GB2477084A

GB2477084A - Laryngoscope blade with conduit

Info

Publication number: GB2477084A
Application number: GB1000586A
Authority: GB
Inventors: Peter Amy
Original assignee: Salisbury NHS Foundation Trust
Current assignee: Salisbury NHS Foundation Trust
Priority date: 2010-01-14
Filing date: 2010-01-14
Publication date: 2011-07-27
Also published as: GB201000586D0

Abstract

A blade for a laryngoscope comprising a blade body extending in an arc. The blade has a proximal end for connecting to a laryngoscope body and a distal end. The blade body has a first conduit extending therethrough having an opening in the proximal end of the blade and a distal opening at the other end. The conduit is arranged to provide ventilation or oxygenation to the airway of the patient when in use. Second, third and/or further conduits may be provided to allow streaming of gases, such as anaesthetic, or passage of instruments, such as a fibreoptic cable, catheter or suction tube. The blade may have a groove formed in the outer surface to act as a guide for an ET tube. The distal end portion of the blade may be moveable with respect to the rest of the blade, it may be pivotally connected and controlled through a conduit of the blade. A laryngoscope comprising the laryngoscope blade is also claimed.

Description

A BLADE FOR A LARYNGOSCOPE AND A LARYNGOSCOPE COMPRISING THE

SAME

The present invention relates to a blade assembly for a laryngoscope and to a laryngoscope comprising the blade assembly.

A laryngoscope is used to access the airway of a patient and is used in a range of procedures. For example, a laryngoscope may be employed to clear debris from the airway and/or to remove obstructions. A laryngoscope is also used by a medical practitioner to inspect the airway, for example the vocal chords and surrounding tissue. One important procedure in which a laryngoscope is employed is intubation. lntubation is performed on a patient to ventilate or oxygenate the patient in situations where the patient is incapable of properly oxygenating or ventilating their own system, for example during surgery or during periods of critical illness.

Intubation of the trachea of a patient requires an endotracheal (ET) tube to be inserted into the trachea of the patient, to provide ventilation or oxygenation to assist the normal respiratory processes of the patient. Correct insertion and placement of the ET tube is critical, for example to avoid damage to tissue or organs in the airway, such as the vocal chords. A laryngoscope is used to view the airway during the insertion of the El tube and ensure correct insertion and placement.

In patients with abnormal anatomy of the mouth and airway, tracheal intubation is particularly difficult. Such abnormal anatomy may arise from trauma to the mouth, jaw or airway, swelling or other conditions, such as the presence of a tumour. In such cases, the view of the larynx may be obstructed by surrounding tissue, blood or secretions. In situations such as these, the use of a laryngoscope is made more difficult. Indeed, in some cases, the laryngoscope itself may cause : epistaxis or haemorrhaging in the airway.

*.. e 30 A conventional laryngoscope typically comprises a curved blade for insertion into the airway of the patient, extending from a holder. The curved blade allows the medical practitioner to manipulate the airway and obtain a better view of the airway itself. Laryngoscopes are often provided with a light source, to illuminate the airway.

Intubation with an ET tube may also be carried out using fibreoptic intubation techniques, in which a fibreoptic system is used by the medical practitioner to better view the airway and the position of the El tube during the intubation procedure. The fibreoptic cable is removed once the ET tube is in place. A typical fibreoptic intubation can take between 5 and 20 minutes to complete. Many patients are unable to maintain their airway fully during this procedure and have a reduced respiratory drive. As a result, oxygenation and/or ventilation of the patient may be required during the intubation procedure. Until the ET tube is in place, other means must be employed to oxygenate and/or ventilate the subject, for example modified face masks employed with a guedal oral airway device.

There is a need for improvements in the means for oxygenating and/or ventilating a patient during intubation procedures, in particular during intubation of difficult patients, where the intubation procedure may take an extended period of time.

There are many variations in design and form of laryngoscopes and laryngoscope blades known in the art.

For example, WO 2004/071285 discloses a single use laryngoscope having a handle and a curved blade extending therefrom. The laryngoscope further comprises a lighting system incorporated into the handle and arranged to provide light to the throat of the patient for a limited period of time. The laryngoscope is indicated to be of particular use in assisting with tracheal intubation of a patient. : 25

WO 2009/157960 concerns a laryngoscope blade and laryngoscope. The laryngoscope blade is curved, to allow depression of the tongue of the patient during tracheal intubation. The laryngoscope comprises a source of ultra-violet light, to induce fluorescence in the vocal chords of the patient, thereby better enabling the El 30 tube to be inserted into the trachea past the vocal chords. * S

US 2009/299146 discloses a laryngoscope blade for improving the transmission of light into the airway of the patient. The blade comprises a channel extending at least partially through the blade for receiving a light source. The channel is provided with a transparent end face disposed towards to the end of the blade. An optical element reduces the ambient light from the light source entering the airway.

