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WO1989011305A1 - Procede et dispositif d'intubation d'un patient - Google Patents

Procede et dispositif d'intubation d'un patient Download PDF

Info

Publication number
WO1989011305A1
WO1989011305A1 PCT/EP1989/000532 EP8900532W WO8911305A1 WO 1989011305 A1 WO1989011305 A1 WO 1989011305A1 EP 8900532 W EP8900532 W EP 8900532W WO 8911305 A1 WO8911305 A1 WO 8911305A1
Authority
WO
WIPO (PCT)
Prior art keywords
endoscope
spatula
clamp
web
tube
Prior art date
Application number
PCT/EP1989/000532
Other languages
German (de)
English (en)
Inventor
Peter Bumm
Original Assignee
Peter Bumm
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Peter Bumm filed Critical Peter Bumm
Publication of WO1989011305A1 publication Critical patent/WO1989011305A1/fr

Links

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

Definitions

  • the invention relates to a method for intubating a patient using an endoscope in addition to the tube, and a device for executing the method.
  • the object on which the invention is based is seen in creating a method together with the device of the type mentioned, by means of which it is possible in a gentle manner while minimizing the risk of injury, taking into account the natural or disease-related morphological conditions present in the respective patient Conditions to perform the intubation process.
  • the indication of the method according to the invention is seen above all in the larynx which is not exactly visible by direct laryngoscopy, less so in the case of the intubation of the monstrous larynx umoreno
  • the endoscope is inserted into the throat in front of the tube to be inserted through the nose or mouth, and thus independently of it. It is also advantageous to use a rigid endoscope with better optical quality, preferably using angle optics of 30 ° or 70 °.
  • the conditions described can be explored and the most expedient path of the tube can be viewed and tracked before the latter even reaches the pharynx areas in which there may be obstacles to intubation.
  • the intubation process itself can also be monitored optically and corrected if necessary.
  • an intubation spatula or a laryngoscope to hold the base of the tongue with one hand
  • the patient is lifted up so that the other hand can be used to push the endoscope through the oral cavity into the oropharynx.
  • the third hand for advancing the tube is missing, so to speak. This means that a third person must either hold the tongue depressor or the endoscope.
  • the endoscope is preferably releasably attached to the same essentially parallel to its wall before the spatula is inserted.
  • the rigid endoscope is particularly expediently attached to the spatula in such a way that it can be pivoted to a limited extent in the lateral and / or vertical direction.
  • a corresponding device for carrying out the method according to the invention using a rigid endoscope and a spatula is characterized by a fastening device by means of which the endoscope can be fastened to the spatula, expediently such that the endoscope pivots to the right and left and / or up and down and / or can be moved laterally, in each case relative to the spatula or to its longitudinal axis.
  • this fastening device is a clamp with two clamping jaws.
  • One of these jaws can be rigidly attached to a holder for the endoscope.
  • the clamp preferably has a socket which can be pushed onto the endoscope and which forms the fixed clamping jaws with a laterally projecting web.
  • On this side bar is a spring in the direction of the bushing, arranged on the spatula wall to fix certain movable jaws.
  • the spatula wall can be clamped between the socket with a web as a fixed clamping jaw and a movable clamping jaw, which advantageously results in a releasable fastening.
  • the bushing can have a coaxial ring nut that can be screwed onto it with the interposition of an O-ring. Since the ring nut and the socket for receiving the endoscope are determined by coaxially inserting the same, screwing the ring nut into the socket allows the lance of the endoscope or the reinforcement tube to be fixed by pressing the O-ring into an appropriately conical ring groove of the socket and thus narrowing the O-ring.
  • the O-ring can advantageously be a slotted plastic ring, which facilitates its radial narrowing. Its shape can be adapted to the groove.
  • a reinforcement tube can be pushed onto its lance and releasably locked on the endoscope, the lance then being inserted into the socket with the reinforcement tube surrounding it and the clamping forces of the O- Recorded around.
  • the spatulas used have essentially vertical or slightly inclined handles which are arranged at the distal end of the spatula relative to the larynx.
  • an extension of the same or the spatula wall beyond the handle or its connection to the actual spatula body is advantageously provided.
  • This extension expediently serves to fasten the endoscope by means of the fastening device or the clamp, in such a way that the clamping takes place on this extension. This makes it easier to clamp the clamp directly in front of the handle arrange or the endoscope under the same.
  • the clamp can also be movable, e.g. Can be moved parallel to itself, guided on the spatula.
  • a clamp can also be arranged firmly on the endoscope and enable it to be attached to the spatula.
  • Figure 1 shows the arrangement of spatula and endoscope in the throat of a patient in a schematic view.
  • Fig. 2 shows a spatula, an endoscope and a clamp attached to the endoscope in a first side view.
  • FIG. 3 spatula, endoscope and clamp according to Fig. 1 after
  • Figure 4 is a plan view of the clamp on an enlarged scale.
