Patent Publication Number: US-6668821-B2

Title: Laryngeal mask airway

Description:
RELATED APPLICATIONS 
     The present application is a continuation-in-part of the Application&#39;s co-pending U.S. patent application Ser. No. 09/840,194, entitled “Laryngeal Mask Airway,” filed on Apr. 23, 2001, which claims priority to U.S. Provisional Patent Application Ser. No. 60/252,347, filed on Nov. 20, 2000. The present application is also a continuation-in-part of the Applicant&#39;s co-pending U.S. patent application Ser. No. 09/767,272, entitled “Method and Apparatus for Ventilation/Oxygenation During Guided Insertion of an Endotracheal Tube,” filed on Jan. 22, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/707,350, filed on Nov. 6, 2000, which is a continuation-in-part of U.S. patent application Ser. No. 09/411,610, filed on Oct. 1, 1999, which is a continuation-in-part of U.S. patent application Ser. No. 08/974,864, filed on Nov. 20, 1997, now U.S. Pat. No. 5,964,217, issued on Oct. 12, 1999, which is a continuation of U.S. patent application Ser. No. 08/607,332, filed on Feb. 26, 1996, now U.S. Pat. No. 5,694,929, issued on Dec. 9, 1997. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates generally to the field of laryngeal mask airways. More specifically, the present invention discloses an intubation guide and laryngeal mask that can be used to simultaneously intubate and ventilate a patient. 
     2. Background of the Invention 
     Endotracheal tubes are often used in semi-emergency situations to ventilate patients with respiratory failure who may be conscious or semi-conscious. The conventional approach requires the patient to lie still while the physician inserts a rigid laryngoscope blade into the patient&#39;s mouth and trachea. Delivery of ventilation and/or oxygen is also interrupted during this period. The endotracheal tube is then inserted into place while the laryngoscope blade keeps the patient&#39;s airway open. Successful intubation depends on the patient being cooperative and completely relaxed, which unfortunately is often not the case. Even with a cooperative patient, intubation is very uncomfortable and can cause the patient to panic due to the difficulty in breathing during the procedure. This procedure can also result in a choking or gagging response that can cause the patient to regurgitate and aspirate contents from the stomach. One conventional response to these shortcomings has been to sedate the patient during intubation. Tranquilizers make the patient more cooperative and less likely to choke during intubation, but also tend to suppress the patient&#39;s breathing and blood pressure. These side effects may be unacceptable when dealing with a patient who already suffers from shallow or irregular breathing or depressed blood pressure. Therefore, a need exists for an improved device to guide insertion of an endotracheal tube and ensure that the patient&#39;s airway is open, and that also allows the patient to continue to receive air/oxygen during the insertion process. 
     Laryngeal masks have also been used for many years for several purposes. For example, laryngeal mask airways have been used to ventilate patients while preventing aspiration of secretions or stomach contents into the lungs. Some types of intubation guides include a laryngeal mask to seal the laryngeal inlet while directing the endotracheal tube into position through the larynx. 
     Prior Art. The prior art in the field includes the following: 
     
       
         
           
               
               
               
             
               
                   
                   
               
               
                   
                 U.S. Pat. No. 
                 Inventor 
               
               
                   
                   
               
             
            
               
                   
                 4,240,417 
                 Holever 
               
               
                   
                 4,351,328 
                 Bodai 
               
               
                   
                 4,416,273 
                 Grimes 
               
               
                   
                 4,509,514 
                 Brain 
               
               
                   
                 4,848,331 
                 Northway-Meyer 
               
               
                   
                 4,995,388 
                 Brain 
               
               
                   
                 5,197,463 
                 Jeshuran 
               
               
                   
                 5,241,956 
                 Brain 
               
               
                   
                 5,249,571 
                 Brain 
               
               
                   
                 5,282,464 
                 Brain 
               
               
                   
                 5,297,547 
                 Brain 
               
               
                   
                 5,303,697 
                 Brain 
               
               
                   
                 5,305,743 
                 Brain 
               
               
                   
                 5,391,248 
                 Brain 
               
               
                   
                 5,355,879 
                 Brain 
               
               
                   
                 5,584,290 
                 Brain 
               
               
                   
                 5,632,271 
                 Brain 
               
               
                   
                 5,642,726 
                 Owens et al. 
               
               
                   
                 5,682,880 
                 Brain 
               
               
                   
                 5,711,293 
                 Brain 
               
               
                   
                 5,771,889 
                 Pagan 
               
               
                   
                 5,871,012 
                 Neame et al. 
               
               
                   
                 5,878,745 
                 Brain 
               
               
                   
                 5,881,726 
                 Neame et al. 
               
