Method and system for endotracheal/esophageal stimulation prior to and during a medical procedure

• US 6,735,471 B2
• Filed: 09/26/2001
• Issued: 05/11/2004
• Est. Priority Date: 04/30/1996
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Euler, David E., Colson, Michael A., Rakow, Nancy J., Ujhelyi, Michael R., Keogh, James R., Jahns, Scott E., Hill, Michael R. S.
• Primary Examiner(s): Layno, Carl
• Application Number:
  US09/964,308
• Publication Number:
  US 20020032468A1
• Time in Patent Office: 958 Days
• Field of Search: 607/2, 607/3
• US Class Current: 607/2
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61N 1/0517 Esophageal electrodes
• CPC Class Codes: A61N 1/0519 Endotracheal electrodes
• CPC Class Codes: A61N 1/0556 Cuff electrodes
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/3629 in combination with non-electric therapy
• CPC Class Codes: A61N 1/385 Devices for inducing an abnormal cardiac function, e.g. fibrillation

Abstract

A method of performing a medical procedure, such as surgery, is provided. A nerve is stimulated in order to adjust the beating of the heart to a first condition, such as a stopped or slowed condition. The medical procedure is performed on the heart or another organ. The stimulation of the nerve is stopped in order to adjust the beating of the heart to a second condition, such as a beating condition. The heart itself may also be stimulated to a beating condition, such as by pacing. The stimulation of the nerve may be continued in order to allow the medical procedure to be continued. Systems and devices for performing the medical procedure are also provided.

Claims

1. A method of performing a medical procedure, comprising:

endotracheal stimulation of a vagal nerve to adjust the beating of a heart to a first condition;

performing the medical procedure on an organ;

reducing endotracheal stimulation of the vagal nerve;

epicardial stimulation of the heart to adjust the beating of a heart to a second condition;

reducing epicardial stimulation of the heart;

endotracheal stimulation of the nerve a subsequent time in order to re-adjust the beating of the heart to the first condition; and

continuing the medical procedure.

2. The method of claim 1 wherein the endotracheal stimulation is stopped to achieve the second condition.

3. The method of claim 1 wherein the epicardial stimulation is stopped to re-adjust the beating of the heart to the first condition.

4. The method of claim 1 wherein the first condition is a stopped condition.

5. The method of claim 1 wherein the first condition is a slowed condition.

6. The method of claim 1 wherein the second condition is a beating condition.

7. The method of claim 1 further comprising:

delivering at least one drug during the medical procedure.

8. The method of claim 7 wherein the drug is selected from the group consisting of:

a beta-blocker, a cholinergic agent, a cholinesterase inhibitor, a calcium channel blocker, a sodium channel blocker, a potassium channel agent, adenosine, an adenosine receptor agonist, an adenosine deaminase inhibitor, dipyridamole, a monoamine oxidase inhibitor, digoxin, digitalis, lignocaine, a bradykinin agent, a serotoninergic agonist, an antiarrythmic agent, a cardiac glycoside, a local anesthetic, atropine, a calcium solution, an agent that promotes heart rate, an agent that promotes heart contractions, dopamine, a catecholamine, an inotrope glucagon, a hormone, forskolin, epinephrine, norepinephrine, thyroid hormone, a phosphodiesterase inhibitor, prostacyclin, prostaglandin, methylxanthine, a P₂-purinoceptor agent, an ischemia agent, and a delta opioid agonist.

