CH710367A2 - Flexible intubating laryngoscope with reusable image recording device. - Google Patents

Abstract

In an intubation laryngoscope according to the invention, comprising a handle (1), an intubation spatula (2) with a guide channel or guide tube (34) and an image recording device (30); wherein the guide channel or guide tube (34) in the region of a distal spatula tip (3) has an optically transparent window (33); and wherein the image capture device (30) has a flexible image guide with a distal optical tip; it is provided that the image recording device (30) is designed as a reusable unit whose image guide and optic tip are releasably inserted into the Intubationsspatel (2) and that applied for optimum image recording the distal optic tip in the installed state with a force in the direction of the window (33) is so that it is pressed against the optically transparent window (33). The intubation laryngoscope according to the invention may also comprise a bendable spatula body which is moved with a tension element for adjusting the curvature.

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 by 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: <tb> 1. <SEP> Normal = Conventional (Miller, Macintosh) Laryngoscope Blades <tb> 2. <SEP> Angled or highly curved laryngoscope blades <tb> 3. <SEP> 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 endoscopic laryngoscopes.

Angled video laryngoscopes or highly curved video laryngoscopes are certainly advantageous for a better view of the vocal cords in known anatomically difficult intubation conditions, but in routine intubation of the normally intubated patient they can complicate intubation.

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.

In practice, more or less disposable resp. Disposable laryngoscopes required to avoid costly and expensive cleaning, disinfecting or even sterilizing the devices. Since the optoelectronic elements of the endoscopic laryngoscopes or video laryngoscopes usually represent the most expensive elements of the laryngoscope, there is a need, however, to design them as reusable elements. For example, WO 9 944 490, US 2014 107 422, WO 11 023 930 and WO 10 120 950 disclose laryngoscopes comprising an image pickup device and a disposable spatula. In this case, the disposable spatula is placed over an image guide of the image recording device with an optically transparent window. Disposable spatula and image recording device are each designed such that the tip of the image recording device is applied to the optical window. However, slight movements of the disposable spatula, such as may occur during insertion of the laryngoscope, affect the rest contact against the window and may affect the quality of imaging. In addition, in the known laryngoscopes with disposable spatula, adjusting the radius of curvature of the spatula is not possible. Especially with flexible spatulas, the problem of contact contact is even more pronounced.

Presentation of the invention

It has been shown that in most known laryngoscopes with movable Intubationsspatel either the top or the 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.

Another object is to provide a partially disposable intubation laryngoscope, the reusable optoelectronic elements are easily and reliably in the disposable part of the intubation laryngoscope, which come into contact with body fluids of the patient, can be used. The aim is to ensure optimum image quality in every situation.

These objects are achieved by an intubation laryngoscope with the features of claim 12 and / or 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 or the handle-facing 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 set forth in the dependent claims 2 to 11 and 13 to 26.

In one embodiment, the deflectable spatula body comprises a first spatula half shell and a second spatula half shell, which are connected together to form the cavity and the gap-free top and the other underside form the leadership 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 non-adjustable 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 can be formed by the underside open incisions, 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 bent guide legs at right angles, 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 on its upper side one or more guide carriages with which the spatula tongue is movably guided in the guide of the spatula body or the two spatula half shells. The guide carriages can have, for example, a T or L profile. 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 fastening element 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 attached to the spatula body or the handle unit (eg. With motor) may be formed.

The cavity in the Intubationsspatel can form a guide channel or guide tube for receiving at least one optical and / or electrical conductor having 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 at 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 inside or outside the video laryngoscope, in the latter case 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 includes, for example, both power supply and 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 intubation spatula with the actuating device can thereby be used as a disposable intubation spatula which can be placed on the handle, e.g. be designed with integrated optoelectronic image guide and lighting.

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 may 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) may be made of plastic and / or metal.

