JP4761837B2 - Intranasal anesthetic application device - Google Patents

Description

  The present invention is used as an endoscope for an upper gastrointestinal tract such as a gastroscope, and is inserted into a subject into which the insertion portion is inserted in a nasal insertion type endoscope that is inserted nasally into a body cavity. The present invention relates to an intranasal anesthetic application device for applying an anesthetic to a required portion of a cavity wall in a route.

  In general, an endoscope for an upper digestive tract or the like is generally an oral insertion in which an insertion portion is guided into a body cavity through the oral cavity. For this purpose, a subject undergoing endoscopy holds a mouthpiece in a lying position, and the insertion portion is guided into the body cavity along a path secured by the mouthpiece. When inserted through the oral cavity, when the insertion part passes through the throat, the throat reflex or vomiting reflex occurs due to the insertion part touching the tongue base, giving the subject a feeling of vomiting, accompanied by pain become. And although an anesthetic is used to suppress this pharyngeal reaction and reduce pain, the pain still remains. Furthermore, since the subject holds the mouthpiece, there are problems that it is difficult to talk with the surgeon and the like, and that mouth breathing is difficult.

  As an endoscope insertion path, not only the oral cavity described above but also a transnasal insertion method is possible. In particular, in recent years, the insertion portion of the endoscope tends to be reduced in diameter, and an endoscope having an optimum outer diameter for insertion through the nasal cavity has been put into practical use. For example, Patent Document 1 points out that the nasal insertion method is advantageous from the viewpoint of subject protection. As is clear from Non-Patent Document 1, a clinical example of endoscopy in which a small-diameter insertion portion is used to guide it into a body cavity nasally has been reported.

In this way, if the insertion part of the endoscope is inserted from the nasal cavity, it does not pass through the throat, so there is no feeling of vomiting and the pain and burden on the subject are reduced, and the anesthetic used is also Since the minute amount is sufficient, there is an advantage that the subject can have a conversation with the surgeon and the like during the examination, and mouth breathing is also possible. Therefore, it is expected that examinations using a nasal insertion type endoscope will increase in the future.
JP 2005-74035 A 54th Annual Meeting of the Japanese Gastroenterological Endoscopy Society 39 (Suppl.2) 1997 VS6-2

  By the way, when the insertion portion of the endoscope is inserted into the nasal cavity, this insertion portion acts as a foreign substance and stimulates the sensitive nasal mucosa, causing pain to the subject. Therefore, in the stage before inserting the insertion part, the anesthetic is previously applied to the insertion path in the nasal cavity, particularly the narrowest part of the insertion path, that is, the path through the middle nasal passage (or lower nasal passage) to the posterior nostril. By supplying, a treatment for reducing the sensitivity to stimulation is performed. It is conceivable that the anesthetic is supplied by spraying, spraying, etc. However, with this method, the anesthetic can not be efficiently distributed to the necessary places, and it is unnecessary as well as the target location. The anesthetic will reach the place.

  The present invention has been made in view of the above points, and the object of the present invention is to limit anesthesia to a necessary portion as a pre-stage to insert the insertion portion of the endoscope nasally. The object is to ensure that an appropriate amount of anesthetic can be applied uniformly and reliably.

In order to achieve the above-described object, the present invention provides a flexible tube having a curved shape with a closed end, a length longer than the distance from the outer nostril to the rear nostril , and an internal passage of the flexible tube. A plurality of spouts that are formed with pores that are limited to the region near the distal end, have a large hole diameter on the distal end side, and gradually or continuously decrease the hole diameter toward the proximal end side; A connecting portion provided at a base end portion of the flexible tube and detachably connected to a supply means for supplying an anesthetic to the internal passage is slidably mounted on an outer peripheral surface of the flexible sleeve. The present invention is characterized by comprising a wedge member mounted on the outer nostril.

  The device for applying an anesthetic within the nasal cavity is for supplying the necessary amount of the anesthetic to the required location. The anesthetic is supplied to the outer surface of the flexible tube, and the anesthetic is applied to the inner wall of the nasal cavity. Apply. Here, in order to use the inside of the nasal cavity as the insertion path of the insertion part, an anesthetic is applied only to the part required by this path, that is, the part that is stimulated by the insertion part when inserted. To do. In this case, the necessary part is a route from the middle nasal passage (or lower nasal passage) to the posterior nostril. The rest of the area, that is, the nasal vestibule on the near side and the area beyond the rear nostril should be kept as little as possible. For this purpose, the inside of the flexible tube is used as an anesthetic supply passage, and an outlet is provided near the tip in order to apply the supplied anesthetic in a limited area. It is possible to provide a single outlet and rotate the flexible tube so that it can be rotated. However, a plurality of outlets are formed around the entire circumference of the flexible tube, and a predetermined number is also provided in the axial direction. It is desirable to provide an outlet for a length, specifically about 6 cm to 7 cm. Thereby, an anesthetic can be reliably applied to a necessary location, and the anesthetic can be prevented from reaching other locations.

