US 3173418 A
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March 16, 1965 o. E. BARAN 3,173,418
DOUBLE-WALL ENDOTRACHEAL CUFF Filed Jan. 10, 1961 2 Sheets-Sheet l INVENTOR. 0 sin pE,B 0 r0 n BY j a.
March 16, 1965 o. E. BARAN 3,173,418
DOUBLE-WALL ENDOTRACHEAL CUFF Filed Jan. 10, 1961 2 Sheets-Sheet 2 FIG.7
OsfopEBc ran ATTORNEY.
United States Patent Ofiiice 3,173,418 DOUBLE-WALL ENDOTRAQHEAL CUFF Ostap E. Barau, 219 E. 12th St, New Yrk,:N.'Y. Filed Jan. 10, 1961, Ser. No. 82,367 6 Claims. (Cl. 128-651) This invention relates to a double-Wall endotracheal end, the external Wall of which is multiperforated for the administration of continuous or intermittent local endotracheal anesthesia. The very same cuff may-be very advantageously employed for endo-esophageal, endo-stomach, endo-duodenal, or pharyngeal surface anesthesia as well as surface anesthesia in any other cavity in the body.
The problem which anesthetists and surgeons have encountered in the use ofo'f endotracheal anesthesiais that shortly (about three quarters of an hour or sooner) after injection of anesthetic into the'trachea and placing of the endotracheal tube, the anesthetic wears off or is destroyed and the patient is thereafter unable to endure the pres ence of said instrument in the trachea. The patient starts to cough and vomit, making it difficult for the surgeon to perform the operating procedure. Attempts have been made to solve this problem by use of deep anesthesia administered to such level that the patient loses all endotracheal feeling and reflexes. Frequently this unnecessarily intoxicates the whole body system and often endangers the life of the patient, especially in the presence of damage to the cardio-vascular system, liver, kidney, lungs or brain centers.
An object of this invention is to provide an'improved endotracheal cuff providing for continuous or intermittent local endotracheal anesthesia around the endotracheal tube which enables the patient to tolerate the endotracheal tube not only during the light-superficial stage of general anesthesia, but also'in the absence of general anesthesia when the patient is awake. Such device may be life saving in conditions such as tetanus or bilateral pneumonia when a continuous free passage of oxygen to the lungs and suction of exudate from the lungs represents most important factors for a successful recovery.
A preferred form of this invention is shown by Way of illustration in the accompanying drawingsin which:
FIGURE 1 is a side View, partly broken away and in section, of a deflated endotracheal double cuff made in accordance with this invention and shown mounted on an endotracheal tube.
FIGURE 2 is a similar view, the endotracheal tube and cuff being rotated 90 degrees from their FIGURE l position, showing the inner cuff in inflated condition.
FIGURE 3 is a view similar to that of FIGURE 2 but showing the outer cuff only inflated and spraying local anesthetic.
FIGURE 4 is still another similar view showing both cuffs inflated and spraying anesthetic proximally'only.
FIGURE 5 is a view similar to that of FIGURE 4 but showing only partial inflation of the inner-cuff and full inflation of the outer cuff and spraying anesthetic around the entire surface of the outer cuff.
FIGURE 6 shows a modification as an'enlarged sec tional view showing the double endotracheal cuff mounted permanently on the endotracheal therewith.
tube as an integral unit FIGURE 6A is a section on the line 6-6 of FIG- URE 6.
FIGURE 7 is a longitudinal section through an endotracheal tube showing its stepped configuration for receiving the double-wall cuff herein claimed.
3,173,418 Patented Mar. 16., 1965 cuffs, namely, the internal cuff E (FIGURE 1 to FIG- URE 6 and FIGURE '8) is conventional, with the difference that after inflation it is tightly adherentto the external multiperforated cuff D except for one small part of theexternal cuff surface extending a distance L about 1 cm. proximally from the internal cuff (see FIGURES 1, 2, 3, 4, 5, 6 and 8). In both cuffs openings 0 and P are formed as extensions of two separate canals S and T (FIGURES 1, 2, 3, 4, 5, 6 and 8). Opening 0 is for in jection of anesthetic drugs H into the external cuff as in FIGURES 3, 4, 5 and 6 (into the space betweenthe internal and external cuff) and opening P is for injection of air into the internal cuff E. When the internal cuff E is inflated it contacts and extends the external cuff D mainly in the middle and lower portions and indirectly presses on the wall of trachea G (FIGURES 2 and 4), thereby tightly closing the tracheo-bronchial air passage below the double cuff. That situation makes itvpossible for the anesthetist to produce positive pressure in the lungs or perform artificial breathing forthe patient'by pressing and reducing the pressure on the rebreathing bag.