US Design Patent US D581,532 discloses a laryngoscope blade having an exposed tube.

In addition, to providing an improved laryngoscope and laryngoscope blade, recent attention has also been paid to improving the design of endotracheal (ET) tubes, with a view to obviating the need for using a laryngoscope during intubation.

CN 101301504 concerns endotracheal (El) tubes. The ET tubes of this document have a front-end or distal end curvature that is adjustable. The curvature of the distal end is set at 110.. A telescopic rod is extendable within the core of the tube to adjust the curvature of the distal end. A similar arrangement is shown in CN 201211382. Neither document appears to relate to laryngoscopes.

A double-lumen trachea catheter is disclosed in CN 101455873. The catheter comprises an intermediate or central catheter tube, with two further catheter tubes disposed one on either side of the intermediate tube. The arrangement is indicated to avoid the need for a special laryngoscope for performing tracheal intubation, as the laryngoscope influences the field of view of the medical practitioner and is not favourable for use in trachea intubations. This would suggest that the double-lumen catheter has been designed to replace conventional ET tubes and avoid the need for a laryngoscope during intubation procedures.

Given the extensive use made of a reliance upon laryngoscopes in intubatiori procedures, it would be very advantageous to provide medical practitioners with an * improved laryngoscope that addresses some or all of the aforementioned problems.

:.: * 30 The present invention provides a blade for a laryngoscope having extending therethrough one or a plurality of conduits of different types, each type of conduit providing access to the airway of the patient at the distal end region of the blade and being accessible at the proximal end of the blade.

According to a first aspect of the present invention there is provided a blade for a laryngoscope, the blade comprising: a blade body extending in an arc and having a proximal end for connecting to a laryngoècope body and a distal end; the blade body having extending therethrough a first conduit having a proximal opening in the proximal end of the blade and a distal opening in the region of the blade at the distal end thereof, the first conduit being arranged to provide ventilation to the airway of the patient or oxygenation to the airway of the patient when in use; and means at the proximal end of the blade body for connecting the blade to a laryngoscope body.

Ventilation of a patient is the supply to the airway of gas under pressure, in particular to inflate the chest of the patient. Oxygenation is the exchange of gases with airway, that is the supply of oxygenated gas and removal of oxygen-depleted gas, to enhance or replace normal respiration by the patient. The laryngoscope blade of the present invention makes it possible to provide the patient with ventilation or oxygenation through the laryngoscope and the laryngoscope blade during an intubation procedure while an endotracheal (ET) tube is being put in place and before ventilation or oxygenation of the patient through the ET tube is possible. In this way, a patient with a difficult airway and/or with impaired respiratory functions can be provided with respiratory assistance during the iritubation procedure. This is particularly advantageous when the intubation procedure is protracted, for example due to the patient having suffered trauma to the mouth jaw or having other conditions that affect the insertion and placement of the ET tube within the airway.

S..... S *

The first conduit may be used for either ventilation or oxygenation. In one * approach, the conduit may be used to provide the patient with oxygenation and :.: 30 ventilation at different times during the procedures in which the laryngoscope blade is being used.

The laryngoscope blade comprises a blade body. The blade body extends in an arc. The shape and form of the blade will be known to the person skilled in the art and such blade forms are known in art, for example from the prior art documents described above. The blade is generally elongate, extending in an arc in its lengthwise direction. The blade is flattened on its upper and lower surfaces, having a width that is greater than the thickness of the blade, in particular the cross-section of the blade having an aspect ratio of at least 2, more preferably at least 3 or greater.

The edges of the blade are preferably rounded, to ease movement of the blade within the airway of the patient when in use.

The laryngoscope blade may be formed in a range of sizes, corresponding to the patients. In particular, the blade may be formed in a range of sizes corresponding to the Guedal airways, for example Adults 2, 3 and 4 sizes. Typical dimensions for the blade are 25 mm wide, 10 mm thick and from 100 to 125 mm long.

The laryngoscope blade has a proximal end and a distal end. In use, the distal end of the blade is inserted into the airway of the patient, with the proximal end remaining generally outside the airway and connected to a laryngoscope body.

The laryngoscope blade is provided at its proximal end with means for connecting the blade to a laryngoscope body. Preferably, the blade is provided with means for releasably connecting the blade to the laryngoscope body. In this way, the blade may be removed from the laryngoscope body when not in use, for example to allow cleaning and sterilisation of the blade. In one embodiment, the laryngoscope blade of the present invention is formed as a disposable item, intended for a single *.,.. 25 use, to avoid the transfer of infections between patients. In this way, the need to sterilise the laryngoscope blade between successive uses is avoided. Suitable means for connecting the blade to the laryngoscope body are known in the art and ** feature in known and commercially available laryngoscopes.

