled or pushed away relative to the handle, thus resulting in a change in the curvature of the blade or bending.

The adjacent to the cavity side walls of the spatula body resp. the first and second spatula half-shells may have at right angles bent guide legs, which form the guide for the spatula tongue. These are preferably directed to the cavity, but could also be directed to the outside. The guide legs are in Spatellängsrichtung in the region of the joint sections resp. interrupted incisions so that they do not preclude a change in curvature of the intubation spatula.

The deflectable spatula tongue may have at its top one or more guide carriage, with which the spatula tongue is movably guided in the leadership of the spatula body or the two spatula half shells. The guide slides, for example, a T or L professional! exhibit. The guide carriages can be arranged at such a distance that they respectively engage in sections of the interrupted guide legs and also by the movement of the spatula tongue relative to the spatula body, respectively. to the spatula half shells do not reach into the interruptions of the guide legs.

The actuator for adjusting the blade curvature can be arranged in the proximal extension of the Intubationsspatels. Preferably, the actuator for adjusting the spatula curvature comprises an adjusting screw, which is rotatably connected to the proximal end of the spatula tongue, so that a rotation of the adjusting screw leads to a translational displacement of the spatula tongue and thus to a change in the blade curvature. The curvature of the intubation spatula is infinitely adjustable.

The screw can be formed in two halves with a central receptacle for a fastener of the spatula tongue, which can also be easily prepared as an injection molded part.

The actuator may be partially formed on the spatula body or on the handle (for example, a socket for the screw), or as on the spatula body or on the handle attached unit (eg. With motor) may be formed.

The cavity in the Intubationsspatel can form a guide channel for receiving at least one optical and / or electrical conductor, which has a distal outlet opening. One or more bulbs (e.g., a light pipe, a lamp, or an LED) and an image pickup means (e.g., a CCD chip or an endoscope) may be disposed in the region of the exit aperture.

The handle may comprise a first handle half shell and a second handle half shell, which are interconnected to form a cavity for receiving the at least one optical and / or electrical conductor. The first handle half shell and the first spatula half shell respectively the second handle half shell and the second spatula half shell can be formed in one piece.

The cavity of the Intubationsspatels and the cavity of the handle can be connected to each other via a passage which passes by the proximal end of the spatula tongue and the adjusting screw. For this purpose, the fastening element of the spatula tongue is preferably designed as a rod-shaped extension, so that there is sufficient distance between the adjusting screw and the proximal end of the spatula tongue.

The different half-shells and the spatula tongue can be produced inexpensively as injection-molded parts, making the intubation laryngoscope suitable as a disposable intubation laryngoscope. The optical resp. electrical conductors may be fixed or detachable in the intubation laryngoscope and terminate with a plug connection on the bottom or side of the handle.

The power supply and the optoelectronic conversion of the image can take place outside the video laryngoscope - either on a plugged onto the laryngoscope small monitor, which includes both power supply and optoelectronic image conversion, or by means of a cable connection to a bedside mounted monitor, which For example, includes both power supply as well as optoelectronic image conversion, or by means of a clip-on wireless connection adapter, which includes, for example, both power supply and optoelectronic image conversion.

Handle and Intubationsspatel can also be releasably connected to each other. In this case, the handle is preferably designed to be reusable and may include the power supply and / or the optoelectronic image conversion and / or a permanently mounted screen. The Intubationsspatel with the actuator can be designed as attachable to the handle disposable Intubationsspatel.

Opto-electronic image conversion and / or current supply can also be introduced as a piston-like insert into the laryngoscope handle and find contact with the optical / electrical conductors inside the laryngoscope handle. This insert may have a screen attached or permanently mounted and / or a plug-in contact for a wireless connection or a cable connection to a display unit screen).