               
                   
                 5,890,488 
                 Burden 
               
               
                   
                 5,896,858 
                 Brain 
               
               
                   
                 5,937,860 
                 Cook 
               
               
                   
                 5,979,445 
                 Neame et al. 
               
               
                   
                 5,983,897 
                 Pagan 
               
               
                   
                 6,012,452 
                 Pagan 
               
               
                   
                 6,050,264 
                 Greenfield 
               
               
                   
                 6,055,984 
                 Brain 
               
               
                   
                 6,079,409 
                 Brain 
               
               
                   
                 6,116,243 
                 Pagan 
               
               
                   
                   
               
            
           
         
       
     
     Holever discloses an adaptor to connect a ventilator to an endotracheal tube, while also permitting insertion of a suction tube. 
     Bodai discloses a system for simultaneous ventilation and endotracheal suctioning of a patient. 
     Grimes discloses a connector valve assembly for endotracheal tubes. 
     The Brain &#39;514 patent discloses a laryngeal mask with a generally elliptical shape and a guide tube. 
     Northway-Meyer discloses a face mask and intubation guide, which includes a connector for ventilation through the face mask and intubation guide. 
     Brain &#39;388 patent discloses a laryngeal mask with a soft flexible collar surrounding the lumen of the mask, and also having a drainage tube. 
     Jeshuran discloses a face mask and adaptor for endotracheal intubation. 
     The Brain &#39;956 patent discloses a laryngeal mask airway with concentric drainage for esophageal discharge. 
     The Brain &#39;571 patent discloses a laryngeal clamp airway. 
     The Brain &#39;464 patent discloses a combined laryngeal mask and reflectance oximeter. 
     The Brain &#39;547 patent discloses a laryngeal mask with an inflatable cuff and a V-shaped posterior side. 
     The Brain &#39;697 patent discloses a laryngeal mask with a rigid handle at the proximal end of the guide tube. 
     The Brain &#39;743 and &#39;248 patents disclose a molding process for producing laryngeal masks. 
     The Brain &#39;879 patent discloses a laryngeal mask with inflatable ring and inflatable back cushion. 
     The Brain &#39;290 patent discloses a laryngeal mask with electrodes. 
     The Brain &#39;271 patent discloses a laryngeal mask with a gastric drainage feature. 
     The Brain &#39;880 patent discloses a laryngeal mask with a removable stiffener that can be attached to the guide. 
     The Brain &#39;293 patent discloses a forming tool for deflating a laryngeal mask, such as that shown in the Brain &#39;547 patent, prior to insertion. 
     The Pagan &#39;889 patent discloses a mask assembly having an inflatable ring and a diaphragm attached to a backing plate. 
     The &#39;012 patent to Neame et al. discloses a laryngeal mask with an inflatable bag. 
     The Brain &#39;745 patent discloses a gastro-laryngeal mask with an inflatable cuff and a back cushion to engage the back wall of the pharynx. 
     The &#39;726 patent to Neame et al. discloses a laryngeal mask with a cuff formed by interlocking ribs. 
     Burden discloses a coupling device for placing a stethoscope and an endotracheal tube in gaseous communication. 
     The Brain &#39;858 patent discloses a laryngeal mask with a hinged bar to elevate the epiglottis. 
     Cook discloses a laryngeal mask with an inflatable toroidal peripheral portion having a recessed front notch. 
     The &#39;445 patent to Neame et al. discloses a method for manufacture of a laryngeal mask in which the edges of the cuff are heat-sealed. 
     The Pagan &#39;897 patent discloses a laryngeal mask with cuffs attached on both sides of a plate. The plate also forms a leading tip. 
     The Pagan &#39;452 patent discloses a laryngeal mask with an air line extending to a foam cuff. The cuff can be compressed for insertion by applying suction to the air line. 
     Greenfield discloses a laryngeal mask requiring an obdurator inserted into the tube. 
     The Brain &#39;984 patent discloses an endotracheal tube having tapered, closed nose with a triangular cross-section and lateral openings. 
     The Brain &#39;409 patent discloses a laryngeal mask having a specific geometry for the guide tube and mask. 
     The Pagan &#39;243 patent discloses a laryngeal mask with a plate separating two separate semi-annular cuffs bonded to opposite sides of the plate. 
     Solution to the Problem. None of the prior art references discussed above teaches or suggests a laryngeal mask airway that enables the patient to continue to be ventilated while being intubated. This system allows the endotracheal tube to be inserted and connected to a ventilator without interrupting the flow of air/oxygen to the patient&#39;s lungs. 
     SUMMARY OF THE INVENTION 