:.:. 30 Alternatively, the laryngoscope blade may form part of a laryngoscope that is intended for a single use. In such a case, the laryngoscope blade may be permanently connected to the laryngoscope body, with the entire laryngoscope being disposed of after use. As a further alternative, the laryngoscope blade may be permanently connected to the laryngoscope body, with the laryngoscope being intended for multiple uses, requiring sterilisation of the entire unit between successive uses.

The connection between the laryngoscope blade and the laryngoscope body may be a rigid connection, in which case the blade is in a fixed orientation with respect to the laryngoscope body. Alternatively, the blade may be mounted to the Iaryngoscope body by a pivotable connection or mount, allowing the blade to be rotated or pivoted with respect to the laryngoscope body.

The laryngoscope blade comprises a first conduit extending therethrough.

The first conduit extends lengthwise through the blade and has a proximal opening in the proximal end of the blade. In one embodiment, the proximal opening of the conduit connects to a corresponding conduit in the laryngoscope body when the blade is attached thereto. In this way, ventilation or oxygenation is provided to the patient through both the laryngoscope body and the laryngoscope blade, with the laryngoscope body being connected at suitable ports to a ventilation or oxygenation apparatus. The first conduit has a distal opening in the distal region of the blade, through which gases enter or are removed from the airway of the patient during use.

In a preferred embodiment, the distal opening of the first conduit is in the distal end of the blade body.

The first conduit through the blade body may have any suitable form, in particular any suitable cross-sectional shape. Preferably, the first conduit is circular in cross-section. The diameter of the first conduit is selected in order to provide the required ventilation or oxygenation to the patient. Preferably, the diameter of the first conduit is substantially constant along the length of the blade body.

*e*S.. S *

In one embodiment, the laryngoscope blade has a second conduit extending * through the blade body. The second conduit is arranged to provide one of ventilation :.: * 30 and oxygenation of the airway of the patient, when in use, with the first conduit * . arranged to provide the other of ventilation and oxygenation of the patient. Features of the second conduit are as described hereinbefore in respect of the first conduit.

The first conduit and, if present, the second conduit, may also be used to provide passage through the blade for other reasons. In particular, an anaesthetic gas composition may be passed through the first conduit and/or the second conduit, if present. Alternatively, or in addition, the first conduit and the second conduit, if present, may be used to provide passage through the laryngoscope blade for such items as a suction tube, connected to a suitable suction apparatus, for providing suction within the airway of the patient to remove liquids, secretions and other matter, or a fibreoptic cable of a fibreoptic imaging system, to provide images of the patient's airway. Further, the first conduit and/or the second conduit, if present, may be used to provide light from a suitable light source to the airway of the patient.

The first conduit and, if present, second conduit are provided through the laryngoscope blade for the passage of gas streams into and out of the airway of the patient when the blade is in use. The conduits are sized to provide for the passage of the required volume of gas at the pressure required. Typically, the first conduit and, if present, the second conduit have a diameter that is from 50 to 60% of the thickness of the blade. The second conduit when present preferably has substantially the same diameter as the first conduit. The diameter of the conduit required to pass a suitable stream of gas will generally be larger than that required for the passage of an implement, such as a suction tube or a fibreoptic cable.

Accordingly, such implements will be easily accommodated by and pass freely through the first and second conduits.

* **. The laryngoscope blade of the present invention may comprise a third conduit *** . . . . extending therethrough. The third conduit is arranged to receive and provide * passage for tubular implements that may be required to be inserted into the airway of the patient during a procedure, for example such items as a fibreoptic cable, a : * suction tube or the like. Again, the third conduit, if present, extends lengthwise through the blade body. The third conduit can be used to provide passage through . 30 the blade for a fibreoptic cable, allowing when in use fibreoptic intubation to be performed through the laryngoscope blade. The third conduit acts as a guide for the fibreoptic cable, facilitating its insertion into the airway of the patient during the intubation procedure. Similarly, the third conduit may be used to provide passage through the laryngoscope blade for a suction tube or the like, as may be requfred during the procedure. Features of the third conduit are as hereinbefore described with respect to the first conduit. The diameter of the third conduit is determined by the outer diameter of the implement to be passed therethrough, such as the fibreoptic cable, the suction tube or the like, and the need for the implement to pass freely along the third conduit. Generally, the third conduit is smaller in diameter than the first conduit, preferably having a diameter of from 20 to 40%, more preferably about 30% of the thickness of the laryngoscope blade. For example, a typical suction tube has a diameter of about 3 mm and should pass freely through the third conduit.

The laryngoscope blade may comprise a first conduit in combination with a second conduit and/or a third conduit. In one preferred embodiment, the laryrigoscope blade comprise first, second and third conduits, as hereinbefore described.

