Blind orolaryngeal and oroesophageal guiding and aiming device

• US 5,038,766 A
• Filed: 11/08/1989
• Issued: 08/13/1991
• Est. Priority Date: 11/08/1989
• Status: Expired due to Term

• Current Assignee: Parker Medical Limited Partnership
• Original Assignee: Jeffrey D. Parker
• Inventors: Parker, Jeffrey D.
• Primary Examiner(s): Burr, Edgar S.
• Assistant Examiner(s): RACITI, ERIC
• Application Number:
  US07/433,687
• Time in Patent Office: 643 Days
• Field of Search: 128/10, 128/11, 128/200.26, 128/207.14, 128/207.15, 128/911, 128/912, 128/4, 128/15, 128/16, 604/23
• US Class Current: 128/200.26
• CPC Class Codes: A61M 16/0409 with mean for closing the oesophagus
• CPC Class Codes: A61M 16/0411 with means for differentiating between oesophageal and tracheal intubation
• CPC Class Codes: A61M 16/0488 Mouthpieces; Means for guiding, securing or introducing the tubes guiding or introducing with laryngoscopes A61B1/267; holding devices on the body A61M25/02
• CPC Class Codes: A61M 16/0493 with means for protecting the tube from damage caused by the patient's teeth, e.g. bite block
• CPC Class Codes: Y10S 2/908 Guard or protector having a hook-loop type fastener

Abstract

The present invention relates to a medical device which facilitates rapid, accurate, blind access to the larynx and/or esophagus such as for emergency intubation of a patient'"'"'s trachea and simultaneous suctioning of the hypopharynx or esophagus. Disclosed is a disposable, one-piece, anatomically contoured guide element having a channel therethrough, the guide element being releasably mounted at the end of a curved blade and handle, which is used to blindly insert the guide element into the throat. When properly seated in the pharynx and hypopharynx, the guide element is positioned about and atop the larynx such that the wall of the channel forms a substantially gap-free junction with and upward continuation of the tubular wall of the laryngeal opening so that an orotracheal tube advanced downward through the channel will be guided exclusively into the larynx and trachea without substantial risk of accidental intubation of the esophagus or other areas of the hypopharynx. Also disclosed are provision of tunnels through the guide element for blindly guiding and/or aiming other tubular-type members into the esophagus or larynx as desired.

Claims

1. A medical device comprising a guide element receivable through the mouth and into the back of the throat, the guide element having channel wall means for advancing a tube therealong, and contour means cooperable, upon insertion of the guide element into the throat, with anatomical features of and adjacent the larynx for blindly positioning the guide element such that the channel wall means is contiguous with at least the posterior portion of the tubular wall of the laryngeal opening to define an upward extension of at least the posterior portion of the tubular wall of the laryngeal opening whereby a tube advanced along the channel wall means will be directed into the larynx.

2. The medical device of claim 1, the channel wall means including an anterior portion adapted to substantially surround the anterior edge of the laryngeal opening.

3. The medical device of claim 1, the channel wall means including an upper posterior portion and a lower posterior portion, the lower posterior portion of the channel wall means having an edge adapted to substantially abut the posterior and lateral edge of the laryngeal opening.

4. The medical device of claim 3, the contour means including a recessed surface bordering the lower posterior channel wall means edge and adapted to mate substantially gap-free around the posterior and lateral edge of the laryngeal opening.

5. The medical device of claim 3, the contour means including a projecting cusp extending from the lower posterior portion of the channel wall means and adapted to be received in the interarytenoid incisure of the larynx.

6. The medical device of claim 1, the guide element further having occluding means posteriorly of the channel wall means for overlying and substantially occluding the esophageal opening.

7. The medical device of claim 6, the guide element further having esophageal tunnel means through the occluding means for defining a tubular path aimed at the esophageal opening.

8. The medical device of claim 1, the guide element further having an annulus portion with a channel therethrough defined by the channel wall means.

9. The medical device of claim 8, the guide element further having a body portion coupled to the annulus portion posteriorly of the channel and occluding means posteriorly of the channel for overlying and substantially occluding the esophageal opening, the body portion carry the occluding means.

10. The medical device of claim 1, the guide element further having slant tunnel means through the guide element and terminating in the channel wall means for defining a tubular path pointing into the larynx.

11. The medical device of claim 10, the channel wall means including an upper posterior portion and a lower posterior portion, the lower posterior portion having an edge adapted to substantially abut the posterior and lateral edge of the laryngeal opening, the contour means including a recessed surface bordering the lower posterior channel wall means edge and adapted to mate substantially gap-free around the posterior and lateral edge of the laryngeal opening.