An intubation laryngoscope comprising a handle and an intubation spatula with a guide channel or guide tube, in particular but not exclusively an intubation spatula with an adjustable radius of curvature, may further comprise an image recording device; wherein the guide channel or guide tube has an optically transparent window in the region of a distal spatula tip; and wherein the image pickup device has a flexible image guide with a distal optical tip. The image recording device is designed as a reusable unit whose image guide and optical tip are releasably inserted into the Intubationsspatel. For optimal image acquisition, the distal optic tip is in the installed state, i. when the reusable image pickup device is inserted, a force is applied toward the window so that it is pressed against the optically transparent window. In this way, it is ensured that the optics of the image recording device always rests satisfactorily on the optically transparent window. This is particularly important for bendable Intubationsspateln of importance. Another advantage is that it also minor tolerances can be compensated for the disposable Intubationsspatel.

An image pickup device with force applied optical tip, can be considered as an independent invention or in combination with all the embodiments described above.

The intubation laryngoscope with handle, Intubationsspatel and reusable image acquisition unit may have the features of the previously described embodiments of a bendable intubation laryngoscope, which are partially transferable to intubation laryngoscopes with fixed intubation spatula.

As a rule, the handle of the intubation laryngoscope has a cavity in which the image recording device is partially accommodated.

In some embodiments, the flexible image guide may be resiliently mounted with respect to the handle, so that the optical tip is loaded in the installed state with a force in the direction of the window, which presses the optical tip against the optically transparent window. That the flexible image guide is acted upon by a spring force such that the spring force is conducted via the image conductor to the optical tip and presses it onto the window. A spring-mounted image guide allows slight movements of the image guide in the longitudinal direction, which always allows optimal image quality especially in a bendable spatula by thereby the optical tip is not detached from the optically transparent window even when bending the spatula. It is also possible to compensate for differently sized intubation spatula or for guide channels or guide tubes of different lengths (see below).

In some embodiments, the image pickup device, an electronics housing with a distal optical mount resp. Include optical insertion, which are arranged in a cavity of the handle, wherein the image conductor at the proximal end with the optical mount resp. Optics introduction is connected.

In some embodiments, the electronics housing may be at least partially inserted or insertable into a cavity of the handle and resiliently mounted relative to the handle, so that the distal optical tip is applied in the installed state with a force in the direction of the window, which the optical tip against the optically transparent window presses. In this case, a spring can be arranged between the electronics housing and a proximal bottom or intermediate bottom of the handle. The electronics housing is so slidably held in the handle in the longitudinal direction. The power supply, the control of the image recording device and the image transmission can be done via a cable with a connector at the proximal end of the handle. Alternatively, in such a solution, the control of the image pickup device and the image transfer to an external monitor may also be wireless (e.g., Bluetooth, WLAN, radio) because the electronics housing is slidably mounted in the handle in the longitudinal direction. In this way, insertion is even easier. The power supply then takes place via a battery arranged in the electronics housing. It is also possible to have a rechargeable battery which is wireless, e.g. inductively, is charged in a corresponding holder.

In some embodiments, the handle may have a lid at the proximal end so that the image-receiving device can be inserted from the proximal end into the cavity of the handle. In this case, the image recording device is supported with a spring relative to the lid.

In some embodiments, the electronics housing of the image pickup device can be formed by a proximal part of the handle, preferably by a respective proximal part of a first and a second handle half shell, wherein the optical holder is resiliently mounted relative to the electronics housing, so that the distal optical tip in built-in state is acted upon by a force towards the window. For this purpose, the optical mount in the longitudinal direction displaceable on a spring, which respectively on the side wall of the electronics housing. the handle is supported, be stored.

In all embodiments, a disposable or disposable part of the intubation laryngoscope respectively the intubation spatula and at least the distal end of the handle resp. the distal handle approach, which is preferably firmly connected to the Intubationsspatel include. In this way, the distal part of the handle, which comes into contact with the mouth opening of the patient during intubation and thus contaminated, is discarded after a single use.

In all embodiments, the dividing line between the disposable distal region of the handle and the reusable proximal region may vary between far distal (small portion of the handle being disposable) and far proximal (small portion of the handle being reusable).