It is often that case that procedures in which a laryngoscope is used require the patient to be provided with an anaesthetic. It is known in the art to provide patients with a local anaesthetic during a laryngoscopy. Other procedures in which a laryngoscope is used may also require administration of a local or general anaesthetic to the patient, such as during surgery. There is therefore a need to deliver the anaesthetic to the patient. As noted above, the anaesthetic composition may be passed along the first conduit and/or, if present, the second conduit.

Alternatively, the laryngoscope blade may further comprise a fourth conduit extending lengthwise therethrough. The fourth conduit is arranged to provide passage for a gas stream, such as an anaesthetic composition through the 25 laryngoscope and into the airway of the patient. In this way, a local anaesthetic may * ***** * be provided to the patient as required for the intubation procedure. The fourth conduit may also be used to provide other anaesthetic compositions, such as a * general anaesthetic, to a patient. Features of the fourth conduit are as hereinbefore described with respect to the first conduit. The diameter of the fourth conduit is selected to meet the requirements of providing the required anaesthetic composition to the patient. The size of the fourth conduit is generally as described above with respect to the first and second conduits.

The laryngoscope blade may comprise a first conduit in combination with a second conduit, a third conduit and/or a fourth conduit. In one preferred embodiment, the laryngoscope blade comprise first, second, third and fourth conduits, as hereinbefore described.

The laryngoscope blade may comprise one of the aforementioned first, second, third and fourth conduits, in any combination as described above.

Alternatively, the blade may comprise two or more of any of the first, second, third and fourth conduits. The type of conduit present in the blade and the number of each type of conduit will be determined by the procedures to be performed on the patient, in particular the number and nature of gas streams and/or implements that will be required to have access to and from the airway of the patient.

Further, one or more of the aforementioned conduits may be used to provide light to the airway of the patient, in particular by having the proximal end of the conduit connected to a suitable light source. As a further alternative, the laryngoscope blade may comprise a fifth conduit therethrough for the passage of light into the airway. Details of the fifth conduit are as hereinbefore described with respect to the first or the third conduit.

As described above, a laryngoscope is often employed during intubation procedures, in particular tracheal intubation during which an El tube is inserted into the airway of the patient. Intubation of the patient may be conducted nasally, that is the ETtube is inserted into the airway through the nasal passage of the patient.

Alternatively, intubation may be oral with the El tube being inserted through the *.. S..

* mouth of the patient. The laryngoscope blade of the present invention preferably comprises a guide on its outer surface for guiding the passage of an El tube into the airway of the patient. In this way, the laryngoscope blade may be first inserted into the airway of the patient, in accordance with normal procedures, to prepare the airway, after which the ET tube may be inserted into the airway through the mouth of the patient using the guide on the outer surface of the laryngoscope blade to facilitate insertion and positioning of the tube. The guide preferably comprises a groove extending lengthwise along the blade. If a single groove is present, the groove preferably extends lengthwise generally centrally of the blade.

The laryngoscope blade is substantially rigid, with the construction of the blade provided the blade with little to no flexibility, in particular in the lengthwise direction. In one embodiment, the laryngoscope blade may be provided with a distal portion that is arranged to flex with respect to the remaining portion of the blade. A distal portion of this kind has been found to assist in the insertion and manipulation of the blade within the airway of the patient. In a preferred embodiment, the distal portion of the laryngoscope blade is pivotably mounted to the remaining portion of the blade, in particular by means of a hinge. In one particularly preferred arrangement, the distal end portion of the blade is connected to the remaining portion of the blade by a living hinge.

The distal end portion of the blade may be of any suitable size, in particular forming a minor portion of the laryngoscope blade. Preferably, the distal portion comprises from 5 to 25%, more preferably from 10 to 20% of the length of the laryngoscope blade, still more preferably from 14 to 17%, in particular about 16%.

The laryngoscope blade may be provided with means to control the movement of the distal end portion. In particular, the blade body may comprise a control conduit extending lengthwise therethrough, having a proximal opening at the proximal end of the blade and a distal portion extending to or into the distal end portion of the blade. Movement of the distal end portion of the blade may be controlled by a control element, such as a rod, cable or the like, extending along the control conduit that may be operated from the proximal end of the laryngoscope 25 blade to manipulate the distal end portion of the blade. For example, the control element may be extended into the blade to contact or extend into the distal end portion, thereby reducing the flexibility and/or movement of the distal end portion.

* Retraction or removal of the control element from the extended position allows the **.

distal end portion to move or pivot freely with respect to the blade body.

Alternatively, and more preferably, the means to control the movement of the distal end portion of the blade allow the angle of the distal end portion relative to the remaining portion of the blade to be varied and controlled.

If the laryngoscope blade comprises a moveable distal end portion, as described above, it is preferred that the conduits extending through the blade body have their distal end openings in the blade body adjacent the distal end portion.

It has further been found that the provision of a laryngoscope blade of conventional or known design with a flexible distal end portion as hereinbefore described is an advantageous modification.