  • FIG. 5 shows a view of the clamp in the direction of arrow K in FIG. 4;
  • FIGS. 6 and 7 sections X and Y from FIG. 4 in an additionally enlarged scale; 8 shows a further embodiment of a spatula in combination with a clamp, guide piece and endoscope;
  • Fig. 9 is a plan view of the combination of Fig. 8;
  • FIG. 10 is a front view of the combination of Figure 8 ⁇ ;
  • Figure 1 shows a schematic representation of a patient lying on his back with his head bent back, in the mouth-throat space 1 a spatula 2 has been inserted below the tongue, not shown in detail, so that a rigid endoscope 3 with its lance 11, the in this case has 70 ° optics, could be introduced.
  • the larynx 5 is thus exposed for viewing in the viewing direction 4.
  • the endoscope 3 has thus already been introduced into the pharynx in front of the tube to be inserted through the nose or mouth, and thus independently of it, here using an intubation spatula or laryngoscope. Then the tube, not shown, can now be inserted in a gentle manner, as is necessary for performing an anesthesia for intubation.
  • the endoscope 3 is releasably attached to the same essentially parallel to the wall 6 thereof before the spatula is inserted.
  • the clamp 3 has a bush 12 which can be pushed onto the lance 11 of the endoscope 3 and on which a laterally projecting web 13 is fixedly arranged.
  • the bushing 12 forms a fixed clamping jaw, while a movable clamping jaw 14 is arranged such that it can pivot about an axle screw 15 arranged on the web 13 under spring pressure in the direction of the double arrow A.
  • a reinforcement tube 16 is pushed onto the lance 11, which is releasably attached to the endoscope 3 by means of a locking head 17, such that the socket 12 surrounds this reinforcement tube 16, which is suitable for protecting the lance against potentially destructive bending moments.
  • the reinforcing tube 16 also absorbs the clamping forces of the bushing 12, more precisely the radially inwardly directed clamping forces applied by a manually operated knurled screw 18, as will be explained in more detail below.
  • FIG. 3 shows the device in a position rotated laterally by 180 °, the endoscope 3 being shown attached to the spatula 2 'by means of the clamp 9 and the endoscope lance 11 extending along the inner wall 19 of the spatula 2' can be clearly seen in its reinforcing tube 16 .
  • an extension 20 of the spatula wall 21 is provided beyond the handle 10, this extension 20 providing space for the engagement of the clamp 9 also in the region of the transition of the handle 10 into the spatula 2', such that the endoscope 3 can be displaced in the circumferential direction along the extension 20 of the spatula wall 21 by means of the clamp 9.
  • the extension 20 thus serves to fasten the fastening device or clamp 9 in the manner of a federal government.
  • the socket 12 is provided with a reinforcing collar 23, from which the web 13 emerges in one piece.
  • the movable clamping jaw 14 has a clamping edge
  • the spatula wall 21 can be clamped between the clamping edge 24 and the flattened portion 25, in the embodiment of the spatula 2 'shown the extension 20, the extension 20 (not shown in FIG. 4) depending on the distance between the clamping edge 24 and a stop surface 26 of the collar 23 of the spatula 2 * can be displaced in the direction of the longitudinal axis 27 of the bushing 12.
  • the possibility of displacement in the circumferential direction of the extension 20, thus perpendicular to the axis 27, has already been mentioned.
  • the movable clamping jaw 14 is equipped on its side facing the web 13 with a U-shaped recess 28 which overlaps the latter and in which the spring 31 is arranged, partially embedded in a blind hole 29 in the recess base 30 , which is supported on the one hand on the bottom of the blind hole 29 and on the other hand on the web 13.
  • the spring 31 is preferably a helical compression spring, the web-side end 32 of which is supported on the web 13 by a slider 33 encompassed by it.
  • the O-ring 34 is expediently a radially slotted plastic ring with an essentially conical chamfer 35, which can be pressed by the ring nut 18 into a correspondingly conical ring groove 36 of the bushing 12 and its diameter can be reduced.
  • the slot 37 of the O-ring 34 is indicated in Figure 6.
  • both the clamp 9 and the endoscope 3 are designed in the same way as in the embodiment described above.
  • a modified spatula 2 '' is used, which is more curved than the lance 11 of the endoscope 3, has a tissue-protecting bead 37 at its end and also has lighting 38 by means of a light bulb which is powered by batteries (not shown) in the handle 10 * becomes. Due to the essentially Z-shaped configuration of the cross section of the spatula 2 1 '(see the dashed course of the wall 38 in FIG. 10), the clamp 9 can only be arranged in the transverse position relative to the handle 10', which simplifies the operation of the clamp 9 .
  • the lance 11 of the endoscope 3 can be pivoted very simply downward in the direction of arrow B and clamped anywhere within a certain angular range.
  • a side pivoting is not possible in this embodiment.
  • pivoting downward is only possible if the clamp has previously been moved into the side region of the wall 21 or the extension 20, which is due to the tubular shape there.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Radiology & Medical Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Pulmonology (AREA)
  • Biophysics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Physiology (AREA)
  • Otolaryngology (AREA)
  • Physics & Mathematics (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Endoscopes (AREA)