The external cuff D extends proximally as at L 1 cm. beyond the internal cuff (FIGURES 1, 2, 3, 4, 5, 6 and 8). Both cuffs are fixed to the basal rubber cylinder F (FIGURES 1, 2, 3, 4 and 5). What is most important, the external cuff D is multiperforated as at M. After injection of the anesthetic fluid H into the space between the internal and external cuffs, that fluid (through the multi-perforated external cuff holes MFIGURES 1, 2, 3, 4, 5, 6 and 8) is sprayed uniformly around the tube K and external cuff D, anesthetizing the internal wall G .of the trachea and'by gravity flowing into the bronchial tree or upper respiratory airway depending on the position of the patient.
If the anesthetist has some reason to limit the aney thesia to the proximal part of the trachea, the larynx and the pharynx, then after inflation of the internal cuff E by air through its separate opening B, canal T, and intracuff opening P (FIGURES 2 and 4), the injected anesthetic-fluid H enters the externalcuff through its separate opening A, canal S, and intra-cuff opening 0, and is accumulated proximally (FIGURE 4). Since the external cuff extends a distance L of about 1 cm. farther proximally beyond the internal cuff (FIGURE 4), local anesthetic is sprayed around the proximal airway only, and by lowering of the upper part of the body only (Trendelenburg position), the anesthetic fluid flows into the larynx and pharynx, anesthetizing that area.
Another advantageous feature ofthe above presented double walled cuff is that, after injection of anesthetic fluid into the space between two surfaces of the cuffs, some amount of anesthetic remains in the capillary space between two cuffs and'continuously supplies some of the local anesthetic by leaking'through the small holes 'M of the external cuff D (FIGURES 3, 4, 5 and 6).
The modus operandi relating to the double walled endotracheal cuff here described and claimed is as follows:
After local spraying of the anesthetic into the pharynx and general induction'of anesthesia, together with injection of relaxant drugs, asisthe common practice today,
and properly oxygenating the patient, the endotracheal tube K with its double walled cuff is inserted into the trachea; Immediately 2 or 3 cc. of Cyclaine or other local mesthetizing agent are injected intoithe space between the internal and external cuffs through the above mentioned separate opening A. Under the fiuid'pr'essure the external cuff is stretched, the small multiple holes M (FIGURE 3) are opened and the anesthetic is sprayed through them around the tube-and on the endotracheal mucous membrane, flowing down into the tracheobronchial tree or into the pharynx according to the position of the patient. If, in some situation, it is important to anesthetize the upper airway only, above the cuff and proximally, then after inflation of the internal cuff E (FIGURE 4) through separate opening B (FIGURE 1) and clamping the canal T (FIGURE 2) by forceps, a tightly separated space is formed in the tracheo-bronchial tree below the double walled cuff. Because the external cuff is extended about 1 cm. (FIGURES 1, 2, 3, 4, 5, 6 and 8) proximally beyond the internal cuff, the anesthetic fluid is sprayed proximally only (FIGURE 4) and flows into the upper airway during and because of the Trendelenburg position of the patient. Usually in about 45 minutes to one hour the anesthetic fluid is absorbed or destroyed and the patient may react to the presence of the tube K in the trachea. To prevent that reflex, another quantity of the anesthetic fluid is injected during deflation of the internal cuff, and the local endotracheal anesthesia is thereby prolonged.
After spraying of anesthetic fluid H and clamping by forceps of external cuff opening A, the internal cuff E may be inflated again if necessary.
Instead of intermittent injection of anesthetic fluid I-I it is possible to maintain a continuous local endo-tracheal anesthesia by continuously dropping local anesthetic into the external cuffs canal S, as it is done in intravenous medication.
In this manner there is the possibility not only of continuously maintaining the local anesthesia, but by continuous absorption of the local anesthetic it may be possible through the blood circulation to support general anesthesia by a local anesthetic, and thereby avoiding the cardio-vascular reflexes, This may be done, for example, by the use of Procaine or Pronestyl during some cardio-vascular operations.
A further advantage of this kind of anesthesia is that local anesthesia of the larynx reduces the danger of laryngo-spasms.
The above mentioned double-Wall endotracheal cuff may be advantageously used with any type of the endotracheal tube by adjusting or confirming the size of the double-Wall cuff to the size of the endotracheal tube (FIGURE 8). These cuffs may be mounted over the tubes, as two separate units (FIGURE 8), or they may be permanently secured to the endotracheal tube K as one unit (see FIGURES 6, 6A and 7).
' Cuff members E, D may be mounted on endotracheal tube K which should have an annular recess R (FIGURE 7) formed around the wall to accommodate the thickness of the cuff walls, thereby presenting a uniform thickness of the tube with the Cuff, which facilitates insertion of the endotracheal tube into the trachea (FIGURES 6, 6A and 7).