12. The medical device of claim 1, the guide element being semi-flexible.

13. The medical device of claim 8, the guide element further having a body portion coupled to the annulus portion posteriorly of the channel, the contour means including at least one of (a) an anterior portion of the channel wall means shaped to receive thereagainst the epiglottis as the guide element is inserted into the back of the throat, (b) valleculae mating means anteriorly of the channel for mating with at least one vallecula as the guide element is inserted into the back of the throat, and (c) tip means at a terminal end of the body portion for stopping the guide element against the posterior pharyngeal wall to prevent over-advancement of the guide element into the throat.

14. The medical device of claim 1 further comprising inserting means coupled to the guide element for blindly inserting the guide element through the mouth and into a position around the larynx by manipulation from outside the mouth.

15. The medical device of claim 17, the inserting means including a member coupled to the guide element and curved to conform generally to the curvature between the mouth and the larynx.

16. The medical device of claim 14, further comprising means for releasably coupling the inserting means to the guide element.

17. The medical device of claim 14, the inserting means including a blade member curved to conform generally to the curvature between the mouth and the larynx and couplable at a distal end to the guide element.

18. The medical device of claim 17, the blade member including a prong on the blade member distal end, the guide element further having socket means therein for receiving the prong.

19. The medical device of claim 18, the socket means being defined in the guide element posteriorly of the channel.

20. The medical device of claim 18, the socket means being defined in the guide element anteriorly of the channel.

21. The medical device of claim 18, the prong having barbs projecting therefrom, the socket means having means for releasably receiving the barbs.

22. The medical device of claim 14 further comprising tube clip means for releasably holding an orotracheal tube or the like to the inserting means.

23. The medical device of claim 22, the tube clip means including means for releasably holding the tube clip means to the inserting means.

24. The medical device of claim 1, the contour means including edge means for mating the guide element around and against the edge of the laryngeal opening, whereby to form a substantially gap-free junction therebetween.

25. The medical device of claim 1, the channel wall means being arcuate so as to extend arcuately up through the throat toward the mouth.

72. The medical device of claim 1, the guide element further having airway path extension means for defining, when the guide element is positioned by the contoured means, an airway path extension atop and coaxial the laryngeal lumen.

73. The medical device of claim 72, the airway path extension means including an annulus portion with a channel therethrough defined by the channel wall means.

74. The medical device of claim 73, the annulus portion being anatomically contoured so as to cooperate with anatomical features of and surrounding the larynx to position the channel against the laryngeal opening such that the upward extension of the laryngeal wall defined by the channel wall means constitutes the airway path extension atop and coaxial the laryngeal lumen.

26. A medical device comprising a guide element receivable through the mouth and into the back of the throat, the guide element having an annulus portion with a channel therethrough, the channel having an anterior wall and a posterior wall, the guide element further having a body portion coupled to the annulus portion posteriorly of the channel and supporting a surface defining an extension of the channel posterior wall, the guide element further having means cooperating with anatomical features of and adjacent the larynx for positioning the guide element about the larynx such that the anterior and posterior channel walls effectively form a continuation of the tubular wall of the laryngeal opening into a substantially exclusive airway path extension atop and coaxial the larynx and being substantially gap-free between the airway path extension and the laryngeal opening, the cooperating means defined by at least one of (a) the anterior wall in the channel being shaped to receive thereagainst the epiglottis when the guide element is inserted into the back of the throat, (b) valleculae mating means anteriorly of the channel for mating with at least one vallecula when the guide element is inserted into the back of the throat, (c) tip means at a terminal end of the body portion for stopping advancement of the guide element at the correct depth as the guide element is being inserted into the throat, (d) a central notch in the annulus portion anteriorly of the channel, shaped and positioned to fit over the median glosso-epiglottic fold when the guide element is inserted into the back of the throat, (e) lateral notches in the annulus portion anteriorly of the channel, shaped and positioned to fit over the lateral glosso- and pharyngo-epiglottic folds when the guide element is inserted into the back of the throat, (f) cusp means projecting from the body portion to fit into and above the interarytenoid incisure when the guide element is inserted into the back of the throat, (g) first edge means associated with a posteriorly beveled edge of the larynx when the guide element is inserted into the back of the throat, and (h) second edge means associated with the body portion for fitting around and against the posteriorly beveled edge of the larynx when the guide element is inserted into the back of the throat.