     This invention provides a laryngeal mask airway having a curved tubular guide for insertion through the patient&#39;s mouth and oropharynx. After insertion of the guide, the beveled distal opening of the guide abuts the laryngeal inlet, while the guide&#39;s proximal opening remains outside the patient&#39;s mouth. A laryngeal mask surrounds the distal opening of the guide to substantially seal the laryngeal inlet about the distal opening of the guide. A ventilation port adjacent to the proximal opening of the guide supplies a flow of air/oxygen through the guide into the patient&#39;s lungs. An endotracheal tube can then be advanced along the length of guide and through the patient&#39;s larynx without interrupting ventilation. 
     These and other advantages, features, and objects of the present invention will be more readily understood in view of the following detailed description and the drawings. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The present invention can be more readily understood in conjunction with the accompanying drawings, in which: 
     FIG. 1 is a front perspective view of a laryngeal mask airway  10  with a rotatable collar  14  for delivery of air/oxygen through the guide  12 . 
     FIG. 2 is rear perspective view of the laryngeal mask airway corresponding to FIG.  1 . 
     FIG. 3 is a cross-sectional view of the laryngeal mask airway  10  corresponding to FIG. 1 with the mask  30  inflated. 
     FIG. 4 is a detail cross-sectional view of the distal portion of the laryngeal mask airway  10 . 
     FIG. 5 is a perspective view of a resuscitation attachment  70  that can be connected to the ventilation port  16  of the laryngeal mask airway  10 . 
     FIG. 6 is a corresponding side view of the resuscitation attachment  70  with flexible tubing  80  having a mouthpiece  84  for resuscitation of the patient. 
     FIG. 7 is a detail side view of an embodiment of the resuscitation attachment  70  having an oxygen port  76 . 
     FIG. 8 is an exploded perspective view of the removable guide cap  91  that can be inserted into the proximal opening of the guide  12  of the laryngeal mask airway  10 . 
     FIG. 9 is a cross-sectional view of the removable guide cap  91  corresponding to FIG.  8 . 
     FIG. 10 is a front perspective view of another embodiment of the laryngeal mask airway  10  in which the ventilation port  16  is fixed relative to the guide  12 . 
     FIG. 11 is a rear perspective view of the laryngeal mask airway  10  corresponding to FIG.  10 . 
     FIG. 12 is a front perspective view of another embodiment of the laryngeal mask airway without a ventilation port. 
     FIG. 13 is a top perspective view of a patient&#39;s airway showing the inlet to the larynx, esophagus, and epiglottis. 
     FIG. 14 is a cross-sectional view of a patient&#39;s airway after the laryngeal mask airway  10  has been initially inserted. 
     FIG. 15 is a cross-sectional view of the laryngeal mask airway  10  and the patient&#39;s airway corresponding to FIG. 14 after the mask  30  has been inflated. 
     FIG. 16 is a cross-sectional view of the patient&#39;s airway and laryngeal mask airway  10  corresponding to FIGS. 14-15 showing a syringe  55  connected to the guide cap  91  on the laryngeal mask airway  10  to squirt anesthetic through the laryngeal mask airway  10  and into the patient&#39;s airway to lessen discomfort. 
     FIG. 17 is a cross-sectional view of the laryngeal mask airway  10  and the patient&#39;s airway corresponding to FIGS. 14-16 after an endotracheal tube  40  has been inserted through the laryngeal mask airway  10 . 
     FIG. 18 is a cross-sectional view of the laryngeal mask airway  10  and the patient&#39;s airway corresponding to FIGS. 14-17 after the endoscope probe  50  has been withdrawn from within the endotracheal tube  40 . 
     FIG. 19 is a cross-sectional view of the laryngeal mask airway  10  and the patient&#39;s airway corresponding to FIGS. 14-18 after the mask  30  has been deflated and the laryngeal mask airway  10  has been removed, leaving the endotracheal tube  40  in place in the patient&#39;s airway. 
     FIG. 20 is a cross-sectional view of the patient&#39;s airway corresponding to FIGS. 14-19 after the cuff  42  of the endotracheal tube  40  has been inflated and the patient has been connected to a ventilator  48 . 
     FIG. 21 is a cross-sectional view of the patient&#39;s airway corresponding to FIG. 14-20 in an alternative methodology in which the laryngeal mask airway  10  is withdrawn over the endoscope probe  50  while leaving the endotracheal tube  40  in place in the patient&#39;s airway. 
     FIG. 22 is a perspective view of the stabilizer  52  that can be attached to an endoscope probe  50  to advance the endotracheal tube  40  along the laryngeal mask airway  10   
     FIG. 23 is a perspective view of the endotracheal tube cap  45  that can be used in conjunction with a stabilizer  52  to advance the endotracheal tube  40 . 
     FIG. 24 is an exploded perspective view of an embodiment of the present invention in which a separate ventilation attachment  100  can either be used in combination with a guide  12  or a conventional laryngeal mask airway  102 . 
     FIG. 25 is an exploded cross-sectional view corresponding to FIG.  24 . 
     FIG. 26 is a cross-sectional view of a ventilation attachment  100  having a fixed ventilation port  16 . 
