Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0402—Special features for tracheal tubes not otherwise provided for
  • A61M16/0409—Special features for tracheal tubes not otherwise provided for with mean for closing the oesophagus
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
  • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
  • A61M16/0816—Joints or connectors
  • A61M16/0833—T- or Y-type connectors, e.g. Y-piece
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
  • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
  • A61M16/0096—High frequency jet ventilation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0463—Tracheal tubes combined with suction tubes, catheters or the like; Outside connections
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
  • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
  • A61M16/0816—Joints or connectors
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
  • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
  • A61M16/0875—Connecting tubes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M2230/00—Measuring parameters of the user
  • A61M2230/40—Respiratory characteristics
  • A61M2230/43—Composition of exhalation
  • A61M2230/432—Composition of exhalation partial CO2 pressure (P-CO2)

Definitions

• the main object of the invention is a jet connector that enables conducting bronchoscopy using a laryngeal mask (LAM) on patients during anesthesia with high frequency ventilation. Further object of the invention is a process to perform bronchoscopy with the use of this jet connector and a laryngeal mask on patients under anesthesia with high frequency ventilation.
• LAM laryngeal mask
• bronchoscopy With the use of bronchoscopy, the visual inspection of the inner surface of the trachea and bronchi can be carried out, and in this way, abnormalities of the lungs (eg. cough, bloody sputum or difficult breathing) detected by clinical methods, laboratory results (elevated inflammatory parameters) or diagnostic imaging technique (CT, MRI, radiography, etc.) can be clarified. Both flexible and rigid bronchoscopy technique can be used for this purpose.
• Bronchoscopy using rigid tubes originates at the end of the 19th, begin- ning of the 20th century.
• a rigid tube is inserted through the mouth, and through the tube a rigid optical system inserted for the inspection of the trachea and the bronchi.
• This system it is also possible to take a sample of the lung tissue or its abnormalities with the use of different instruments (forceps, needle biopsy, laser, bronchial brush, etc.).
• the insertion of the rigid tube into the lungs is very awkward (extreme backwards tilting of the head), painful and uncomfortable for the patient, so these processes are performed under general anesthesia.
• general anesthesia for patients in a poor general condition general anesthesia (anesthetic agents, analgesic drugs, muscle relaxants) means a severe cardiovascular stress, instability of the circulation, heart rhythm disturbances and oxygenation problems.
• the rigid tube examination has several risk factors and complications. These include the mechanical damage to the mouth, teeth, the larynx and the trachea, occurrence of bleedings and injuries caused by tilting back the neck. The inspection of the trachea right below the vocal cords is inhibited by "falling out" of the rigid tube from the larynx.
• the flexible bronchoscope is a short, approximately 600 mm long, 5-6 mm diameter fiber- or videooptic equipment with a forward-looking optical part.
• the bronchoscope is inserted into the lungs through the nasal or mouth cavity of the patient.
• the equipment is inserted through the larynx and the vocal cords into the trachea and to the main bronchi and the lungs.
• the distal tip of the bronchoscope inserted to the patient, contains an optical unit that enables the visualization of the internal surface of the bronchi using different imaging techniques.
• the image can be transmitted to a monitor through a camera connected to the device.
• the proximal tip of the bronchoscope containing the camera can be manipulated with knobs arranged on the handle.
• the bronchoscope comprises a working channel for different forcipes and brushes to take a lung and pathological tissue biopsy during visualization.
• the flexible and rigid bronchoscopes are connected to a workstation that contains different diagnostic and therapeutic working options and units including the monitor used for watching the process of interventions.
• the progression of diagnostic and therapeutic processes can be visualized on the monitor by the workstation.
• Anesthesia itself has a danger and risk for the patients due to the effects and adverse events caused by the anesthetic drugs.
• the drugs affect the circulation (serious blood pressure decrease), the heart (benign and malignant rhythm disturbances, heart failure), the circulation of other organs, the respiratory center of the brain (blocking the respiration), and consciousness. Additionally, they can induce allergy and increased secretion in the lungs. Following the sur- gery nausea, vomiting and respiratory muscle weakness can occur leading to respiratory failure in patients with low respiratory function.
• Local anesthesia in conscious patients means that the pharynx, the larynx and the trachea are anesthetized with a local anesthetic fluid.
• the disadvantage of the approach is that the patient maintains the spon- taneous breathing, and the movement of the lungs (inspirations-expirations) disturb the process, interfere with the accuracy of sample collection and some therapeutic interventions cannot be performed.
• the so called laryngeal masks are widely used.
• the plastic mask comprises an approximately 20 cm ventilation tube and a heart shaped mask part connected to the tube, which surrounds the laryngeal inlet.
• the mask is inserted through the mouth after starting the anesthesia.
• the cuff of the mask can be inflated to improve sealing.
• the ventilation tube of the laryngeal mask is connected to the conventional closed loop ventilation system.
• the advantage of the mask is that it can be inserted easily and does not require the use of muscle relaxants. However, it is not used in open, high frequency systems because it is not considered to provide full sealing and is easily dislocated.
• the surgical location is the intra- traceal area, and the patient must be ventilated through the same area.
• the system must be opened because of the instruments inserted into the trachea. When the system is opened, the ventilation becomes insufficient due to the volume reduction by the air leakage before reaching the lungs.
• the so called high frequency jet ventilation is used to maintain ventilation. It is performed through a so called jet injector wherein high flow, low volume (about 60-100ml), high frequency (100-1500/min) and simultaneous inspiration-expiration are characteristic.
• the ventilation system is opened through the distal end of the rigid tube.
• the rigid tube itself is the working chan- nel for the surgical devices, while the ventilation volume flows to the patient from the lateral side through an adapter connected to the rigid tube. So far, the use of jet ventilation in tracheal surgery has only been used through a rigid tube. A closed system anesthesia with previously used laryngeal masks could not be combined with high frequency ventilation, because the laryngeal mask does not have a connector to the jet ventilation apparatus so its use has never been considered for this purpose.