27. The medical device of claim 26, the cooperating means including a plurality of items (a)-(h).

28. The medical device of claim 26 further comprising inserting means coupled to the guide element for manipulating from outside the mouth the guide element in the mouth and throat.

29. The medical device of claim 28 further comprising means for releasably coupling the inserting means to the guide element.

30. The medical device of claim 28, the inserting means including a blade member curved to conform generally to the curvature between the mouth and the larynx and couplable at a distal end to the guide element.

31. The medical device of claim 28 further comprising tube clip means for releasably holding an orotracheal tube or the like to the inserting means.

32. The medical device of claim 31, the tube clip means including means for releasably holding the tube clip means to the inserting means.

33. The medical device of claim 26, the guide element being semi-flexible.

34. The medical device of claim 26, the guide element further having occluding means posteriorly of the channel for overlying and substantially occluding the esophageal opening.

35. The medical device of claim 26, the guide element further having esophageal tunnel means through the body portion for defining a tubular path aimed at the esophageal opening.

36. The medical device of claim 26, the guide element further having slant tunnel means through the guide element and terminating in the airway path extension for defining a tubular path pointing into the larynx.

37. A medical device for blind aiming of a flexible fiberoptic laryngoscope into the larynx comprising a guide element receivable through the mouth and into the back of the throat, the guide element having an annulus portion with a channel defined by a channel wall extending through the annulus portion, contour means cooperating with anatomical features of and adjacent the larynx for positioning the guide element about the larynx such that the channel wall and the tubular wall of the laryngeal opening meet at a substantially gap-free junction therebetween and such that the channel defines a substantially exclusive airway path extension atop and coaxial the larynx, and slant tunnel means extending exterior of the channel through the guide element and terminating in the channel for defining a tubular path pointing obliquely into the laryngeal opening from its posterior aspect.

38. The medical device of claim 37, the slant tunnel means being dimensioned to hold a distal end of a fiberbundle of a fiberoptic laryngoscope whereby to aim the fiberdundle into the larynx.

39. The medical device of claim 38 further comprising an elongated support member having a distal end coupled to the guide element.

40. The medical device of claim 39 further comprising support means associated with a proximal end of the elongate support member for supporting the laryngoscope.

41. The medical device of claim 39 further including means for protecting the laryngoscope fiberbundle passing between the teeth of the patent.

42. The medical device of claim 37, the guide element further having a body portion coupled to the annulus portion posteriorly of the channel, the contour means including at least one of (a) an anterior portion of the channel wall shaped to receive thereagainst the epiglottis as the guide element is inserted into the back of the throat, (b) valleculae mating means anteriorly of the channel for mating with at least one vallecula as the guide element is inserted into the back of the throat, and (c) tip means at a terminal end of the body portion for stopping advancement of the guide element at the correct depth as the guide element is being inserted into the throat.

43. The medical device of claim 37, the guide element further having a body portion coupled to the annulus portion posteriorly of the channel, the body portion including occluding means for overlying and substantially occluding the esophageal opening.

44. The medical device of claim 43, the guide element further including esophageal tunnel means through the body portion and the occluding means for defining a tubular path aimed at the esophageal opening.

45. The medical device of claim 43, the body portion further including a surface defining an extension of a posterior portion of the channel wall.

46. A medical device for blind intubation comprising a guide element receivable through the mouth and into the back of the throat, the guide element having:

(1) an annulus portion and a body portion depending from the annulus portion, a channel having a posterior wall extending through the annulus portion and along a surface of the body portion and terminating in a projecting cusp;

(2) contour means defining on the annulus and body portions cooperating with anatomical features at the back of the throat for stabilizing the guide element against the larynx such that the channel is contiguous with at least the posterior edge of the laryngeal lumen and surrounds the posterior and lateral aspects of the laryngeal lumen with the cusp projecting through the interarytenoid incisure, the contour means including (a) an interior wall in the channel shaped to receive thereagainst the epiglottis as the guide element is inserted into the back of the throat, (b) valleculae mating means anteriorly of the channel for mating with at least one vallecula as the guide element is inserted into the back of the throat, and (c) tip means at a terminal end of the body portion for stopping advancement of the guide element at the correct depth as the guide element is being inserted into the throat; and

(3) surrounding means including the channel walls, the surface of the body portion and the cusp for substantially surrounding the laryngeal opening and embracing the larynx when the channel is aligned with the laryngeal lumen.