Accordingly, in a further aspect, the present invention provides a blade for a laryrigoscope, the blade comprising: a blade body extending in an arc and having a proximal end for connecting to a laryngoscope body and a distal end; the blade body having a distal end portion that is moveable with respect to the remaining portion of the blade; and means at the proximal end of the blade body for connecting the blade to a laryngoscope body.

The distal end portion of the laryngoscope blade is preferably pivotably connected to the remaining portion of the blade, more preferably by a hinge, in particular a living hinge.

The Iaryngoscope blade may further comprise means for controlLing the movement of the distal end portion of the blade body. The means preferably comprises a control conduit extending lengthwise through the blade body, the control conduit being arranged to receive a control element. In one embodiment, the control * element is moveable within the control conduit between a retracted position and an * extended position. In one embodiment, the retracted position is one, in which the S.....

distal end portion of the blade is free to move with respect to the remaining portion of the blade body, and the extended position is one in which movement of the distal end portion with respect to the remaining portion of the blade body is controlled. In a preferred embodiment, the control element is moveable between a retracted position S 55*S * and an extended position, with the angle of the distal end portion varying according to the position of the control element.

In a further aspect, the present invention provides a laryngoscope comprising a laryngoscope body having extending therefrom a laryngoscope blade as hereinbefore described. As noted above, the laryngoscope blade is preferably releasably mounted to the laryngoscope body, so as to be removable therefrom.

The laryngoscope body is preferably provided with ports that correspond to an connect with the or each conduit extending through the blade, the body comprising corresponding conduits therethrough for connection to appropriate apparatus.

If the laryngoscope blade comprises a moveable distal end portion, as described above, the laryngoscope body preferably comprises means for the user to manipulate and control the distal end portion. In one preferred arrangement, the laryngoscope body is provided with a lever pivotably mounted to the body and connected to the control element extending through the control conduit in the laryngoscope blade. The lever may be operated to move, in particular extend and retract, the control element within the control conduit. In one embodiment, the control element is moved by a rack and pinion assembly in response to movement of the lever.

In embodiments in which the laryngoscope blade comprises a guide on its outer surface for an ET tube, it is preferred that a corresponding guide is provided on the outer surface of the laryngoscope body. In particular, where the guide on the laryngoscope blade comprises a groove formed in the outer surface of the blade, a *.. . . . corresponding groove is preferably provided on the laryngoscope body aligned with * *.*.* * the groove in the blade.

In a further aspect, the present invention provides a method of operating a laryngoscope, the method comprising: providing a laryngoscope blade; and providing ventilation or oxygenation through a conduit extending lengthwise through the laryngoscope blade.

The method may further comprise providing one or more of suction, an anaesthetic composition and a fibreoptic cable through one or more conduits extending through the laryngoscope blade, most preferably each through a conduit dedicated therefore.

In a still further aspect, the present invention provides a method of operating a laryngoscope, the method comprising: providing a laryngoscope blade, the blade having a blade body comprising a distal end portion that is moveable with respect to the remaining portion of the blade body; and moving the distal end portion.

The distal end portion is most preferably pivoted about a connection with the remaining portion of the blade body.

Embodiments of the present invention will now be described, by way of example only, having reference to the accompanying drawings, in which: Figure 1 is a side elevation of a laryngoscope according to one embodiment of the present invention; Figure 2 is a perspective view of the laryngoscope of Figure 1; * S Figure 3 is a perspective cross-sectional view through the blade of the laryngoscope of Figure 1 along the line Ill -Ill; **S.5

S

Figure 4 is an enlarged view of the distal end portion of the blade of the * laryngoscope of Figure 1; 4. 3 S., Figure 5 is an enlarged view of a portion of the laryngoscope body of the laryngoscope of Figure 1; and Figure 6 is a diagrammatical representation of a cross-section through the laryngoscope body of the laryngoscope of Figure 1.

Turning to Figure 1, there is shown a laryngoscope according to one embodiment of the present invention, generally indicated as 2. The laryngoscope 2 comprises a laryngoscope body 4 having extending therefrom a laryngoscope blade having a blade body 6. The laryngoscope 2 is shown in front perspective view in Figure 2. As viewed in Figures 1 and 2, the laryngoscope body 2 can be considered to have an upper end portion 8, from which the laryngoscope blade 5 extends laterally, and a lower end portion 10. It will be appreciated that the laryngoscope need no necessarily be used in the orientation shown in the figures and the references to upper' and lower' end portions are merely for explanatory purposes.

The laryngoscope body 4 is arranged to be held in the hand of a medical practitioner and has a grip portion 12 disposed between the upper end portion 8 and the lower end portion 10 for accommodating the fingers and hand of the user. The laryngoscope body 2 comprises a lever 14 pivotably mounted at one end to the lower end portion 10 of the laryngoscope body, with the other end of the lever movable with respect to the laryngoscope body and the blade 5. The operation of the lever 14 is described in more detail below.