• a connecting piece is provided on the one hand, that contains a central working tube for the insertion of a flexible bronchoscope and has a socket piece for the attachment of the ventilation tube of a laryngeal mask; at least one canal opening at one end into the central tube and containing another socket piece at the other end, to be attached to the ventilation pipe of a high frequency ventilation system and at least one canal opening at one end into the central tube, and containing at the other end another socket piece to be attached to the measuring pipe of a high frequency ventilation system.
• the socket pieces may be branches of the central tube and the canals are then connecting pipes arranged outside the central tube.
• the socket pieces and canals are bores in the thickened wall of the central tube.
• the second canal(s) or connecting pipe(s) is(are) preferably opening into the central tube closer to the socket piece to be attached to the ventilation tube of the laryngeal mask, than the first canal(s) or connecting piece(s).
• a depression and/or a directing/protecting element at the opening of the second can- al(s) into the central tube.
• the jet connector according to the invention is provided with an element to be attached to a supporting system.
• the attachment element may be a bush fixed on the outer surface of the central tube.
• a process is also object of the present invention, said process containing the following steps: narcosis of the patient using anesthetic agents and analgesic drugs without muscle relaxants; insertion of the laryngeal mask; connecting the ventilation pipe of the respiratory system to the first canal of the jet connector; connecting the measuring pipe of the respiratory system to the second canal of the jet connector; insertion of the bronchoscope through the central tube of the jet connector and performing the required proce- dures/interventions.
• Further object of the invention is the use of the laryngeal mask that has never before been used for this purpose in combination with the jet connector in conformity with the invention for bronchoscopy conducted under anesthesia using a high frequency ventilation system.
• the bronchoscopy according to the invention conducted under anesthesia significantly decreased the previously mentioned clinical and technical limitations and results in a wider range of indication (smaller side effects on the heart, circulation, less respiratory depression and respiratory muscle weakness) for both anesthesia and bronchoscopy.
• Fig. 1 shows a side view of a preferred embodiment of the jet connector according to the invention, partly shown in section;
• Fig. 2 shows a side view of another embodiment of the jet connector according to the invention, shown in section
• FIG. 3 shows a schematic illustration of the use of the jet connector in combination with a laryngeal mask
• Fig. 4 shows the jet connector connected to a partly illustrated supporting system.
• a preferred embodiment of the jet connec- tor according to the invention is basically a connecting piece containing a central tube 1 and two socket pieces 2, 3, wherein the socket pieces 2 and 3 are connected to the central tube 1 through connecting pipes 4 and 5.
• an attachment element e.g. a bush 6.
• the diameter of the central tube 1 is wide enough to enable easy inser- tion of the devices used during the bronchoscopy.
• a laryngeal mask 8 At the lower end of the central tube 1 there is another socket piece 7 that fits into the ventilation tube 9 of a laryngeal mask 8 as it can be seen in Figure 3.
• Socket pieces 2 and 3 are appropriately fit into the ends of the standard pipes of high frequency ventilation systems and the passages of connecting pipes 4 and 5 matching with the openings on the ends of those tubes.
• One of the socket pieces 2 is used for the input of the inspiration volume coming from the ventilation system, while through the other socket piece 3 the exhaled sampled air flows for monitoring.
• two connecting pipes 4, 5 are connected to each socket piece 2 and 3.
• the passages of socket piece 2 are attached to the connecting tubes of low- and high frequency ventilator machines; one of the passages of socket piece 3 can be attached to the airway pressure monitoring pipe, the other to the CO 2 measuring pipe.
• connecting pipes 4 and 5 connected to socket pieces 2 and 3 are arranged outside the central tube 1 and the second socket piece 5 used for monitoring is inserted to the central tube closer to the socket piece 7 for the ventilation tube 9 of a laryngeal mask 8, than the socket piece 4 used for gas input.
• FIG. 2 only differs from that of Figure 1 in that socket pieces 2 and 3 do not form separate branches as in Figure 1 ; they are shaped within the thickened wall of the central tube 1 and canals 10 and 11 connecting them to the inside of the central tube 1 are provided instead of con- necting pieces 4 and 5 arranged outside the central tube .
• a further difference is that only one single canal 10, 11 is connected to each socket piece 2, 3 because in most cases only high frequency ventilation and pressure monitoring is needed.
• the lower, monitoring canal 11 used for pressure measurement is open- ing to the central tube 1 at a depression 12 made in the wall of the central tube and/or there is a directing/protecting element 13 above the opening to avoid the disturbance caused by the instruments moving in the central tube 1.
• bronchoscope 18 After that the bronchoscope 18 is inserted into the central working tube 1 of the jet connector, local anesthetics are injected into the larynx and to the vocal cords and bronchoscope 18 is advanced through ventilation tube 9 of laryngeal mask 8 into the trachea and the trachea and bronchi are anesthetized.
• the working line required for the examinations includes the central tube 1 of the jet connector, the ventilation tube 9 of the laryngeal mask and the trachea itself and the bronchi.
• the diagnostic and therapeutic devices connected to the workstation 19 are inserted through them.
• the ventilation air volume input and pressure, occasionally C0 2 monitoring is done through connection trunks 2 and 3 of the connector while the expiration occurs through the central canal to the atmosphere. If needed, the open system enables quick switching and changing of instruments.
• the laryngeal mask remains in position until the patient is fully awake (sufficiently spontaneously breathing, eye-opening, adequate consciousness), then it is removed.
• FIG. 3 shows a supporting system 20 . Details of this system.
• the system contains a pin 21 that fits into the connecting bush 6 on the outer surface of the central tube.
• a flexible arm 22 is attached to the pin, and the other end of the flexible arm is connected to an adjustable mast 23 that can be fixed to any surrounding device like the ventilator machine or the operating table.
• the use of the jet connector of the invention offers numerous advantages: Ventilation can be easily achieved and controlled through the jet connector.
• the inspection of the apnoic lung while using high frequency ventilation is more effective, the interventions and sample collections are more accurate (eg. ultrasound, transbronchial biopsy) and the pulmonary intervention (bronchoscopy) is more comfortable for the pulmonologist.
• the intervention requires minimal anesthesia and can be used also in patients suffering from serious lung diseases; the awakening is fast without side effects. There is no need for muscle relaxants, so the complications of respiratory muscle weakness can be avoided. Due to the short anesthetic induction and finishing, the anesthesia period is reduced, so more time remains for surgeries. Minimal anesthesia has a minimal effect on the circulation and the heart.