The handle may have a motor drive, which resp. Activate adjusting screw for adjustment of the blade curvature. In this case, appropriate switches can be attached to the handle, so that the user can adjust the radius of curvature by pressing a button. It is also conceivable that an attachable from the outside motor drive can be attached, which the actuator respectively. Activate adjusting screw for adjustment of the blade curvature. In this case, appropriate switches can be attached to the handle approach, so that the user can adjust the radius of curvature by pressing a button.

The intubation laryngoscope can have a channel or tube which extends from the handle to the exit opening of the cavity in the intubation spatula and is hermetically sealed at the distal end by means of a light / image-transmissive lens. Into the canal or tube, an endoscope with image-light transmission can be advanced to the tip of the intubation spatula. Preferably, the intubation laryngoscope has a fastening and tensioning mechanism at the endoscope entry point into the handle, which can fix the thin endoscope or press it towards the spatula tip towards the lens. This allows a reuse of the optoelectronic components (endoscope with image-light transmission) of the laryngoscope, without having to clean them consuming.

Depending on whether the laryngoscope is reusable, partially reusable (e.g., a reusable handle) or designed as a disposable laryngoscope, the handle and or intubation spatula (or parts of the intubation spatula) can be made of plastic and / or metal.

Brief explanation of the figures

The invention will be explained in more detail with reference to embodiments in conjunction with the drawings. Show it: <Tb> FIG. 1 <SEP> a side view of an intubation laryngoscope with a relaxed intubation spatula; <Tb> FIG. 2 <SEP> a side view of the intubation laryngoscope with curved intubation spatula; <Tb> FIG. 3 <SEP> an enlarged sectional view through the intubation spatula; <Tb> FIG. 4 <SEP> an exploded view of the intubation laryngoscope; <Tb> FIG. 5 <SEP> is a perspective view of the intubation laryngoscope; and <Tb> FIG. FIG. 6 is a perspective view of the intubation laryngoscope without a first half shell. FIG.

Ways to carry out the invention

FIGS. 1 and 2 show the functional principle of the intubation laryngoscope. 1 is a side view of an intubation laryngoscope with a relaxed intubation spatula, i. the Intubationsspatel is shown in contrast to Figure 2 with the least curvature. and Fig. 2 shows the intubation laryngoscope with curved intubation spatula, i. with the strongest possible curvature.

The intubation laryngoscope comprises a handle 1 and a curved Intubationsspatel 2. Next, the laryngoscope shown in the proximal extension of the Intubationsspatels 2 with an actuator 4, here in the form of a screw 14, provided with which the blade curvature can be adjusted continuously.

The intubation spatula 2 has on its underside, i. the concave side facing the handle 1, as a pulling element a spatula tongue 6, which is fixed with its distal end in the region of the spatula tip 3. In its middle region, the intubation spatula 2 has a plurality of joint sections in the form of incisions 5. In this area, the spatula tongue 6 is held displaceably. A proximal end of the spatula tongue 6 (not visible in FIGS. 1 and 2) is operatively connected to the adjusting screw 14 of the actuating device 4, so that a rotation of the adjusting screw 14 leads to a translatory movement of the spatula tongue 6 in the longitudinal direction of the intubation spatula. In this case, the spatula tip 3 can be pulled in the direction of the handle 1, whereby the incisions 5 in the intubation spatula 2 close continuously and the intubation spatula is guided to the position with the strongest curvature (FIG. 2).

3 to 5 illustrate the structure of the laryngoscope. FIG. 3 shows an enlarged sectional representation (FIG. 1: section A-A) through the intubation spatula 2. 4 shows an exploded view of the intubation laryngoscope with the various parts. And FIGS. 5 and 6 each show a perspective view of the intubation laryngoscope, respectively. of the partially open intubation laryngoscope. In all figures, no optical and / or electrical conductors or guide elements for receiving and guiding electrical / optical elements are shown.

The intubation spatula 2 comprises a bendable spatula body comprising a first spatula half shell 2a and a second spatula half shell 2b. The handle 1 comprises a first handle half-shell 1a and a second handle half-shell 1b. In the embodiment shown, the first handle half shell 1a and the first spatula half shell 2a respectively the second handle half shell 1b and the second spatula half shell 2b are integrally formed.