The image conductor may comprise at least one optical and / or at least one electrical conductor, which supply the optical tip with light and transmit the images taken at the optical tip. The supply of light can be done, for example, fiber optically by means of a light source in the electronics housing of the image pickup device and a light guide to the optical tip or electrically by means of a lamp or a LED. The image transmission can also be made fiber-optically to a camera (chip camera) in the electronics housing of the image recording device or electrically with a chip camera installed in the optical tip (for example CCD or CMOS sensor). The flexible image conductor or the optical and / or electrical conductors alone are led into the electronics housing.

The transmission of the video signal or the video camera raw signal can be done via cable to an external monitor or on a attachable to the handle monitor. For this purpose, the handle can be provided with a plug connection. The transmission can also be done wirelessly to an external or attachable monitor.

For power supply, the image pickup unit may be provided with a battery, which is preferably housed in the electronics housing. The power supply and the opto-electronic conversion of the image can take place outside the video laryngoscope - either on a small monitor plugged into the laryngoscope, which contains, for example, both power supply and optoelectronic image conversion, or by means of a cable connection to a bedside monitor. which includes, for example, both power supply as well as optoelectronic image conversion, or by means of an attachable wireless connection adapter which includes, for example, both power supply and opto-electronic image conversion.

For a better introduction of force and better usability of the reusable image recording device, the Intubationsspatel have a cavity for receiving the flexible image guide, which is designed as a guide channel and / or in which a guide tube is arranged. The guide channel resp. Thus, guide tube can be a molded-on component of an intubation laryngoscope, or can be designed as a separate part, which can be inserted into the cavity. In general, the guide channel resp. the guide tube in approximately the cross section of the image guide resp. the optical tip and can be tapered towards the distal end. The cross section of the image guide or at least the optical tip or the guide tube / guide channel is configured (for example, rectangular) such that a rotation of the image guide, respectively. the optical tip in the guide tube / guide channel is prevented. The optically transparent window at the distal end of the guide channel or the guide tube may be formed as a lens.

In some embodiments, the guide tube may extend from the distal portion of the handle to the area of the distal spatula tip. Preferably, it extends along the disposable part of the intubation laryngoscope. It is also possible for an inserted guide tube to extend from the hollow space of the handle into the proximal region of the intubation spatula, where it merges into a guide channel.

The guide tube or guide channel can be sealed off at the distal end with the optically transparent window and / or be designed to be flexible.

In some embodiments, the guide channel or guide tube may have a funnel-shaped opening at the proximal end to facilitate initial insertion of the optic tip / image conductor.

Both the bendable Intubationsspatel and the interchangeable image pickup device with spring-loaded image guide can each be considered as a separate invention, the described reusable image pickup device with both a bendable laryngoscope blade as well as a laryngoscope with a fixed spatula shape (straight / crooked / angled) can be combined ,

Brief explanation of the figures

The invention will be explained in more detail by means of 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; <Tb> FIG. 6 <SEP> is a perspective view of the intubation laryngoscope without a first half shell; <Tb> FIG. FIG. 7 is a perspective view of an intubation laryngoscope with a reusable image pickup device; FIG. <Tb> FIG. 8 <SEP> is a perspective view of a guide tube; <Tb> FIG. 9 <SEP> is a perspective view of a reusable image pickup device with flexible image guide; <Tb> FIG. FIG. 10 is a side view of an intubation laryngoscope with a reusable image pickup device; FIG. <Tb> FIG. FIG. 11 shows a perspective view of an intubation laryngoscope with a reusable image recording device during insertion of the image recording device; FIG. and <Tb> FIG. 12 <SEP> A side view of an intubation laryngoscope with a rigid intubation spatula and a reusable image capture device.

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 set 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).

Figs. 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 one side wall 12a, 12b of the spatula half shells 2a, 2b are provided with a plurality of V-shaped incisions 5 which are open toward the underside 10 and 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.