     FIG. 27 is a cross-sectional view corresponding to FIG. 26 showing insertion of an endotracheal tube  40  through the ventilation attachment  100 . 
     FIG. 28 is a cross-sectional view of a laryngeal mask airway  10  with a removable ventilator connector  110  attached to its proximal end in place of the ventilation attachment  100 . 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Structure of the Laryngeal Mask Airway. Turning to FIGS. 1 and 2, front and rear perspective views are provided of a laryngeal mask airway  10  in accordance with the present invention. This embodiment includes a tubular guide  12  with a laryngeal mask  30  surrounding its distal end. FIG. 3 is a corresponding cross-sectional view of the laryngeal mask airway  10  with the laryngeal mask  30  inflated. FIG. 4 is a detail end view of the laryngeal mask  30  and the distal portion of the guide  12 . The size and shape of the guide  12  are selected so that its distal portion can be readily inserted into the patient&#39;s mouth and upper airway with the laryngeal mask  30  substantially sealing the laryngeal inlet  27 , as shown in FIGS. 14-18. The proximal end of the guide  12  remains outside of the patient&#39;s mouth and therefore is accessible to the healthcare provider. 
     The guide  12  is generally J-shaped to follow the profile of a typical patient&#39;s airway through the mouth, over the tongue  22 , and into the laryngopharynx  21  just above the opening to the larynx  24  (see FIGS.  13  and  14 ). The guide  12  is shaped to prevent the patient&#39;s tongue  22  and collapsible pharynx from obstructing access to the trachea, while also defining a channel for later insertion of an endotracheal tube. The guide  12  is typically made of plastic with sufficient strength and rigidity to keep the patient&#39;s teeth apart and prevent the patient from biting down on the endotracheal tube. This flexibility allows the guide  12  to accommodate a wide range of patient sizes and conditions. The inside diameter of the guide  12  should be sufficiently large to allow an endotracheal tube  40  to freely pass through the guide  12 , as shown for example in FIG. 17, with extra room to allow air/oxygen to flow through the guide  12  around the endotracheal tube  40 . Preferably, the distal opening of the guide  12  is beveled to substantially match the angle of the laryngeal inlet  27  after insertion of the laryngeal mask airway  10  into the patient&#39;s airway. 
     The laryngeal mask  30  consists a central support member  31  extending outward from the guide  12  to an inflatable member as illustrated in FIGS. 1-4. The laryngeal mask  30  is preferably made of a soft, flexible material (e.g., a polymer or rubber) to enable it to be advanced into position without injury to the patient and to create a substantially air-tight seal about the laryngeal inlet  27 . The degree of inflation of the laryngeal mask  30  can be adjusted through a small inflation tube  34  and air valve  32 . Alternatively, the laryngeal mask  30  can be a cushion made of a soft, spongy material that is not inflatable. The laryngeal mask  30  and its support member  31  are shaped to meet several requirements. The lower portion  35  of the laryngeal mask  30  substantially blocks the esophagus to minimize the risk of regurgitation of stomach contents and the passage of air into the stomach. The upper portion  36  of the laryngeal mask  30  guides the distal end of the guide  12  into alignment with the laryngeal inlet  27  as the guide is inserted along the patient&#39;s airway. 
     In the embodiment shown in the drawings, the laryngeal mask  30  is generally boot-shaped when inflated. The lower portion  35  of the laryngeal mask  30  forms the toe of the boot, which blocks the esophagus. The lower portion  35  of the laryngeal mask  30  also helps to align the distal opening of the guide  12  with the patient&#39;s laryngeal inlet  27 . After the mask  30  is inflated, the upper portion  36  of the mask  30  substantially fills the laryngopharynx  21  at the level of the laryngeal inlet  27 . The upper portion  36  of the laryngeal mask  30  surrounds the laryngeal inlet  27  so that the distal opening of the guide  12  is sealed in fluid communication with the laryngeal inlet  27 . Thus, substantially all of the gas inhaled or exhaled by the patient passes through the guide  12 . For example, the laryngeal mask  30  can be formed by injection blow molding, rotational molding, or dip molding. 
     In particular, the upper portion  36  of the mask  30  surrounding the distal opening of the guide  12  is canted at an angle to complement the natural angle of the laryngeal inlet  27 . The distal end of the guide  12  can also be beveled at this complementary angle. This enables the laryngeal mask airway  10  to directly engage the laryngeal inlet  27  along the longitudinal axis of the patient&#39;s airway as the guide  12  is advanced. The shape of the upper portion  36  of the laryngeal mask  30  further helps to guide the distal opening of the guide  12  so that it is axially aligned with the laryngeal inlet  27  and abuts the laryngeal inlet  27  in an end-on relationship as the guide is inserted along the patient&#39;s airway. In contrast, conventional laryngeal masks typically approach the laryngeal inlet  27  from a posterior or inferior position. 