The two spatula half shells 2a, 2b are connected to form a cavity 7 and a closed, gap-free top 8 with each other. The cavity 7 of the intubation spatula 2 forms a guide channel for receiving at least one optical and / or electrical conductor, which has a distal outlet opening 15 in the region of the spatula tip 3. The spatula tip 3 is formed by one of the two spatula half shells 2a, 2b. In the embodiment shown, it is the second spatula half shell 2b.

In each case, a side wall 12a, 12b of the spatula half shells 2a, 2b are provided with a plurality of V-shaped incisions 5 open towards the bottom 10, which form the joint sections of the intubation spatula 2. On the underside 10, the two spatula halves 2a, 2b form a guide 11, in which the spatula tongue 6 is held movably. This guide 11 is formed in the illustrated embodiment by right-angled inwardly bent guide legs 12a, 12b, which are arranged on the underside of the side walls 12a, 12b. In the area of the cuts 5, the guide legs 12a, 12b are interrupted.

To keep the spatula tongue 6 in the guide 11 of the spatula half-shells 2a, 2b, this has a plurality of arranged on the top guide carriage 13, which in the embodiment shown have a T-profile.

The spatula tongue 6 is in the embodiment shown a flexible, elongated plate, which completely covers the incisions 5 seen in the composite Intubationsspatel 2 from the bottom, thus forming a closed, gap-free bottom 9 of the Intubationsspatels 2. In this way, there is no risk of injury to a patient by pinching tissue in the incisions 5 of the intubation spatula 2. In the embodiment shown, the spatula tongue 6 is wider than the underside 10 of the spatula half shells 2a, 2b, so that it protrudes on one side and a guide surface 16th forms for a tube, which is formed in the spatula tip 3, and is formed there by second spatula half shells 2b.

At the proximal end, the spatula tongue 6 has a fastening element 17, here in the form of a rod with an attached plate 18. The fastening element 17 is rotatably held in the adjusting screw 14. In the embodiment shown, the adjusting screw 14 consists of two halves 14a, 14b which form an external thread and an actuating knob 19. The adjusting screw 14 is held in a corresponding holder 20 with internal thread at the proximal end of the Intubationsspatels 2 in the upper region of the handle 1.

In the embodiment shown, the guide carriages 13 are asymmetrical, i. laterally offset at the top of the elongated plate of the spatula tongue 6 arranged. The fastening element 17 and thus also the actuating device 4 is also arranged offset laterally in order to exert an optimal power transmission to the spatula tongue 6.

In the embodiment shown, the handle 1 is hollow and can also serve as a guide channel or receptacle for optical and / or electrical conductors. For this purpose, a passage is present between the cavity 7 of the intubation spatula 2 and the cavity of the handle 1, which passes between the proximal end of the spatula tongue 6 and the adjusting screw 14 on the fastening element 17. For this purpose, the rod-shaped fastening element 17 is formed sufficiently long that a passage between the proximal end of the elongated plate of the spatula tongue 6 and the adjusting screw 14 is present.

name list

[0052] <Tb> 1 <September> handle <tb> 1a <SEP> first grip half shell <1b> 1b <SEP> second handle half shell <Tb> 2 <September> intubation <tb> 2a <SEP> first spatula half shell <2b> 2b <SEP> second spatula half shell <Tb> 3 <September> spatula <Tb> 4 <September> actuator <Tb> 5 <September> hinge section <Tb> 6 <September> Spatelzunge <Tb> 7 <September> cavity <tb> 8 <SEP> Top of the intubation spatula <tb> 9 <SEP> Bottom of the intubation spatula <tb> 10 <SEP> Bottom of the spatula shells <Tb> 11 <September> Leadership <tb> 11a, 11b <SEP> Guide legs <tb> 12a, 12b <SEP> Sidewall <Tb> 13 <September> guide carriage <Tb> 14 <September> screw <tb> 14a, 14b <SEP> Adjusting screw half <Tb> 15 <September> outlet opening <Tb> 16 <September> guide surface <Tb> 17 <September> fastener <Tb> 18 <September> Plates <Tb> 19 <September> actuator button <Tb> 20 <September> bracket <Tb> 21 <September> Continuity