The laryngoscope blade 5 is shown in more detail in Figure 3, in particular with a cross-section through the blade body 6 shown. The blade body 6 extends : 25 lengthwise in an arc, as shown in Figure 1, and has a proximal end portion 20 * * releasably connected to a collar 22 on the upper end portion 8 of the laryngoscope body. The proximal end portion 20 of the blade is an interference fit within the collar 22. The collar 22 is shown in Figures 1 and 2 as a part of the laryngoscope body 4 and rigidly mounted thereto. In an alternative arrangement, the collar 22 may be L: 30 pivotably mounted to the laryngoscope body 4, allowing the angle of the blade body 6 with respect to the laryngoscope body 4 to be varied.

The blade body 6 is generally flattened and has an upper surface 24 and a lower surface 26, as viewed in Figure 3. The blade body 6 has a width several times greater than its thickness. General dimensions of the blade body are 25 mm wide, mm thick and between 100 to 125mm long. The edges 28 of the blade are rounded. The upper surface 24 of the blade body 6 is provided with a lengthwise extending groove 30. The laryngoscope body 4 is provided with a corresponding groove 32 (shown in more detail in Figure 5) in its upper end portion 8 aligned with the groove 30 in the blade body 6. In use, the grooves 32 and 30 in the body 2 and blade body 6 are used to guide a tube, such as an ET tube, being inserted into the airway of the patient into which the blade 5 extends, during oral intubation.

A plurality of conduits of different types extend lengthwise through the blade body 6, as shown in Figure 3. Thus, a first conduit 40 extends along one side of the blade and is for providing oxygenation to the airway of the patient when the laryngoscope is in use. The first conduit 40 has a circular cross-section and is substantially constant in diameter along the length of the blade body. The laryngoscope body 4 is provided with a conduit extending therein with which the first conduit 40 connects, the conduit within the laryngoscope body terminating in a connector 42 in the lower end portion 10, for connection to a suitable oxygenator.

The first conduit 40 has a diameter of about 5 to 6 mm.

It will be understood that the first conduit may be used to provide passage for other gas streams into and out of the airway of the patient or to provide passage for an implement, such as a catheter, suction tube or fibreoptic tube, as may be required during the procedure. S.. * . S...

A second conduit 44 extends adjacent the first conduit and is arranged to provide passage for an implement through the blade body 6 and into the airway of the patient, when in use. For example, a suction tube or catheter may be inserted through the second conduit 44, to allow suction to be applied to the airway of the * ** patient during use. The second conduit 44 has a circular cross-section and is :.: . 30 substantially constant in diameter along the length of the blade body. The laryngoscope body 4 is provided with a conduit extending therein with which the first conduit 44 connects, the conduit within the laryngoscope body terminating in a connector 46 in the upper end portion 8 (as shown in Figure 5), for connection to a suitable suction apparatus. The second conduit has a diameter of about 3 to 4 mm.

A third conduit 48 extends along the other side of the blade to the first and second conduits and is for providing additional passage through the blade body 6. In particular, the third conduit can provide passage for a fibreoptic cable into the airway of the patient when the laryngoscope is in use. Alternatively, the third conduit may provide passage through the blade body 6 for an anaesthetic gas composition and/or ventilation or oxygenation of the patient's airway. The third conduit 48 has a circular cross-section and is substantially constant in diameter along the length of the blade body. The laryngoscope body 4 is provided with a conduit extending therein with which the third conduit 48 connects, the conduit within the laryngoscope body terminating in a connector 50 in the lower end portion 10, for connection to a fibreoptic viewing system, an anaesthetic system or the like. The third conduit 48 has a diameter of about 5 to 6 mm.

A fourth conduit 52 extends adjacent the third conduit and is for providing a further passage through the blade body 6, for example passage for an anaesthetic composition to be delivered directly into the airway of the patient when the laryngoscope is in use. Alternatively, the fourth conduit 52 may provide passage for a suction tube or catheter into the airway, for a fibreoptic cable, or for light into the airway of the patient. The fourth conduit 52 has a circular cross-section and is substantially constant in diameter along the length of the blade body. The laryngoscope body 4 is provided with a conduit extending therein with which the fourth conduit 52 connects, the conduit within the laryngoscope body terminating in a *.Ia connector 54 in the lower end portion 10, for connection to suitable apparatus, such as for dispensing and metering anaesthetic composition, a light source or a suction system.