The inside of the nasal cavity is narrow and has a considerable length, most of which is covered with mucous membranes. Since it is an apparatus for applying an anesthetic, the flexible tube having a smaller diameter than the insertion portion of the endoscope can be used. Therefore, the flexible tube can be easily inserted into a route in the nasal cavity having a narrowed portion. Also, when inserting into the nasal cavity, the distal end of the flexible tube does not damage the nasal cavity's mucous membrane, so that the distal end of the flexible tube has a convex curved shape without an edge, For example, it has a convex spherical shape, and preferably has a flexible structure. Furthermore, it is desirable to leave the flexible tube in the nasal cavity for a predetermined time in order to distribute the anesthetic into the nasal cavity. For this purpose, the wedge member can be fitted to the flexible tube. And , if the flexible tube is made of a material having excellent chemical resistance and autoclave resistance such as silicon rubber and fluorine rubber, it becomes possible to sterilize after use, and the anesthetic application device can be used repeatedly. Can do.

  As the anesthetic, for example, xylocaine biscus or the like is preferably used. It is preferable that this anesthetic is exuded by an appropriate amount rather than being ejected from around the flexible tube. Therefore, the outlet has a pore size corresponding to the viscosity of the anesthetic so that it does not flow out excessively. The portion where the outflow port is provided is the outer peripheral surface on the distal end side of the flexible tube, but desirably it is made to substantially coincide with the length from the middle nasal passage (or lower nasal passage) to the rear nostril. Thus, the flexible tube is inserted by a predetermined length, and the anesthetic is fed by the anesthetic supply means connected to the proximal end portion thereof, and the flexible tube is slightly twisted. By operating as described above, it is possible to supply a necessary amount of anesthetic only in a necessary portion. And in order to apply | coat an anesthetic uniformly, the opening diameter of the pore which comprises an outflow port is changed to the axial direction of a flexible tube. That is, the base end side of the flexible tube is formed as an outlet having a narrow opening diameter, and the opening diameter of the outlet is increased continuously or stepwise toward the distal end side. As a result, the amount of the anesthetic exuding from the periphery of the flexible tube is made substantially uniform.

  As described above, the anesthetic can be supplied to the insertion path of the insertion portion of the endoscope in the nasal cavity only in a necessary portion, and an appropriate amount of the anesthetic can be applied uniformly and surely and easily. It becomes like this.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, in FIG. 1, reference numeral 1 denotes an endoscope. The endoscope 1 is provided by connecting a main body operation unit 3 to a proximal end portion of an insertion unit 2 to be inserted into a body cavity. The universal cord 4 connected to the apparatus or the processor is extended. The insertion portion 2 is inserted into the upper digestive tract such as the esophagus, stomach, duodenum, etc., and is used for performing a desired examination or treatment. Here, the insertion part 2 is inserted into the body not through the oral cavity of the subject but through the nasal cavity. That is, a route is taken from the outer nostril, which is the entrance of the nasal passage, through the nasal cavity including the middle nasal passage and the lower nasal passage, and from the rear nostril to the nasopharynx and esophagus.

  An anesthetic is applied at a stage before the insertion portion 2 of the endoscope 1 is inserted into the nasal cavity. The anesthetic is applied by inserting an anesthetic application device from the outer nostril and applying it uniformly and in a necessary amount to the intranasal route from the middle nasal passage and the lower nasal passage to the posterior nostril. An example of an anesthetic application device used for this purpose is shown in FIGS.

  In FIG. 2, 10 is a flexible tube and 20 is a connection part. The flexible tube 10 has at least a length from the outer nostril to the rear nostril, specifically a length of about 15 cm to 20 cm, and the thickness is equal to or less than that of the insertion portion 2 of the endoscope 1. It is said. The internal passage of the flexible tube 10 functions as an anesthetic supply passage 11 as shown in FIG. 3, and its distal end portion 10a is closed, and this closed distal end is shown. The portion 10a has a convex spherical shape such as a convex hemispherical surface or a spheroidal surface in order to improve insertability, and there is no edge or corner portion.