Furthermore, it is advisable that all canals of the double-wall cuffs be formed within the wall of the endotracheal tube K (FIGURES 6 and 6A), with an excava tion N between two canals to provide a greater lumen through the endotracheal tube K at that section, then extending separately outside the wall approximately 2-3 cm. This is helpful to the surgeon (while operating in the oral cavity), since all tubes are confined to one place (FIGURE 6).
The separate cuff canals S, T should be long enough to permit each canal to be separately clamped by forceps.
It is to be understood that the above described and illustrated instrument is but a preferred form of the invention and that it may be modified in many ways within the scope and spirit of the invention, as it is defined in the claims of this application.
The invention claimed is:
1. An endotracheal cuff for introduction into the trachea comprising a tubular base member, an imperforate inflatable tubular inner cuff member and a distensible tubular outer cuff member, said cuff members having substantially coextensive end portions at one end thereof secured to said base member, said outer cuff member and inner cuff member having the other ends thereof respectively secured to said base member at longitudinally displaced points, whereby the outer cuff member has a greater longitudinal wall extent between the secured ends thereof than that of said inner cuff member, the wall of said outer cuff member being multiperforated at spaced points, passage means communicating with the space between said cuff members for introducing anesthetic into said space and transmission thereof outwardly through the perforations in the wall of said outer cuff member, and passage means communicating with the space between said inner cuff member and said base member for inflating said inner cuff member to displace wall portions thereof toward the wall of said outer cuff member whereby to vary the spacing between the opposed walls of said inner and outer cuff members and to displace the wall of the outer cuff member selectively to positions in spaced or sealing relation to the trachea.
2.An endotracheal cuff as in claim 1 wherein said base member is an endotracheal tube, the wall of said tube being formed with a pair of passages respectively communicating with the space between said tube and said inner cuff member and the space between said cuff members.
3. An endotracheal cuff as in claim 2 wherein said tube is formed with an annular recess on its outer surface to provide longitudinally spaced annular shoulder portions, the opposite ends of said cuff members abutting the respective shoulder portions of said recess.
4. An endotracheal cuff for introduction into the trachea comprising a tubular base member, a tubular outer cuff member of distensible material secured at its opposite ends to said base member, an imperforate inner tubular cuff member of distensible material between said outer cuff member and said base member and secured at its opposite ends to said base member, the wall of said outer cuff member being formed with spaced perforations, passage means communicating with the space between said inner cuff member and said base member for inflating said inner cuff member to bring wall portions thereof into a regulated extent of contact with opposed wall portions of said outer cuff member whereby the wall of said outer cuff member is brought selectively into positions in spaced or sealing relation to opposed portions of the trachea, and passage means communicating with the space between said cuff members for introducing anesthetic fluid therein for regulated transmission outwardly through the perforations in said outer cuff member into contact with selected portions of the trachea,
5. An endotracheal cuff for introduction into the trachea comprising an endotracheal tube, an inner cuff member having a cylindrical imperforate inflatable wall mounted on said tube with the opposite ends of said inner cuff member secured to spaced portions of said tube, an outer cuff member having a cylindrical multiperforated inflatable wall mounted over the inner cuff member with the opposite ends of said outer cuff member secured to spaced portions of said tube, air conduit means communicating with the space between opposed wall portions of said tube and the inner cuff member, for inflating said inner cuff member to bring the wall thereof toward the opposed wall portions of the outer cuff member whereby the wall portions of the outer cuff member are moved toward sealing relation with the trachea, said wall portions of the inner and outer cuff members providing a space therebetween of an extent regulated by the degree of inflation of the inner cuff member, and anesthetic conduit means communicating with the space between said inner and outer cuff members for introducing anesthetic into said space for regulated transmission through the perforations in the wall of said outer cuff member for contact with selected portions of the trachea.
6. An endotracheal cuff as in claim 5 wherein the walls of said inner and outer cuff members have their secured ends at one end thereof in coextensive relation and the secured end of the wall of the outer cult member at the other end thereof being longitudinally displaced beyond the secured end of the wall of the inner cuff member at the other end thereof whereby in the fully inflated condition of the inner cuff member to bring the outer cuff member in sealing relation with the trachea, opposed Wall portions of said cuff members distally related to the point of entry of said anesthetic conduit means are in contact with each other While opposed Wall portions of 1 said cuff members proximally related to the point of entry of said anesthetic conduit means are in spaced relation to each other to provide a space for receiving anesthetic from said anesthetic conduit means for application to portions of the trachea proximally related to the point of 1 sealing of the outer cult member relative to the trachea.
References Cited in the file of this patent UNITED STATES PATENTS FOREIGN PATENTS Great Britain July 1,
OTHER REFERENCES Anesthesiology, vol. 21, No. 6, November-December 1960, page 775 required.
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