Abstract

Selon un procédé d'intubation d'un patient, on utilise, outre le tube, un endoscope introduit dans la région du pharynx avant le tube, lequel est introduit par le nez ou par la bouche et indépendamment de celui-ci. Lorsque l'on utilise une spatule d'intubation ou un laryngoscope, l'endoscope est assujetti à la spatule, parallèlement à sa paroi, avant son introduction. On obtient ainsi un tubage moins agressif, exempt du risque de blessures par le tube des tissus de l'oropharynx, étant donné que l'on peut explorer optiquement au préalable les conditions morphologiques.
PCT/EP1989/000532 1988-05-16 1989-05-16 Procede et dispositif d'intubation d'un patient WO1989011305A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DE3816639 1988-05-16
DEP3816639.9 1988-05-16
DEP3816784.0 1988-05-17
DE3816784 1988-05-17

Publications (1)

Publication Number Publication Date
WO1989011305A1 true WO1989011305A1 (fr) 1989-11-30

Family

ID=25868137

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1989/000532 WO1989011305A1 (fr) 1988-05-16 1989-05-16 Procede et dispositif d'intubation d'un patient

Country Status (2)

Country Link
EP (1) EP0414780A1 (fr)
WO (1) WO1989011305A1 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0465942A1 (fr) * 1990-07-09 1992-01-15 Circon Corporation Sonde à intubation pour laryngoscope
US5379755A (en) * 1991-11-14 1995-01-10 Richard Wolf Gmbh Device for attaching and securing an auxiliary instrument to a surgical instrument
WO1998046121A1 (fr) * 1997-04-14 1998-10-22 Karl Storz Gmbh & Co. Endoscope medical a manche en coude
EP1062905A1 (fr) * 1999-06-21 2000-12-27 Karl Storz GmbH & Co. KG Laryngoscope à intubation pour les lames prets d'echange et système de laryngoscope à intubation associé
US6508811B2 (en) 1999-07-26 2003-01-21 Karl Storz Gmbh & Co. Kg Fastening element for a medical instrument and such medical instrument
US9687141B2 (en) 2003-04-29 2017-06-27 Aircraft Medical Limited Laryngoscope with means to restrict re-use of blades

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4314551A (en) * 1980-03-06 1982-02-09 Kadell Roger J Laryngoscope
DE3217476A1 (de) * 1981-05-19 1982-12-30 Storz, Karl, 7200 Tuttlingen Laryngoskop
EP0110333A2 (fr) * 1979-11-28 1984-06-13 Michael S. Upsher Laryngoscope

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0110333A2 (fr) * 1979-11-28 1984-06-13 Michael S. Upsher Laryngoscope
US4314551A (en) * 1980-03-06 1982-02-09 Kadell Roger J Laryngoscope
DE3217476A1 (de) * 1981-05-19 1982-12-30 Storz, Karl, 7200 Tuttlingen Laryngoskop

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0465942A1 (fr) * 1990-07-09 1992-01-15 Circon Corporation Sonde à intubation pour laryngoscope
US5379755A (en) * 1991-11-14 1995-01-10 Richard Wolf Gmbh Device for attaching and securing an auxiliary instrument to a surgical instrument
WO1998046121A1 (fr) * 1997-04-14 1998-10-22 Karl Storz Gmbh & Co. Endoscope medical a manche en coude
EP1062905A1 (fr) * 1999-06-21 2000-12-27 Karl Storz GmbH & Co. KG Laryngoscope à intubation pour les lames prets d'echange et système de laryngoscope à intubation associé
US6508811B2 (en) 1999-07-26 2003-01-21 Karl Storz Gmbh & Co. Kg Fastening element for a medical instrument and such medical instrument
US9687141B2 (en) 2003-04-29 2017-06-27 Aircraft Medical Limited Laryngoscope with means to restrict re-use of blades
US9737202B2 (en) 2003-04-29 2017-08-22 Aircraft Medical Limited Laryngoscope with camera attachment
US10178947B2 (en) 2003-04-29 2019-01-15 Aircraft Medical Limited Laryngoscope with camera attachment
US10786146B2 (en) 2003-04-29 2020-09-29 Aircraft Medical Limited Laryngoscope with camera attachment
US11612313B2 (en) 2003-04-29 2023-03-28 Covidien Ag Laryngoscope with camera attachment

Also Published As

Publication number Publication date
EP0414780A1 (fr) 1991-03-06

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