  The flexible tube 10 is flexible in the bending direction, and the distal end portion 10a is solid and has a substantially uncompressed structure. As is clear from FIG. 4, a large number of pores 12 are provided in the length direction from the outer peripheral surface in the vicinity of the distal end of the flexible tube 10 over a length of about 6 cm to 7 cm. The pores 12 communicate with the supply passage 11 of the flexible tube 10, and when an anesthetic is supplied into the supply passage 11, the pores 12 flow out to the outer surface. Thus, the pore 12 is an anesthetic outlet. Here, in order to manage the coating amount, it is preferable that the anesthetic flows out so as to ooze out rather than ejecting from the pores 12. Therefore, the opening diameter of the pores 12 is set in relation to the viscosity of the anesthetic. When a high-viscosity anesthetic is used, the anesthetic can be easily supplied by increasing the diameter of the pores 12. Moreover, when using a low-viscosity anesthetic, in order not to supply excessively, the diameter of the pore 12 is made small. The pores 12 can be provided not only in the vicinity of the tip but also in the tip portion 10a having a convex curved shape. In addition, since the place where the pores 12 are formed has a predetermined length and the anesthetic is supplied from the proximal end side of the flexible tube 10, an anesthetic having a certain degree of viscosity such as xylocaine biscus is used. In some cases, a sufficient amount of anesthetic may not flow out from the pores 12 located on the tip side. For this reason, as shown in the drawing, it is desirable that the pore 12 on the distal end side has a large pore diameter, and the pore diameter is gradually or continuously reduced as it goes toward the proximal end side.

  The anesthetic is supplied from the proximal end side of the flexible tube 10, and for this purpose, the connecting portion 20 is connected to the proximal end side of the flexible tube 10. The connecting portion 20 has a diameter larger than that of the flexible tube 10, and an anesthetic supply means is connected to the proximal end portion of the connecting portion 20. Here, as the anesthetic supply means, particularly when a medium to high viscosity anesthetic is used, for example, as shown in FIG. 5, the syringe 21 is detachably connected. For this purpose, the connecting portion 20 is made of a hard pipe, and a bayonet groove 22 is formed at the base end portion thereof, and a fitting portion that is detachably connected to the bayonet groove 22 at the distal end of the syringe 21. 21a is provided.

  Moreover, when using a liquid anesthetic with a low viscosity, the nebulizer 30 shown in FIG. 6 is used, for example. This sprayer 30 is provided with a needle-like nozzle 32 in a main body container 31 provided with pump means. A seal ring 33 having an inner diameter smaller than the outer diameter of the nozzle 32 is inserted into the connection portion 20 provided at the proximal end of the flexible tube 10, and the nozzle 32 is inserted into the seal ring 33. By manually operating the pump means provided in the main body container 31, the sprayed anesthetic can be fed into the supply passage 11 provided in the flexible tube 10.

  In the anesthetic application device configured as described above, first, either an anesthetic supply means including a syringe 21 or the like or a sprayer 30 is connected to the connection portion 20, and the supply passage 11 of the flexible tube 10 is previously provided. Infuse anesthetic and fill. Then, the anesthetic flows out so as to ooze out from the pores 12, but before the flexible tube 10 is inserted, the anesthetic is allowed to flow out to some extent, including the distal end portion 10a. It is desirable to apply to the surface. In this state, the distal end portion 10a of the flexible tube 10 is inserted into the outer nostril of the subject. Since the distal end portion 10a of the flexible tube 10 has a convex curved surface shape, it can be smoothly inserted without damaging the mucous membrane in the nasal cavity, which is a narrow passage, or giving damage to the subject. Distress is minimized.

  As the flexible tube 10 advances into the nasal cavity, the anesthetic is supplied to the inner surface of the nasal cavity by operating the anesthetic supply means including the syringe 21 or the sprayer 30, that is, by operating the syringe to push in. Will be applied. Since the flexible tube 10 has pores 12 formed on the entire circumference thereof on the distal end side, the anesthetic is applied over almost the entire circumference of the mucous membrane in the nasal cavity. Further, when the pores 12 as anesthetic outlets have the same diameter and are evenly arranged on the outer peripheral surface of the flexible tube 10, at the time of supplying the xylocaine biscus, the bleeding starts from the base end first. It will not reach the side. Therefore, as shown in FIG. 4, a uniform oozing amount is ensured by increasing the hole diameter on the base end side and decreasing the hole diameter toward the front end side. In addition, since the anesthetic exudes from the supply passage 11 through a large number of pores 12, uneven application can be minimized. And in order to control the application quantity of this anesthetic, the pushing operation of an anesthetic supply means should just be performed slowly. The amount of application can also be increased by slowing the insertion speed of the flexible tube 10 into the nasal cavity. In this way, when the distal end portion 10a of the flexible tube 10 reaches the rear nostril, the anesthetic is uniformly applied over the entire inner surface of the nasal cavity.