47. The medical device of claim 46 further comprising a blade member coupled at a distal end to the guide element.

48. The medical device of claim 47 further comprising means for releasably holding a distal end of an orotracheal tube in the channel.

49. The medical device of claim 48, the body portion being positioned relative to the channel to define a barrier which prevents orally introduced tubular members passing downward through the channel from entering the esophageal opening.

50. The medical device of claim 49, the body portion further being positioned relative the channel such that the tip means substantially occludes the esophageal opening.

51. The medical device of claim 49, the guide element further including tunnel means through the body portion and exiting at the tip means for defining a tubular path aimed at the esophageal opening when the channel is aligned with the laryngeal lumen.

52. The medical device of claim 49, the guide element further having slant tunnel means through the guide element and terminating in the posterior wall of the channel for defining a tubular path pointing into the larynx when the channel is aligned with the laryngeal lumen.

53. The medical device of claim 46, the guide element being semi-flexible.

54. A medical device comprising a guide element sized and shaped to be received through the mouth and into the throat, the guide element having an annulus portion having anterior arc means for engaging the epiglottis and posterior arc means for substantially surrounding the upper axial portion of the laryngeal opening, body portion means adjacent said posterior arc means for substantially enclosing and isolating from surrounding anatomical spaces the lower axial portion of the laryngeal opening, and channel means extending through the annulus portion and along the body portion for guiding an orotracheal tube substantially exclusively into the laryngeal opening.

55. The medical device of claim 54, the guide element further having slant tunnel means therein for stabilizing and aiming the fiberbundle of a fiberoptic laryngoscope.

56. The medical device of claim 54, the guide element further having esophageal tunnel means through the body portion for aiming a tubular-type member substantially exclusively into the esophagus.

57. The medical device of claim 54 further comprising means coupled to the guide element for inserting the guide element into the throat.

58. The medical device of claim 57, the inserting means including a blade member with blade prongs at one end thereof for releasably engaging sockets in the guide element, and handle means at the opposite end of the blade member for manipulating the guide element.

59. A method for blindly and rapidly introducing an orotracheal tube into a patient'"'"'s trachea comprising:

providing an airway path extension anatomically contoured to fit about and atop the laryngeal opening;

inserting the airway path extension through the mouth and into the throat;

naturally positioning the airway path extension about and atop the laryngeal opening in substantially gap-free contact with the edge of the laryngeal opening whereby to receive an orotracheal tube therethrough and substantially exclusively into the larynx; and

advancing an orotracheal tube through the airway path extension whereby the tube advances into the larynx and trachea.

60. The method of claim 59 further comprising removing the airway path extension without removing the orotracheal tube from the larynx.

65. The method of claim 59, further comprising:

providing a tunnel into the airway path pointing at the vocal cords.

69. The method of claim 59, providing an esophageal tunnel aimed at the esophageal opening whereby to permit rapid, blind, esophageal access.

61. A method for blindly and rapidly introducing an orotracheal tube into a patient'"'"'s trachea wherein a one-piece guide element having a channel with an upper and a lower end is anatomically contoured to mate substantially gap-free with the edge of the laryngeal opening, the guide element having a tip end posterior to the lower end of the channel and mammillate nodules anterior to the upper end of the channel, the method comprising:

attaching to the guide element a curved blade, the blade having handle means for manipulating the guide element attached to the blade;

placing the distal tip of an orotracheal tube partially within the channel;

inserting the tube-containing guide element into through the patient'"'"'s mouth and into a position about and atop the laryngeal opening to define a substantially exclusive airway path extension in substantially gap-free contact with the edge of the laryngeal opening by manipulating the blade with the handle means, and advancing the guide element thereby along the upper surface of the tongue with the channel inclined forward approximately 45°

from the vertical axis of the trachea until at least one of (i) the channel hooks around the epiglottis, (ii) the tip end impinges against the posterior pharyngeal wall, and (iii) the mammillate nodules slide into corresponding vallecular depressions at the base of the tongue, thereby stopping advancement of the guide element into the throat, and exerting gentle downward pressure on the guide element with the blade while rotating the tip end and channel of the guide element by manipulating the blade so as to bring the channel into alignment with the laryngeal opening whereby to receive an orotracheal tube through the channel and substantially exclusively into the larynx; and

advancing an orotracheal tube through the airway path extension whereby the tube advances into the larynx and trachea.