9. The method of claim 8 wherein the drug is naturally occurring.

10. The method of claim 8 wherein the drug is chemically synthesized.

11. The method of claim 1 wherein the medical procedure is selected from the group consisting of:

surgical procedures, non-surgical procedures, endoscopic procedures, fluoroscopic procedures, stent delivery procedures, aortic aneurysm repairs, cranial aneurysm repairs, delivery of drugs, delivery of biological agents, cardiac surgery with cardiopulmonary bypass circuits, cardiac surgery without cardiopulmonary bypass circuits, brain surgery, cardiograms, heart valve repair, heart valve replacement, MAZE procedures, transmyocardial revascularization, CABG procedures, beating heart surgery, vascular surgery, neurosurgery, electrophysiology procedures, diagnostic ablation of arrhythmias, therapeutic ablation of arrhythmias, endovascular procedures, treatment of injuries to the liver, treatment of the spleen, treatment of the heart, treatment of the lungs, treatment of major blood vessels, non-invasive procedures, invasive procedures, and port-access procedures.

12. A system for performing a medical procedure, comprising:

an endotracheal nerve stimulator to inhibit beating of the heart;

a cardiac stimulator in communication with the endotracheal nerve stimulator to stimulate beating of the heart; and

a respiratory controller for controlling respiration.

13. The system of claim 12 further comprising:

drug delivery means for delivering at least one drug during the medical procedure.

14. The system of claim 13 wherein the drug delivery means is selected from the group consisting of:

a spray, a cream, an ointment, a medicament, a pill, a patch, a catheter, a cannula, a needle and syringe, a pump, and an iontophoretic drug delivery device.

15. The system of claim 14 wherein the endotracheal nerve stimulator stimulates a parasympathetic nerve fiber.

16. The system of claim 15 wherein the endotracheal nerve stimulator stimulates a vagus nerve fiber.

17. The system of claim 12 wherein the endotracheal nerve stimulator comprises at least one electrode.

18. The system of claim 17 wherein the electrode is selected from the group consisting of:

nerve stimulation electrodes, endotracheal electrodes, transcutaneous electrodes, intracutaneous electrodes, balloon-type electrodes, basket-type electrodes, umbrella-type electrodes, tape-type electrodes, suction-type electrodes, screw-type electrodes, barb-type electrodes, bipolar electrodes, monopolar electrodes, metal electrodes, wire electrodes, patch electrodes, cuff electrodes, clip electrodes, needle electrodes and probe electrodes.

19. The system of claim 12 wherein the cardiac stimulator comprises at least one electrode.

20. The system of claim 19 wherein the electrode is selected from the group consisting of:

cardiac stimulation electrodes, clip electrodes, needle electrodes, probe electrodes, pacing electrodes, epicardial electrodes, endocardial electrodes, patch electrodes, intravascular electrodes, balloon-type electrodes, basket-type electrodes, tape-type electrodes, umbrella-type electrodes, suction-type electrodes, endoesophageal electrodes, transcutaneous electrodes, intracutaneous electrodes, screw-type electrodes, barb-type electrodes, bipolar electrodes, monopolar electrodes, metal electrodes, wire electrodes and cuff electrodes.

21. A device for performing a medical procedure comprising:

a processor;

an endotracheal nerve stimulation electrode operatively connected to the processor;

a cardiac stimulation electrode operatively connected to the processor, wherein the processor processes output from the nerve stimulation electrode and adjusts output from the cardiac stimulation electrode based on output from the nerve stimulation electrode; and

a drug pump for delivering at least one drug, the drug pump operatively connected to the processor wherein the processor adjusts the output of the drug.

22. A device for performing a medical procedure comprising:

a processor;

an endotracheal nerve stimulation electrode operatively connected to the processor;

a cardiac stimulation electrode operatively connected to the processor, wherein the processor processes output from the nerve stimulation electrode and adjusts output from the cardiac stimulation electrode based on output from the nerve stimulation electrode; and

a respiratory controller for controlling respiration, the respiratory controller operatively connected to the processor wherein the processor adjusts the output of the respiratory controller.

23. A device for performing a medical procedure comprising:

a processor;

an endotracheal nerve stimulation electrode operatively connected to the processor and arranged on an endotracheal tube;

a cardiac stimulation electrode operatively connected to the processor, wherein the processor processes output from the nerve stimulation electrode and adjusts output from the cardiac stimulation electrode based on output from the nerve stimulation electrode.