Claims (15)

1. intubation laryngoscope comprising a handle (1), an intubation spatula (2) with a plurality of joint sections (5) and an actuating device (4) with a tension element for adjusting the blade curvature or spatula angle, wherein the tension element in the region of the tip (3) of the intubation spatula ( 2), characterized in that the intubation spatula (2) comprises a bendable spatula body with a cavity (7) and a gapless upper side (8), on whose underside (10) a guide (11) is formed; wherein the Intubationsspatel further comprises a bendable spatula tongue (6) which is guided along the guide (11) in the longitudinal direction of the Intubationsspatels (2) and forms a gap-free, bottom (9) of the Intubationsspatels (2). 2. intubation laryngoscope according to claim 1, characterized in that the deflectable spatula body comprises a first spatula half shell (2a) and a second spatula half shell (2b), which are connected to form the cavity (7) and the gapless upper side (8) and at the Form bottom (10), the guide (11). 3. Intubation laryngoscope according to one of the preceding claims, characterized in that the bendable spatula tongue (6) forms the tension element. 4. intubation laryngoscope according to one of the preceding claims, characterized in that the joint portions (5) of the Intubationsspatels by the bottom (9) open towards incisions, preferably V-shaped incisions, in the cavity (7) adjacent side walls (12a, 12b) are formed of the spatula body and the bendable spatula tongue (6) seen from the underside of the incisions (5) covers. 5. intubation laryngoscope according to one of the preceding claims, characterized in that the deflectable spatula tongue (6) is connected to a distal end in the region of the spatula tip (3) with the spatula body. 6. intubation laryngoscope according to one of the preceding claims, characterized in that on the cavity (7) adjacent side walls (12a, 12b) at right angles bent guide legs (11b) which form the guide (11) for the spatula tongue (6). 7. intubation laryngoscope according to one of the preceding claims, characterized in that the deflectable spatula tongue (6) at its upper side at least one guide carriage (13), with which the spatula tongue (6) in the guide (11) of the Intubationsspatels (2) movably guided is. 8. intubation laryngoscope according to one of the preceding claims, characterized in that the actuating device (4) for adjusting the blade curvature in the proximal part or in the proximal extension of the Intubationsspatels (2) is arranged. 9. intubation laryngoscope according to one of the preceding claims, characterized in that the actuating device (4) for adjusting the spatula curvature comprises an adjusting screw (14) rotatably connected to the proximal end of the spatula tongue (6), so that a rotation of the adjusting screw (14 ) leads to a translational displacement of the spatula tongue (6) and thus to a change in the blade curvature. 10. intubation laryngoscope according to one of the preceding claims, characterized in that the cavity (7) forms a guide channel for receiving at least one optical and / or electrical conductor having a distal outlet opening (15). 11. intubation laryngoscope according to one of the preceding claims, characterized in that in the region of the outlet opening one or more lighting means and an image pickup means are arranged. 12. intubation laryngoscope according to one of the preceding claims, characterized in that the handle (1) is integrally formed or a first handle half-shell (1 a) and a second handle half-shell (1 b). 13. Intubation laryngoscope according to claim 10, characterized in that the first handle half shell (1a) and the first spatula half shell (2a) respectively the second handle half shell (1b) and the second spatula half shell (2b) are integrally formed. 14. Intubation laryngoscope according to one of the preceding claims, characterized in that the handle (1) and the Intubationsspatel (2) are detachably connected to each other. 15. intubation laryngoscope according to one of the preceding claims, characterized in that the Intubationsspatel (2) and / or the handle (1) made of plastic and / or metal is made.