* ***S. * S

A further connector 56 in the upper end portion 8 of the laryngoscope body 4 * ** is shown in Figure 5, providing an alternative route for accessing the third conduit 48 :.: 30 in the blade body. * *

The laryngoscope blade 6 comprises a distal end portion 60 pivotably connected to the remaining portion of the blade body by a living hinge 62, as shown in more detail in Figure 4. The hinge 62 is formed in the lower surface 26 of the blade 6 body. The distal end portion 60 is free to move with respect to the remainder of the blade 6 by pivoting about the hinge 62, thereby varying the arc and angle of the distal end of the blade 6 body. The remaining or major portion of the blade 6 body has an end face 64 opposing the distal end portion. The first, second, third and fourth conduits 40, 44, 48 and 52 terminate in openings in the end face 64.

A control conduit 70, having a generally rectangular cross-section, extends lengthwise through the centre of the laryngoscope blade body 6. A control element in the form of a cable 72 extends along the control conduit 70 from a connection at its distal end to the upper end of the lever 14 to the distal end portion 60 of the blade.

Movement of the lever 14 by the user caused the cable 72 to move within the control conduit 70 between a retracted position and an extended position, thereby effecting movement of the distal end portion 60 of the blade body 6.

Turning to Figure 6, there is shown a diagrammatical cross-section of the laryngoscope body 4. The laryngoscope body 4 is generally hollow and comprises a pivot 80, to which the lever 14 is mounted and about which the lever rotates. A spring 82 is connected at one end to the lever 14, on one side of the pivot 80, and at the other end to the laryngoscope body 4, to bias the lever 14 into the position shown in Figure 6. A pinion wheel 84 is rotatably mounted to the laryngoscope body 4 and is connected by an arm 86 to the lever 14. The arm 86 is connected to the lever 14 on the opposite of the pivot 80 to the spring 82. The arm 86 is further connected eccentrically to the pinion wheel 84, such that movement of the lever 14 about the * *** pivot 80 causes the pinion wheel 84 to rotate. The pinion wheel 84 in turn engages with teeth 88 on a control rod 90, connected at one end to the cable 72. In operation, movement of the lever 14 about the pivot 80 is converted by the pinion wheel 84 into reciprocating motion of the control rod 90, in turn causing the cable 72to move longitudinally within the control conduit 70. In this way, the position of the distal end : * portion 60 of the blade body 6 may be adjusted by operation of the lever 14.

*** 30 In use, the laryngoscope blade 5 is inserted into the airway of the patient, in conventional manner. Ventilation, suction and anaesthetic may be provided to the airway of the patient as required from appropriate apparatus through the respective conduits extending through the laryngoscope body 4 and the blade body 6. If fibreoptic intubation is to be performed, the fibreoptic cable may be introduced into the airway of the patient through the respective conduits in the laryngoscope body and blade. A tube, such as an ET tube, may be guided into the airway of the patient using the grooves 32 and 30 in the upper end portion 8 of the laryngoscope body 4 and the upper surface 24 of the blade body 6. At any time during the procedure, the orientation of the distal end portion 60 of the laryngoscope blade body 6 may be adjusted by operation of the lever 14 in the laryngoscope body 4, in turn operating the cable 72 extending through the control conduit 70 in the blade body 6. * * : 25 * * * * * * I. * * * *** * *

I..... * *

Claims

CLAIMS1. A blade for a laryngoscope, the blade comprising: a blade body extending in an arc and having a proximal end for connecting to a laryngoscope body and a distal end; the blade body having extending therethrough a first conduit having a proximal opening in the proximal end of the blade and a distal opening in the region of the blade at the distal end thereof, the first conduit being arranged to provide passage for a gas stream into or out of the airway of the patient when in use; and means at the proximal end of the blade body for connecting the blade to a laryngoscope body.
2. The laryngoscope blade according to claim 1, wherein the means for connecting the blade to a laryngoscope body form a releasable connection.
3. The laryngoscope blade according to claim 2, wherein the blade is disposable.
4. The laryngoscope blade according to any preceding claim, wherein the first conduit is arranged to provide passage for ventilation to the airway of the patient, an anaesthetic gas stream, or oxygenation to the airway of the patient when in use.
5. The laryngoscope blade according to any preceding claim, further comprising 25 a second conduit extending therethrough having a proximal opening in the proximal end of the blade and a distal opening in the region of the blade at the distal end *.**.. . . . thereof, the second conduit being arranged to provide passage for a gas stream into or out of the airway of the patient when in use. * **

