Classifications

• • 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
  • 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
  • A61B1/005—Flexible endoscopes
  • A61B1/0051—Flexible endoscopes with controlled bending of insertion part
  • A61B1/0055—Constructional details of insertion parts, e.g. vertebral elements
• • 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

Definitions

• This invention relates to a intubating videoendoguidescope with an extendable video- endoguidestylet which is characterized by motorable extending video- endoguidestylet, distal flexible tip with real time vision, channeled case and endotracheal tube sliding over it.
• endotracheal tube generally designates an appropriate size tube that is inserted through the mouth into the trachea.
• Orotracheal intubation consists in inserting a tube through the mouth, the laryngeal inlet and into the trachea of a patient. This procedure is commonly performed in medical conditions in patients who are unable to protect their airways, are at risk of pulmonary aspiration and those that require assistance with mechanical ventilation. It is also commonly performed to enable mechanical ventilation for safe general anaesthesia during surgery.
• a laryngoscope assists with intubation by allowing the clinician to visualize the path of the endotracheal tube as it passes through the glottis towards the trachea.
• Tracheal intubation can be performed by direct laryngoscopy or indirect laryngoscopy.
• direct laryngoscopy a laryngoscope is used to obtain a direct view of the vocal cords.
• An orotracheal tube is inserted under direct vision through the vocal cords normally in an unconscious patient.
• a laryngoscope typically comprises a handle and a blade. There are many types of laryngoscopes designed for direct laryngoscopy.
• the blade may be curved (e.g. the Macintosh blade), straight (e.g. the Miller blade) or may comprise a moveable hinged blade tip (e.g. McCoy laryngoscope).
• the technique of orotracheal intubation begins with the blade inserted into the right corner of the patient’s mouth.
• the blade is shaped such that a flange will push the tongue to the left side of the oropharynx to create space in the oropharynx through which a view of the larynx will be sought.
• the epiglottis is visualised.
• the laryngoscope handle is manipulated so that the blade lifts the epiglottis directly with the straightblade or indirectly with the curved blade thereby exposing the laryngeal inlet in normal patients.
• the endotracheal tube is then advanced past the vocal cords into the trachea. Most intubations are straightforward using the direct laryngoscopy procedure described above.
• videolaryngoscope such as those sold under the trademarks Airtraq and GlideScope and also with fiberoptic or fiberless flexible bronchoscope.
• These videolaryngoscopes have a light source and imaging modality embedded in or inserted near to the distal portion of the blade.
• the blade is shaped such that with manipulation the imaging modality can be positioned adjacent to the larynx. This enables visualization of the laryngeal inlet on a viewer or screen.
• Fibreoptic intubating laryngoscopes are also used for intubation, particularly if direct laryngoscopy is judged to be difficult or dangerous.
• These flexible endoscopes introduced with various manoeuvre to direct it into trachea over which endotracheal tube can be pass over into the trachea.
• the tip can be visualised on the screen as it passes through the vocal cords. It is common however with videolaryngoscopes for a good laryngoscopic view on the screen to be achieved but for the user to have difficulty directing the endotracheal tube into the laryngeal inlet. Most problematic is the endotracheal tube tip directing too posteriorly. This problem of endotracheal tube passing posteriorly occurs with both channeled as well as non channeled videoscopes. The channeled videoscopes have 2 compartments, one for the imaging mechanism and the other for the endotracheal tube, thus making them more bulky.
• a stiff introducer or bougie can be inserted into the endotracheal tube to try to overcome this difficulty but this adds complexity and risk to the procedure.
• Some videolaryngoscopes for example the Airtraq® , have an insertion technique completely different to that used in direct laryngoscopy and have an open sided rigid channel to help guide the tube.
• a disadvantage of these rigid open sided channels is that the endotracheal tube is not placed with a technique similar to direct laryngoscopy which is familiar to all anesthesiologists.
• Another disadvantage is that depending upon tube diameter used, the tube tip is not always gripped sufficiently to direct it along the blade in a sufficiently anterior direction.
• Another disadvantage is that the rigidity of the guiding channel can impede the removal of the laryngoscope over the endotracheal tube when intubation has been achieved and the laryngoscope needs to be removed. And in case of channeled videoscopes there has to be space available to introduce either endotracheal tube directly or guiding bougie to be introduced first over which endotracheal tune can be inserted over it. Also there may occur situation when after good laryngeal inlet view insertion of tube or bouige become difficult.