  In some cases, the flexible tube 10 is left in the nasal cavity for a predetermined time in order to spread the anesthetic. In this case, for example, as shown in FIG. 7, the wedge member 40 is fitted to the flexible tube 10. The wedge member 40 is made of an elastic member such as rubber and can slide along the outer surface of the flexible tube 10. The wedge member 40 is formed as a tapered ring in which the distal end portion 40a of the flexible tube 10 is thin and the proximal end portion 40b is thick, and a friction member 41 is provided on the inner surface on the distal end portion 40a side. . In normal times, the wedge member 40 including the friction member 41 is fitted so as to easily slide along the outer surface of the flexible tube 10.

  When placing the flexible tube 10, the wedge member 40 is slid along the outer surface of the flexible tube 10, and the wedge member 40 is inserted into the outer nostril of the subject. Here, since the base end side of the wedge member 40 swells in a tapered shape, when the wedge member 40 is pushed into the outer nostril, the distal end portion 40a is deformed so as to be compressed. As a result, the friction member 41 is pressed against the inner surface of the flexible tube 10, and the flexible tube 10 is held so that it cannot move. Accordingly, the wedge member 40 has a distal end portion 40a having an outer diameter smaller than the outer nostril, and a proximal end portion 40b having an outer dimension sufficiently larger than the outer nostril. As described above, the wedge member 40 exhibits a function of preventing the flexible tube 10 from falling off, but further functions as a stopper for preventing the flexible tube 10 from being completely embedded in the nasal cavity. To demonstrate. Therefore, when this wedge member 40 is not provided, a stopper ring having an inner diameter that is between the outer diameter of the flexible tube 10 and the outer diameter of the connecting portion 20 and whose outer diameter is sufficiently larger than the outer nostril, etc. It is desirable to be fitted to the flexible sleeve 10.

  When the application of the anesthetic is completed by inserting the flexible tube 10 into the nasal cavity, the flexible tube 10 is pulled out from the nasal cavity. Thereafter, preferably after waiting until the anesthetic agent sufficiently acts, the insertion portion 2 of the endoscope 1 is inserted into the nasal cavity, and the distal end portion of the insertion portion 2 is advanced to a position to be examined. The endoscopic examination is performed by appropriately operating the insertion portion 2. Then, if necessary, a predetermined treatment can be performed by inserting a treatment instrument such as forceps into the body cavity via the treatment instrument insertion channel.

  Here, since the insertion part 2 of the endoscope 1 is inserted through the nasal cavity and does not go through the throat, there is no unpleasant feeling such as vomiting during insertion. In addition, since the subject can breathe easily with the mouth and can talk with the surgeon or the like, the pain and the like in the endoscopic examination are remarkably reduced. Furthermore, since the route by the nasal cavity is narrower than the route by the oral cavity, the area to which the anesthetic is applied is limited, so the application amount itself is also reduced. As a result, the burden on the subject can be reduced.

It is explanatory drawing which shows the state which inserts the insertion part of an endoscope in a subject's body cavity. It is a front view which shows the whole structure of the anesthetic agent application apparatus which shows one Embodiment of this invention. FIG. 3 is a cross-sectional view of FIG. 2. It is an enlarged view of the front-end | tip part of FIG. It is a principal part external view of the anesthetic agent application apparatus of the state which connected the syringe to the trial apparatus as an example of an anesthetic supply means. It is principal part sectional drawing of the anesthetic agent application | coating apparatus of the state which connected the nebulizer to the trial apparatus as another example of an anesthetic supply means. It is composition explanatory drawing which shows the state which mounted | wore the flexible tube with the stopper.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Insertion part 3 Main body operation part 4 Universal cord 10 Flexible tube 10a Tip part 11 Supply path 12 Fine hole 20 Connection part 21 Syringe 30 Sprayer 40 Wedge member

Claims (2)

A flexible tube having a curved shape with the tip closed and having a length equal to or greater than the distance from the outer nostril to the rear nostril ;
It consists of pores that are open only in the area near the tip, leading to the internal passage of this flexible tube, the tip diameter is large, and the hole diameter is stepwise or continuously as it goes toward the base end. A plurality of spouts made smaller,
A connecting portion provided at a proximal end portion of the flexible tube, to which a supply means for supplying an anesthetic to the internal passage is detachably connected;
An intranasal anesthetic application device comprising a wedge member slidably attached to the outer peripheral surface of the flexible sleeve and attached to an outer nostril.   2. The intranasal anesthetic application device according to claim 1, wherein the pores are formed over a range of 6 to 7 cm from the tip of the flexible tube.

Images