:.: * 30
6. The laryngoscope according to claim 5, wherein the second conduit is arranged to provide ventilation to the airway of the patient, an anaesthetic gas stream, or oxygenation to the airway of the patient when in use.
7. The laryngoscope blade according to any preceding claim, further comprising a third conduit extending therethrough having a proximal opening in the proximal end of the blade and a distal opening in the region of the blade at the distal end thereof, the third conduit being arranged to provide passage for a tubular implement through the laryngoscope blade body.
8. The laryngoscope blade according to claim 7, wherein the third conduit is arranged to provide passage for a fibreoptic cable, a catheter or a suction tube.
9. The laryngoscope blade according to any preceding claim, further comprising a fourth conduit extending therethrough having a proximal opening in the proximal end of the blade and a distal opening in the region of the blade at the distal end thereof, the fourth conduit being arranged to provide passage for a tubular implement to the airway of a patient when in use.
10. The laryngoscope blade according to claim 9, wherein the fourth conduit is arranged to provide passage for a fibreoptic cable, a catheter or a suction tube.
11. The laryngoscope blade according to any preceding claim, further comprising a guide on the outer surface of the blade body for guiding an ET tube during insertion of the tube into the airway of the patient during use.
12. The laryngoscope blade according to claim 11, wherein the guide comprises a groove formed in the outer surface of the laryngoscope blade. : 25
13. The laryngoscope blade according to claim 12, wherein the groove extends lengthwise substantially the entire length of the blade body.* **
14. The laryngoscope blade according to any preceding claim, wherein the blade :.: 30 body has a distal end portion that it movable with respect to the remaining portion of **.as.

* * the blade body.
15. The laryngoscope blade according to claim 14, wherein the distal end portion is pivotably connected to the remaining portion of the blade body.
16. The laryngoscope blade according to claim 15, wherein the distal end portion is connected to the remaining portion of the blade body by a living hinge.
17. The laryngoscope blade according to any of claims 14 to 16, further comprising means for controlling the position of the distal end portion of the blade body.
18. The laryngoscope blade according to claim 17, wherein the control means comprises a control conduit extending through the blade body from its proximal end to its distal end portion.
19. The laryngoscope blade according to claim 18, wherein the control means further comprises a control element extending through the control conduit.
20. The laryngoscope blade according to claim 19, wherein the control element is movable within the control conduit between a retracted position and an extended position, movement of the control element varying the angle of the distal end portion relative to the remaining portion of the blade body.
21. A blade for a laryngoscope, the blade comprising: a blade body extending in an arc and having a proximal end for connecting to a laryngoscope body and a distal end; the blade body having a distal end portion that is moveable with respect to the 25 remaining portion of the blade; and means at the proximal end of the blade body for connecting the blade to a * laryngoscope body. *. *

: **
22. The laryngoscope blade according to claim 21, wherein the distal end portion *** * is pivotably connected to the remaining portion of the blade body.

**...I * .
23. The laryngoscope blade according to claim 22, wherein the distal end portion is connected to the remaining portion of the blade body by a living hinge.
24. The laryngoscope blade according to any of claims 21 to 23, further comprising means for controlling the position of the distal end portion of the blade body.
25. The laryngoscope blade according to claim 24, wherein the control means comprises a control conduit extending through the blade body from its proximal end to its distal end portion.
26. The laryngoscope blade according to claim 21, wherein the control means further comprises a control element extending through the control conduit.
27. The laryngoscope blade according to claim 22, wherein the control element is movable within the control conduit between a retracted position and an extended position, movement of the control element varying the angle of the distal end portion relative to the remaining portion of the blade body.
28. A laryngoscope comprising a laryngoscope body having extending therefrom a laryngoscope blade according to any preceding claim.
29. The laryngoscope according to claim 28, wherein the laryngoscope blade is releasaby connected to the laryngoscope body.
30. The laryngoscope according to either of claims 28 or 29, wherein the laryngoscope blade comprises a first, second, third and/or fourth conduit extending :: 25 therethrough, the laryngoscope body comprising one or more conduits extending therethrough corresponding to one of more of the conduits in the blade. * *

*
31. The laryngoscope according to any of claims 28 to 30, wherein the : ** laryngoscope blade comprises a guide on its outer surface, the laryngoscope body *** * comprising a corresponding guide aligned with the guide on the blade.

****** * .
32. The laryngoscope according to any of claims 28 to 31, wherein the laryngoscope blade comprises a blade body having a distal end portion moveable with respect to the remaining portion of the blade body and means for controlling the movement of the distal end portion, the laryngoscope body comprising means for operating the control means of the laryngoscope blade.
33. A method of operating a laryngoscope, the method comprising: providing a laryngoscope blade; and providing ventilation or oxygenation through a conduit extending lengthwise through the laryngoscope blade.
34. The method according to claim 33, further comprising providing one or more of suction, an anaesthetic composition and a fibreoptic cable through the laryngoscope blade.
35. A method of operating a laryngoscope, the method comprising: providing a laryngoscope blade, the blade having a blade body comprising a distal end portion that is moveable with respect to the remaining portion of the blade body; and moving the distal end portion.
36. The method according to claim 35, wherein the distal end portion is pivotable about a connection with the remaining portion of the blade body.
37. A laryngoscope blade substantially as hereinbefore described having reference to the accompanying figures.:": 25
38. A laryngoscope substantially as hereinbefore described having reference to the accompanying figures. * . * S

I
39. A method of operating a laryngoscope substantially as hereinbefore * ** described.:. : 30 * *