     In the embodiment depicted in FIGS. 1-4, the proximal end of the guide  12  can be sealed by a removable guide cap  91  as shown in FIG. 8,  9 , and  14 . FIG. 8 is an exploded perspective view of the guide cap  91 , while FIG. 9 is provides a cross-sectional view of the guide cap  91 . FIG. 14 is a cross-sectional view of a patient&#39;s airway after the laryngeal mask airway  10  has been initially inserted. As shown in FIG. 14, the guide cap  91  has an outside diameter dimensioned to seat into the proximal opening of the guide  12  and thereby prevent the escape of gas through this opening. When inserted, the guide cap  91  abuts and seals against an annular seal ring  13  within the guide  12  as illustrated in FIG.  14 . The guide cap  91  has a small passageway or port extending vertically through the guide cap  91 . As shown in FIG.  9 , a luer connector  92  with a one-way valve  93  (e.g., a duck-bill valve) is permanently attached to the guide cap  91  so that air or fluid can only flow down the passageway of the guide cap  91 , but not up. Thus, the one-way valve  93  serves to prevent air/oxygen from escaping through the guide  12  during resuscitation. 
     As illustrated in FIG. 16, a syringe  55  containing anesthetic can be secured to the luer connector  92  on the guide cap  91 . As the guide  12  is advanced into the patient&#39;s mouth and hypopharynx, the healthcare provider squirts anesthetic from the syringe  55 , through the one-way valve  93  and guide  12  to lessen discomfort. After the guide  12  has been advanced into position, the guide cap  91  is removed from the guide  12  to allow insertion of an endotracheal tube  40  and fiber optic probe  50  through the guide  12 , as will be discussed below. 
     A flow of air/oxygen is delivery to the patient via the guide  12  through a ventilation port  16  extending at an angle from the side of the guide  12 . A rotatable collar  14  allows the ventilation port  16  to be rotated about the central axis of the guide  12  to any desired orientation. Air/oxygen flows through the ventilating port  16  into the annular space between the collar  14  and the guide  12 , and through a series of ventilation holes  18  into the interior of the guide  12 , as shown in greater detail in FIG.  3 . For example, the ventilation port  16  can be connected to a conventional ventilator or a resuscitation bag. 
     Resuscitation Attachment. Alternatively, a mouthpiece can be connected to the ventilation port  16  for initial patient resuscitation by a healthcare provider. For example, FIG. 5 is a perspective view of a resuscitation attachment  70  that can used in place of a ventilator or resuscitation bag for resuscitation by the healthcare provider. The resuscitation attachment  70  has an output port  71  that can be removably connected to the ventilation port  16  of the laryngeal mask airway  10 . The resuscitation attachment  70  includes an air filter  74  across the flow path between the input port  72  and output port  71  to help prevent the exchange of contaminants between the healthcare provider and patient. A one-way valve  75  (e.g., a duckbill valve) directs any backflow of air or contaminated fluids from the patient to the exhaust port  73 , and thereby serves to further protect the healthcare provider from contaminants. 
     The healthcare provider can breathe directly into the input port  72  of the resuscitation attachment  70 . Alternatively, a length of flexible tubing  80  can be connected to the resuscitation attachment  70  by means of a connector  82  that can be plugged into the input port  72  of the resuscitation attachment  70 , as shown in FIG.  6 . In the preferred embodiment, the flexible tubing  80  is approximately six inches in length and forms a helical coil for easier storage. The proximal end of the flexible tubing  80  has a mouthpiece  84  with an oval opening. 
     The resuscitation attachment  70  can also be equipped with an oxygen port  76 , as shown in FIG. 7, that can be connected by tubing to a external oxygen source to supply supplemental oxygen to the patient through the flow path, in addition to the resuscitation provided by the healthcare provider. Each exhalation by the healthcare provider then carries oxygen-enriched air through the laryngeal mask airway  10  and into the patient&#39;s lungs. The oxygen port  76  can be closed with a removable cap  77  when the oxygen port  76  is not in use. The internal passageway within the flexible tubing  80  and resuscitation attachment  70  upstream from the one-way valve  75  serve as a reservoir for accumulation of oxygen between each exhalation by the healthcare provider. 
     FIG. 7 shows an embodiment of the resuscitation attachment  70  with the oxygen port  76  placed below the one-way valve  75  and filter  74 . In this embodiment, the internal passageway within the resuscitation attachment  70  downstream from the one-way valve  75  serves as a reservoir for accumulation of oxygen between each exhalation by the healthcare provider. The one-way valve  75  helps to prevent oxygen from escaping during the remainder of the resuscitation cycle. However, the exhaust port  73  prevents a build-up of excessive pressure that might be injurious to the patient&#39;s lungs. 