In order to hold 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 viewed from the underside of the composite Intubationsspatel 2 and so forms 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 asymmetric, 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 are 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.

7, 10 and 11 each show an intubation laryngoscope with a reusable image recording device 30. In Fig. 7, a first spatula half shell is not shown to better illustrate the internal elements. In Fig. 10, a first spatula half shell and a first handle half shell is not shown. In Fig. 11, a part of a first handle half-shell is not shown. The intubation laryngoscopes of FIGS. 10 and 11 differ in the construction of the image recording device 30.

In contrast to the intubation laryngoscope shown in FIGS. 1 to 6, in the intubation laryngoscopes from FIGS. 7, 10 and 11, the handle 1 resp. a proximal portion of the handle 1 releasably connected to the Intubationsspatel 2. In this case, the Intubationsspatel 2 and the distal part of the handle 1 as a disposable Intubationsspatel resp. Handle part e.g. be formed of plastic. In this case, the proximal region of the handle 1 partially contains the reusable image recording device 30, which is arranged in a cavity 41 of the handle 1. The dividing line in the handle 1 may also be arranged differently than in the embodiments shown further in the proximal region.

The handle 1 has a cavity 41, in which a substantial part of the image pickup device 30 (electronics housing 37 and optics holder / optical introduction 36) is arranged.

In the cavity 7 of the Intubationsspatels 2, a flexible guide tube 34 is inserted, which is sealed off at the distal end with an optically transparent window 33. The window 33 can also be designed as a lens. The optically transparent window 33 comes to rest in an outlet opening 15 of the intubation spatula 2. At the proximal end of the guide tube 34 has a funnel-shaped opening 35 for facilitated insertion of an elongated, flexible image conductor 31 of the image pickup device 30. Because of the guide tube 34 sealingly sealed off at the distal end, the flexible image conductor 31 of the reusable image recording device 30 does not come into contact with body fluids of the patient, which makes cleaning considerably easier or even unnecessary during reuse. 8 shows a perspective view of such a guide tube 34.

In the illustrated embodiment of a bendable intubation laryngoscope, the guide tube 34 extends between the fastening element 17 of the spatula tongue 6 and the second spatula half shell 2 b during the transition from the handle 1 to the intubation spatula 2.

FIG. 9 shows a perspective view of a compact image recording device 30 with a flexible image conductor 31. The image recording device 30, in the form shown, has an electronics housing 37 with a distal optical mount 36. In the electronic housing 37 in particular the electronic elements of the image pickup device 30, such as the power supply (battery), image processing means, an electronic control, connections, etc. are included (not shown). The image recording device can be used with the electronics housing 37 in the cavity 41 of the handle 1.

At the distal end of the electronics housing, i. at the optics holder resp. Optic introduction 36, the flexible image conductor 31 is inserted and held in the electronics housing. The distal end of the image guide 31 is provided with an optical tip 32, which has a lighting means and an image pickup means. Depending on the design, the flexible image conductor 31 comprises at least one optical and / or at least one electrical conductor for image transmission, respectively. to the light supply.

Fig. 11 shows a perspective view of the intubation laryngoscope during insertion of the flexible image guide 31 of the image pickup device 30 into the disposable part of the intubation laryngoscope.

When inserting the image pickup device 30 in the disposable part of the intubation laryngoscope of flexible image conductor 31 is inserted with its optical tip 32 in the funnel-shaped opening 35 of the guide tube 34 until the optical tip 32 rests on the optically transparent window 33 at the distal end of the guide tube 34. In this case, the guide tube 34, for example, a rectangular inner cross-section and the flexible image conductor 31, for example, have a rectangular outer cross-section to prevent rotation of the two parts to each other.

In order to ensure optimum image acquisition by the optically transparent window 33, the optical tip 32 is acted upon in the installed state with a force which presses the optical tip 32 in a so-called "closed-contact" against the optically transparent window 33. When adjusting the blade curvature, it is ensured that the "closed-contact" is always present.