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• Health & Medical Sciences (AREA)
• Pulmonology (AREA)
• Hematology (AREA)
• Life Sciences & Earth Sciences (AREA)
• Engineering & Computer Science (AREA)
• Anesthesiology (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Veterinary Medicine (AREA)
• Emergency Medicine (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Otolaryngology (AREA)
• Endoscopes (AREA)
• Surgical Instruments (AREA)
• External Artificial Organs (AREA)

Priority Applications (2)

Applications Claiming Priority (2)

Publications (2)

Family

ID=89989258

Family Applications (1)

Country Status (5)

Cited By (1)

Citations (1)

Family Cites Families (3)

• 2009
  • 2009-09-21 HU HU0900595A patent/HUP0900595A2/hu unknown
  • 2009-09-21 HU HU20091200100U patent/HU4178U/hu unknown
• 2010
  • 2010-11-22 WO PCT/HU2010/000126 patent/WO2011033331A2/en active Application Filing
  • 2010-11-22 DE DE202010017671U patent/DE202010017671U1/de not_active Expired - Lifetime
  • 2010-11-22 RU RU2012114241/14U patent/RU125472U1/ru not_active IP Right Cessation
  • 2010-11-22 AT ATGM9010/2010U patent/AT13456U1/de not_active IP Right Cessation

Patent Citations (1)

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