62. The method of claim 61 the guide element further having a surface between the tip end and the lower end of the channel and a cusp projecting from the lower end of the channel, the method further comprising continuing to exert gentle downward pressure on the guide element until the channel substantially surround the epiglottis and laryngeal opening, and so that the surface of the guide element is brought firmly against the posterior edge of the laryngeal opening and the cusp is brought into the interarytenoid incisure, such positioning of the guide element around, against, and atop the edge of the laryngeal opening thereby causing the channel to axially enclose the exposed portion of the laryngeal lumen and to form a substantially continuous, tubular, upward extension of the laryngeal opening into the mouth.

63. The method of claim 61, further comprising releasably securing the tube to the blade before inserting the guide element.

64. The method of claim 63 further comprising releasing the tube from the blade after inserting the guide element.

66. A method for blindly and rapidly gaining visual access to a patient'"'"'s larynx through the patient'"'"'s mouth in preparation for visual observation of orotracheal intubation wherein a one-piece guide element carrying a tunnel and having a channel is anatomically contoured to mate substantially gap-free with the edge of the laryngeal opening, the tunnel being angled relative the channel to point obliquely into the laryngeal opening from its posterior aspect, the guide element having a tip end spaced posteriorly the channel and mammillate nodules space anteriorly the channel, the method comprising:

attaching to the guide element a curved blade, the blade having securing means for securing a fiberoptic laryngoscope to the blade;

securing a fiberoptic laryngoscope having an image guide to the blade;

passing the image guide of the laryngoscope through a bite protector housing mounted on said blade where it passes between the patient'"'"'s teeth;

inserting a distal tip of the image guide into the tunnel;

placing the distal tip of an orotracheal tube partially within the channel;

inserting the tube-containing guide element through the patient'"'"'s mouth and into a position about and atop the laryngeal opening to define a substantially exclusive airway path extension in substantially gap-free contact with the edge of the laryngeal opening by manipulating the blade, and advancing the guide element thereby along the upper surface of the tongue with the channel inclined forward approximately 45°

from the vertical axis of the trachea until at least one of (i) the channel hooks around the epiglottis, (ii) the tip end impinges against the posterior pharyngeal wall, and (iii) the mammillate nodules slide into corresponding vallecular depressions at the base of the tongue, thereby stopping advancement of the guide element into the throat and exerting gentle downward pressure on the guide element with the blade while rotating the tip end and channel of the guide element by manipulating the blade so as to bring the channel and tunnel into alignment with the laryngeal opening whereby visual access to the larynx is provided by the image guide in the tunnel.

67. The method of claim 66 wherein the larynogoscope includes an eyepiece, the method further comprising:

viewing the vocal cords through the eyepiece;

releasing and advancing the orotracheal tube into the larynx and between the vocal cords and into the trachea while watching these events through the laryngoscope eyepiece.

68. The method of claim 67 further comprising:

removing the guide element without removing the tube; and

removing the fiberoptic image guide from the tunnel by gentle traction.

70. A guide element to assist in intubating an animal'"'"'s trachea through the animal'"'"'s larynx, the guide element having an airway path therethrough, contour means directly cooperating with anatomical contours of and adjacent the larynx upon insertion of the guide element into the throat for blindly positioning the guide element with the airway path coaxial the laryngeal lumen, and means for effectively extending the laryngeal opening exclusively into the airway path when the guide element is so positioned.

71. The guide element of claim 70, wherein said contour means further includes means for positioning the guide element against the larynx such that the airway path and laryngeal opening meet at a substantially gap-free junction.

75. A method for blindly and rapidly introducing an orotracheal tube from outside the mouth into a patient'"'"'s trachea comprising:

inserting a curved channel having a concave bearing surface through the mouth and into the throat;

while keeping the concave bearing surface oriented toward the oral opening, aligning the channel to extend upwardly from, and with an edge thereof contiguous with, at least the posterior edge of the tubular wall of the laryngeal opening so as to provide an artificial upward extension of the posterior laryngeal wall; and

advancing an orotracheal tube along the concave bearing surface whereby the tube advances into the larynx and trachea.

76. The method of claim 75 further comprising removing the channel from the throat without removing the orotracheal tube from the larynx.

77. The method of claim 75 further comprising providing a tunnel through the concave bearing surface such that the tunnel points into the larynx when the channel is aligned whereby to permit rapid, blind, stable access of tubular instruments into the larynx.

78. The method of claim 75 further comprising providing an esophageal tunnel carried posteriorly of the channel such that the esophageal tunnel is aimed at the esophageal opening when the channel is aligned whereby to permit rapid, blind oroesophageal access.