     FIGS. 10 and 11 are front and rear perspective views of another embodiment of the laryngeal mask airway  10  in which air/oxygen is introduced directly into the guide  12  through a fixed ventilation port  16 . This embodiment would be simpler and less expensive to build. 
     FIG. 12 is a front perspective view of yet another embodiment of the laryngeal mask airway  10  without a separate ventilation port. The patient can be supplied with air/oxygen through a connector or cap placed in the proximal opening of the guide  12 . Alternatively, the patient can be intubated without ventilation. 
     Method Of Use For The Laryngeal Mask Airway. The following is a description of a typical method of use for the laryngeal mask airway  10 . 
     The curved distal portion of the guide  12  is first inserted into the patient&#39;s mouth and laryngopharynx  21  with the laryngeal mask  30  deflated, as shown in FIG.  14 . If necessary, the ventilation port  16  can be used as a hand grip during insertion of the guide  12 . FIG. 13 is a corresponding top perspective view of a patient&#39;s airway, including the larynx  24 , esophagus  23 , and epiglottis  25 . The positions of the guide  12  and laryngeal mask  30  relative to the patient&#39;s anatomy after insertion are shown in dashed lines in FIG.  13 . The lower portions of the support member  31  and laryngeal mask  30  extend into the esophagus  23 . The upper portions of the support member  31  and the laryngeal mask  30  surround the laryngeal inlet  27 . 
     A protrusion  33  on the anterior portion of the distal tip of the guide  12  or support member  31  is inserted to the patient&#39;s vallecula  26  (i.e., the notch between the base of the tongue  22  and the epiglottis  25 . The protrusion  33  pushes on the vallecula  26 , which tends to lift the epiglottis  25  from the laryngeal inlet  27  and helps to ensure patency of the patient&#39;s airway. 
     After the distal portion of the guide  12  and the laryngeal mask  30  are appropriately positioned relative to the laryngeal inlet  27 , the laryngeal mask  30  is inflated via the inflation tube  34  to establish a seal around the laryngeal inlet  27 , as depicted in FIG.  15 . The lower portion  35  of the inflated laryngeal mask  30  substantially blocks the esophagus  23 . The upper portion  36  of the inflated laryngeal mask  30  substantially fills the laryngopharynx  21  adjacent to the laryngeal inlet  27 , and thereby seals the distal opening of the guide  12  in fluid communication with the laryngeal inlet. The side portions  37  and  38  (shown in FIG. 4) pinch the sides of the epiglottis  25 , which also tends to lift the epiglottis  25  from the laryngeal inlet  27 . 
     If necessary, the guide cap  91  can be removed and an endoscope probe can be inserted through the proximal end of the guide  12  to enable the physician to view the insertion process and verify that the laryngeal mask  30  is correctly positioned. 
     Optionally, a syringe  55  containing a local anesthetic (e.g., lidocaine or xylocaine) can be connected to the luer connector on the guide cap  91  at the proximal end of the guide  12  to squirt anesthetic as the guide  12  is inserted through the patient&#39;s mouth and into the laryngopharynx  21 , as shown in FIG.  16 . If squirted with sufficient force, the anesthetic can be carried as far as the larynx  24  to deaden any discomfort associated with insertion of the laryngeal mask airway  10  and endotracheal tube  40 . 
     During and after insertion of the guide  12 , the patient can be resuscitated by supplying air/oxygen through the ventilation port  16 . For example, the flow of air can be supplied by a resuscitation bag attached to the ventilation port  16  that is manually squeezed periodically to simulate natural breathing. Alternatively, a resuscitation attachment (such as shown in FIGS. 5-7) can be removably attached to the ventilation port  16  to enable a healthcare provider to directly resuscitate the patient. 
     After the patient&#39;s condition has been stabilized to some degree during initial resuscitation, an endotracheal tube  40  is inserted over the distal end of an endoscope probe  50 . The guide cap  91  is removed from the proximal end of the guide  12 . Resuscitation, oxygenation, or artificial ventilation continue without interruption while the endoscope probe  50  and endotracheal tube  40  are advanced along the guide  12  and through the laryngeal mask  30  to a position within the trachea past the larynx  24 . FIG. 17 is a cross-sectional view of the laryngeal mask airway  10  during insertion of the endotracheal tube  40  and endoscope probe  50 . 
     The seal ring  13  within the proximal end of the guide  12  has an inside diameter that is only slightly larger than the outside diameter of the endotracheal tube  40 . This maintains a sufficiently tight fit around the endotracheal tube  40  to prevent the escape of gas through the seal. However, air/oxygen flows freely through the space between the endotracheal tube  40  and the surrounding guide  12  to maintain patient respiration. 