• fibreoptic for intubation also have many disadvantages. Firstly they are very costly and not easily available in all hospitals. Also its use requires a long learning curve. Since it is made up fibreoptic bundles which are very fine and any break in the bundle due to biting by the patient teeth during the procedure can damage it. While intubation fibreoptic passes through either oral cavity or nasal cavity which are the most unsterile areas so in this way we transmit infection to the lungs. Fiber optic will not pass through if there is even slightly sedated or obtunded patient as there will be soft tissue collapse. Also advancing fiberoptic scope after obtaining good path vision is also tedious task to perform.
• the inherent curve of the intubating videoendoguidescope will negotiate through airway of patients thus not causing problems of obstruction to passage due to collapse of soft tissue structures of airway as in cases of sedated or obtunded patient, or patient under anaesthesia.
• the extendable videoendoguidestylet with a camera at its flexible tip helps in situation where the laryngeal inlet is anterior. Hence by just extending the
• endotracheal tube Due to the videoendoguidestylet , endotracheal tube can be guided over it into trachea even in neutral position of cervical spine without any need to give extention to patient’s neck thus making it safe in situation like trauma or fixed cervical spine patient.
• the flexible tip with smaller diameter videoendoguidestylet can be manipulated easily avoiding injury to arytenoid or epiglottis which can cause edema and post procedure sore throat.
• the learning curve is much lesser as compared to other airway equipments hence the total time of intubation can be sufficiently less so complication like desaturation, hyperdynamic response, secreations and injury are less likely.
• the intubating videoendoguidescope does not require lifting of epiglottis hence no
• Videoendoguidescope is half the size of available videoscopes as their imaging channel and channel for endotracheal tube is same, thus it requires very little mouth opening.
• the videoendoguidestylet is accompanied by a channel which can be either used as a suction channel or oxygen port. This when used as a suction channels helps in clearing secretions and gives a better visual field and when used as oxygen supply port helps as antifogging mechanism, keeping the secretions away and preventing hypoxia.
• the main object of this invention is to give a novel airway instrumentation device for intubation which can be used in all airways especially difficult airway with automated advancing
• Figure 1 is a longitudinal section (side view) of the videoendoguidescope. It shows.
• Figure 2 is also the longitudinal section with ETT(8) over videoendoguidestylet and ETT pusher (7) pushing it down over videoendoguidestylet.
• FIG. 3 shows the bidirectional motor switch in down position(9) for extension of
• Figure 4 is also a longitudinal section with minute detailed structure of mechanics. It shows the bidirectional pulley (12) controlling videoendoguidestylet extension and retraction, bidirectional motor(13), cord/ camera cord controlling retraction (14), cord controlling extention of videoendoguidestylet (15), flexi tip controller cord(16) and fixed part of videoendoguidestylet (17).
• Figure 5 shows a specialized mechanism to flex the Flexitip camera at any desired extention.
• the Flexitip controller(l ) is in neutral position, hence the Flexitip cord clamper is in open position (18), and the Flexitip controlling cord (16) is not controlling or flexing the Flexitip camera.
• the Flexitip controller (1 ) is in pulled up position, hence the Flexitip cord clamper is in clamped position (19), and the Flexitip controlling cord (16) is clamped and pulled up and can control or flex the Flexitip camera if Flexitip controller is further pulled up.
• Videoendoguidescope lenghth and size will be variable depending on length and size required for particular patient age.

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• General Health & Medical Sciences (AREA)
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• Heart & Thoracic Surgery (AREA)
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• Otolaryngology (AREA)
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• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Optics & Photonics (AREA)
• Pathology (AREA)
• Emergency Medicine (AREA)
• Physiology (AREA)
• Hematology (AREA)
• Anesthesiology (AREA)
• Endoscopes (AREA)

Applications Claiming Priority (2)

Publications (1)

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• 2019
  • 2019-02-08 WO PCT/IB2019/051043 patent/WO2020128645A2/fr active Application Filing

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