For this purpose, the image recording device 30 is mounted with the electronics housing 37 at the proximal end on a spring 40 which is supported against a proximal bottom or intermediate bottom of the handle 1, as shown in Fig. 11. The electronics housing 37 is held in the cavity 41 of the handle in the longitudinal direction displaceable.

Alternatively, the spring 40 may be disposed between the distal optics holder 36 and the electronics housing 37, in which case the electronics housing 37 is supported against a proximal bottom or intermediate bottom of the handle 1, as shown in FIG. In this case, only the optical holder 36 is slidably held in the cavity 41 of the handle 1 in the longitudinal direction.

The length of the flexible image conductor 31 has a slight excess in relation to the distance between the optical mount 36 and window 33, so that when inserted image pickup device 30, the spring force of the spring 40 acts on the image conductor 31 to the optical tip 32 and thereby the optical tip 32 is pressed on the window 33. In the inserted state, therefore, a gap 39 between the optics holder 36 and the funnel-shaped opening 35 of the guide tube 34 is present.

For image transmission and power supply, a cable 38 between the electronics housing 37 and a connector at the proximal end of the handle 1 is provided. The image transmission can also be wireless.

The distal end of the handle 1 is designed such that it can be inserted into the disposable part of the laryngoscope. To fix the handle 1 in the disposable part of the laryngoscope are locking means 42 are present.

FIG. 12 shows a side view of an intubation laryngoscope which, unlike the other laryngoscopes shown, has a rigid, non-bendable intubation spatula 2. In the embodiment shown, the intubation spatula 2 and the handle 1 are likewise each formed with two half-shells, wherein the first spatula half-shell is not shown. The handle 1 has a cavity 41, in which the reusable image pickup device 30 with its electronics housing 37 can be inserted. As already described above, this is resiliently mounted on a spring (not recognizable), so that in the inserted state the optical tip 32 is pressed onto the optically transparent window 33 in the region of the spatula tip 3. The detachable connection between the proximal part of the handle 1 and the Intubationsspatel 2 is carried out as already described.

In contrast to the embodiments shown above, the cavity 7 in Intubationsspatel 2 as a guide channel for the optical tip 32, respectively. formed the image conductor 31. Only at the proximal end of the cavity 7, a guide tube 34 is inserted, which optical tip 32, respectively. guides the image conductor 31 from the distal region of the cavity 41 of the handle 1 around a corner into the intubation spatula 2. At the proximal end of the guide tube 34, the funnel-shaped opening 35 is formed.

name list

[0091] <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 <Tb> 30 <September> image recording device <tb> 31 <SEP> flexible image guide <Tb> 32 <September> Optics top <tb> 33 <SEP> optically transparent window <Tb> 34 <September> hose <tb> 35 <SEP> funnel-shaped opening <tb> 36 <SEP> Optical mount resp. optics introduction <Tb> 37 <September> electronics housing <Tb> 38 <September> Cables <Tb> 39 <September> gap <Tb> 40 <September> Spring <Tb> 41 <September> cavity <Tb> 42 <September> latching means

Claims (26)