     Optionally, a removable cap  45  can be inserted into the proximal end of the endotracheal tube  40  and a stabilizer tube  52  can be attached to the endoscope probe  50 , as shown in FIG. 17, to assist in advancing the endotracheal tube  40  along the guide  12 . In the preferred embodiment, the stabilizer  52  is a flexible plastic tube having a C-shaped cross-section, as shown in FIG. 22, that can be readily clipped over the fiber optic probe  50  at any desired location along its length. The inside diameter of the stabilizer  52  should be selected to provide a snug, frictional fit against the exterior of the endoscope probe  50  so that the stabilizer  52  will not readily slide after it has been attached to the fiber optic probe  50 . The stabilizer  52  can also be readily removed from the endoscope probe  50  by the healthcare provider for cleaning or to adjust its location on the probe  50 . The stabilizer  52  should have outside dimensions sufficiently large to push the endotracheal tube  40  forward as the fiber optic probe  50  is advanced by the healthcare provider. 
     The proximal end of the endotracheal tube  40  can be fitted with a removable cap  45  shown in FIG.  23 . This cap  45  has outside dimensions selected so that it can be inserted snugly into the proximal opening of the endotracheal tube  40  and yet is sufficiently small to pass through the guide  12 , if necessary. A central passageway extends axially through the endotracheal tube cap  45  to receive the endoscope  50 . The endoscope probe  50  passes freely through the cap  45 . However, the cap passageway has an inside diameter smaller than the stabilizer  52 , so that the stabilizer  52  will abut and push against the proximal end of the endotracheal tube  40  as the fiber optic probe  50  is advanced by the healthcare provider. This approach enables the endotracheal tube  40  and endoscope probe  50  to be advanced along the guide  12  and patient&#39;s airway as a single assembly. 
     The shape of the guide  12 , the support member  31 , and laryngeal mask  30  tend to align the distal opening of the guide  12  with the larynx  24  so that the endoscope probe  50  and endotracheal tube  40  will pass through the opening between the vocal cords. However, after emerging from the distal end of the guide  12 , the direction of the distal tip of the endoscope probe  50  can be controlled by the physician. This allows the physician to carefully guide the endoscope probe  50  and endotracheal tube  40  to a position past the larynx  24  while resuscitation continues. Many conventional endoscopes include a suction channel extending the length of the fiber optic probe to its distal tip. This feature can be used to suction mucus or other secretions from the patient&#39;s airway as the endoscope/endotracheal tube assembly is inserted. Alternatively, an endoscope  50  may not be needed at all due to the anatomical alignment provided by the laryngeal mask  30 , which permits “blind” intubation of the patient. In any event, the patient is being ventilated throughout the intubation process, so the normal risks associated with intubation are not as serious if delays are encountered in completing the intubation process using the present invention. 
     In one methodology, the endoscope probe  50  is then removed from within the endotracheal tube  40 , as shown in FIG.  18 . The laryngeal mask  30  is deflated and the guide  12  is removed while leaving the endotracheal tube  40  in place within the trachea, as illustrated in FIG.  19 . Alternatively, the guide  12  can be left in place to serve as an oral airway and to protect the endotracheal tube  40  from being bitten by the patient&#39;s teeth. However, the laryngeal mask  30  should be deflated if the device is to be left in place in the patient&#39;s airway for an extended period time to minimize damage to the mucous lining. 
     The cuff  42  on the endotracheal tube  40  is then inflated via an inflation tube  44  and air valve  46 . Finally, a ventilator  48  is connected to the proximal end of the endotracheal tube  40  to ventilate the patient, as shown in FIG.  20 . Alternatively, the patient can be manually ventilated by connecting a resuscitation bag to the proximal end of the endotracheal tube  40 . 
     FIG. 21 depicts an alternative methodology in which the laryngeal mask airway  10  is withdrawn over the endoscope probe  50  while leaving the endotracheal tube  40  in place in the patient&#39;s airway. In this methodology, after the endotracheal tube  40  has been moved into position with its distal end in the trachea as illustrated in  17 , the laryngeal mask  30  is deflated and the guide  12  is removed over the proximal end of the endotracheal tube  40  while leaving the endotracheal tube  40  and fiber optic probe  50  in place. Before removing the guide  12 , the healthcare provider may wish to slide the stabilizer  52  a few centimeters toward the distal end of the fiber optic probe  50 . This allows the endoscope  50  to be pulled back relative to the endotracheal tube  40 , so that the distal tip of the endoscope  50  is located within the distal end of the endotracheal tube  40  and offers a view of both the endotracheal tube&#39;s distal tip and the patient&#39;s trachea. This enables the healthcare provider to monitor the position of the endotracheal tube  40  relative to the trachea as the guide  12  is removed, as described above. 