An intubation laryngoscope comprising a handle (1), an intubation spatula (2) with a guide channel or guide tube (34) and an image recording device (30); wherein the guide channel or guide tube (34) in the region of a distal spatula tip (3) has an optically transparent window (33); and wherein the image recording device (30) has a flexible image conductor (31) with a distal optical tip (32); characterized in that the image recording device (30) is designed as a reusable unit, the image conductor (31) and optical tip (32) are releasably inserted into the Intubationsspatel (2) and that for optimal image acquisition, the distal optical tip (32) in the installed state with a Force in the direction of the window (33) is applied, so that it is pressed against the optically transparent window (33). 2. intubation laryngoscope according to claim 1, characterized in that the flexible image conductor (31) relative to the handle (1) is resiliently mounted, so that the optical tip (32) in the installed state with a force in the direction of the window (33) is acted upon, which the optical tip (32) presses against the optically transparent window (33). 3. Intubation laryngoscope according to one of the preceding claims, characterized in that the image recording device (30) comprises an electronics housing (37) with a distal optics holder (36), which in a cavity (41) of the handle (1) are arranged, wherein the image guide (32) is connected to the optics holder (36) at the proximal end. 4. intubation laryngoscope according to one of the preceding claims, characterized in that the image recording device (30) at least partially in a cavity (41) of the handle (1) is insertable and relative to the handle (1) is resiliently mounted, so that the distal optical tip (30). 32) in the installed state with a force in the direction of the window (33) is acted upon. 5. intubation laryngoscope according to claim 3, characterized in that the optics holder (36) relative to the electronics housing (37) is resiliently mounted, so that the distal optic tip (32) in the installed state with a force in the direction of the window (33) is acted upon the electronics housing (37) in the handle (1) is fixed. 6. intubation laryngoscope according to one of the preceding claims, characterized in that the Intubationsspatel (2) has a cavity (7) for receiving the flexible image guide (31), which is designed as a guide channel and / or in which a guide tube (34) is arranged , 7. Intubation laryngoscope according to one of the preceding claims, characterized in that the guide tube (34) extends from the distal region of the handle (1) to the region of the distal spatula tip (2). 8. intubation laryngoscope according to one of the preceding claims, characterized in that the guide channel or the guide tube (34) is sealed at the distal end with the optically transparent window (33). 9. intubation laryngoscope according to one of the preceding claims, characterized in that the guide tube (34) at the proximal end has a funnel-shaped opening (35). 10. intubation laryngoscope according to one of the preceding claims, characterized in that the guide tube (34) is flexible. 11. intubation laryngoscope according to one of the preceding claims, characterized in that the Intubationsspatel is a bendable Intubationsspatel (2) with adjustable blade curvature. 12. 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). 13. Intubation laryngoscope according to claim 12, characterized in that the bendable spatula body comprises a first spatula half shell (2a) and a second spatula half shell (2b), which are joined together to form the cavity (7) and the gapless upper side (8) and at the Form bottom (10), the guide (11). 14. Intubation laryngoscope according to one of claims 12 to 13, characterized in that the bendable spatula tongue (6) forms the tension element. 15. intubation laryngoscope according to one of claims 12 to 14, characterized in that the joint portions (5) of the intubation spatula by the underside (9) open incisions, preferably V-shaped incisions, in the cavity (7) adjacent side walls (12a, 12b) of the spatula body are formed and the bendable spatula tongue (6) seen from the underside covers the incisions (5). 16. intubation laryngoscope according to one of claims 12 to 15, characterized in that the bendable spatula tongue (6) is connected to a distal end in the region of the spatula tip (3) with the spatula body. 17. intubation laryngoscope according to one of claims 12 to 16, characterized in that on the cavity (7) adjacent side walls (12 a, 12 b) at right angles bent guide legs (11 b), which the guide (11) for the spatula tongue (6) form. 18. intubation laryngoscope according to one of claims 12 to 17, characterized in that the bendable 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) is movably guided. 19. intubation laryngoscope according to one of claims 12 to 18, 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. 20. intubation laryngoscope according to one of claims 12 to 19, characterized in that the actuating device (4) for adjusting the blade 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. 21, intubation laryngoscope according to one of claims 12 to 20, 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). 22. intubation laryngoscope according to one of claims 12 to 21, characterized in that in the region of the outlet opening one or more lighting means and an image pickup means are arranged. 23. intubation laryngoscope according to one of claims 12 to 22, 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). 24. Intubation laryngoscope according to claim 21, 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. 25. intubation laryngoscope according to one of claims 12 to 24, characterized in that the handle (1) and the Intubationsspatel (2) are detachably connected to each other. 26 intubation laryngoscope according to one of claims 12 to 25, characterized in that the Intubationsspatel (2) and / or the handle (1) made of plastic and / or metal is made.