     The fiber optic probe  50  is then withdrawn from within the endotracheal tube  40  and the endotracheal tube cap  45  is removed if one is present. Finally, the patient can be ventilated via a conventional ventilator  48  connected to the endotracheal tube  40 , as shown in FIG.  20 . 
     Ventilation Attachment. FIG. 24 is an exploded perspective view of an embodiment using a separate ventilation attachment  100  with a rotatable ventilation port  16 . FIG. 25 is an exploded cross-sectional view corresponding to FIG.  24 . The ventilation attachment  100  provides the same functionality as the proximal portion of the laryngeal mask airway  10  in the previous embodiments. The ventilation attachment  100  has a passageway with a diameter large enough to allow an endotracheal tube to pass through the ventilation attachment  100 . A ventilation port  16  allows a flow of air/oxygen to be supplied through the guide  12  around the periphery of the endotracheal tube and into the patient&#39;s lungs during insertion of the endotracheal tube, as previously discussed. A seal ring  13  in the passageway forms a seal around the endotracheal tube as the endotracheal tube is inserted through the ventilation attachment  100  and along the guide  12 . In other words, the seal ring  13  provides a seal around the endotracheal tube as it is inserted through the ventilation attachment  100  to prevent air/oxygen from escaping from within the passageway while the patient is being ventilated. But, the seal ring  13  allows the endotracheal tube to be advanced through the ventilation attachment  100  and guide  12  with minimal resistance. 
     The ventilation attachment  100  can either be used in combination with a J-shaped guide  12  similar to that shown in the previous embodiments, or with a conventional laryngeal mask airway  102 . If used in combination with the J-shaped guide  12 , the cuff  101  at the lower end of the ventilation attachment  100  fits directly over the proximal opening of the guide  12 . In contrast, conventional laryngeal mask airways  102  typically have a standard 15 mm respirator connector (not shown) at their proximal end, which may or may not be removable depending on the specific model involved. If possible, the respirator connector should be removed from the end of the laryngeal mask airway  102 , as illustrated in FIG. 24 to provide a larger diameter for subsequent insertion of an endotracheal tube. If the respirator connector cannot be removed from the end of the laryngeal mask airway  102 , the ventilation attachment  100  can be attached over the respirator connector. If necessary, a tubular adapter  103  can be inserted between the cuff  101  of the ventilation attachment  100  and the upper end of the guide to accommodate any change in diameter between the cuff  101  and the end of the guide. 
     It should be understood that the term “guide” encompasses any type of guide or laryngeal mask airway for the purposes of this invention. In either case, the cuff  101  serves to coaxially align the passageway of the ventilation attachment  100  with the guide, so that an endotracheal tube can be inserted through both. 
     The embodiment illustrated in FIGS. 24-25 includes a rotatable collar  14  so that the ventilation port  16  can be rotated to any desired orientation relative to the longitudinal axis of the guide. In contrast, FIG. 26 is a cross-sectional view of an embodiment of the ventilation attachment  100  having a fixed ventilation port  16 . The orientation of the ventilation port  16  can be adjusted by rotating the cuff  101  (and therefore the entire ventilation attachment  100  including the ventilation port  16 ) relative to the guide. 
     The embodiments in FIG. 24-26 are intended for use primarily in a clinical setting (e.g., while administering anesthesia in an operating room). The vast majority of surgical patients do not encounter complications that would require intubation with an endotracheal tube. For these patients, a laryngeal mask airway  102  by itself is sufficient for administering anesthesia. If the patient gets into trouble requiring intubation, the ventilation attachment  100  can be quickly added to the proximal end of the laryngeal mask airway  102  as shown in FIGS. 24 and 25, and an endotracheal tube  40  can then be inserted through the ventilation attachment  100  as shown in FIG.  27  and described above. The embodiment of the ventilation attachment  100  depicted in FIG. 26, in particular, would be simpler to manufacture and more cost effective for this type of infrequent use. 
     FIG. 28 is a cross-sectional view of a guide  12  with a removable ventilator connector  110  attached to its proximal end in place of the ventilation attachment  100 . The ventilation connector  110  has a standard 15 mm diameter that allows the patient to be connected to a conventional ventilator. If the patient encountered difficulties requiring intubation, the ventilator connector  110  can be quickly removed from the guide  12  and replaced with the ventilation attachment  100  as shown in FIGS. 24-25. 
     The above disclosure sets forth a number of embodiments of the present invention. Other arrangements or embodiments, not precisely set forth, could be practiced under the teachings of the present invention and as set forth in the following claims.