Patent Publication Number: US-2006004260-A1

Title: Endotracheal video device

Description:
PRIORITY DOCUMENTS  
      This application is a continuation-in-part of U.S. patent application Ser. No. 11/068,600 filed Feb. 28, 2005, which is a continuation application of U.S. patent application Ser. No. 10/285,190 filed Oct. 31, 2002, now U.S. Pat. No. 6,890,298, which is a continuation-in-part of U.S. patent application Ser. No. 09/418,542 filed Oct. 14, 1999, now U.S. Pat. No. 6,494,826. 
    
    
     FIELD OF THE INVENTION  
      The invention relates to an endotracheal intubating device, and more particularly to a portable video endotracheal intubating device utilizing an illuminating light guide and a video guide.  
     BACKGROUND OF THE INVENTION  
      In the United States, approximately 20 million patients are operated on and anesthetized each year. Approximately 50% of surgeries are performed using general anesthesia, which means the patient is put to sleep and the ventilation and other physiological function are monitored. While anesthetized, the patient&#39;s breathing functions are temporarily disabled. Ventilation is therefore supplied to the patient by the anesthesiologist during the procedure.  
      Ventilation should be typically controlled mainly in the elderly, difficult cases with severe underlying disease, or those with severe trauma by introducing a tube into the windpipe (trachea), and the respiratory function are controlled by an automatic ventilator. In a small percentage, (5-10%) of patients who have to undergo general anesthesia, a Laryngeal Mask (LMA) intubation is employed. A special group of patients are those with emergency situations. A LMA may include a Supra Laryngeal Device (SLD), which typically includes a flexible tube (18-20 mm OD), which has an attached small inflatable mask at the distal end. This device is introduced through the mouth into the hypo-pharynx. The inflatable mask is inflated and the esophagus is blocked to avoid air-oxygen inflation in the gastrointestinal organs. The open part of the mask is positioned opposite the vocal cords. The inflated mask is blocking the air insufflation into the esophagus and stomach. The ventilation is provided through a tube connecting the opening of the mask into the trachea. The proximal end of the tube is connected to a ventilator, which is adjusted according to the physiological parameters of the patient&#39;s needs.  
      Ventilation is typically provided through an endotracheal tube. This tube is inserted into the trachea, and it is closed against the wall of the trachea by an inflatable cuff. The insertion of this tube involves risks that the anesthesiologist seeks to avoid or at least minimize. It is estimated that between one in 6,000 to one in 8,000 general anesthesia procedures result in death. There are of course many causes but of these it is estimated that about one third of them are caused by the intubation procedure.  
      The foremost obstacles encountered by the anesthesiologist include; the remoteness of the location where the tube is to be positioned, the consequent restriction of view as the tube is inserted, variations and anomalies in the anatomy of the patients, an uncomfortable and unnatural position for the anesthesiologist while holding the instrument, the potential need to change blades during the procedure, and the necessity for rapid intubation.  
      The positioning of the LMA, of which there are numerous types, is typically performed blindly. The proper position can be assessed by the exhaled CO 2  content (capnometer), but this is typically only available in operating rooms.  
      It should be noted that when the tube is inserted, the patient is asleep hyperoxygenated and then paralyzed for the procedure, and therefore not breathing. In addition, the ventilator is not yet in operation. This gives the anesthesiologist only about two minutes in which to intubate the patient, inflate the cuff, and start ventilation. If he is delayed because of unsuccessful attempts, he must stop, apply a ventilation mask to the patient, supply oxygen for a time through the mask, remove the mask, adjust medication if necessary, and then start over again. This delays the operation and extends the patient&#39;s time under anesthesia. This extension of time while under anesthesia may have very serious consequences, especially for elderly patients.  
      With the advent of endoscopic equipment and small cameras, instrumentation has been improved to the extent that it can enable viewing of the cords and larynx on a video screen thereby facilitating the intubation of the patient in a relatively quick and safe manner. However, conventional instrumentation may be further improved such that the laryngoscope is easier to use, thereby reducing the time involved for instance, to change blades or attach and detach peripheral components.  
      Endoscopes are now widely used in minimally invasive surgery. Endoscopes typically contain a light guiding system, usually in the form of fiber optic cables, in order to bring light to the surgical area. The light guiding system typically extends through the handle of the laryngoscope and through a guide tube located in the blade so as to position the light guiding system to illuminate the area ahead of the blade. Endoscopes also typically contain an image guiding system, for example in the form of a rigid rod lens system, arranged in the shaft of the endoscope. The image guiding system can also be configured as an ordered, flexible fiber optic bundle. The image guiding system is utilized to transmit reflected light from the area ahead of the blade to a camera. The camera, attached at the proximal end of the endoscope, usually contains a CCD (charge coupled device) sensor, in the form of a light-sensitive chip that converts the optical signals into electrical signals that are conveyed from the image-sensing camera module to a remotely located image processing system. The image guide typically extends from the distal end of the blade through the guide tube and then through the handle of the laryngoscope.  
      Typically, the combination light guiding system and image guiding system are permanently attached to the handle and are continuous, extending from the distal end of the blade, through the handle of the laryngoscope and to the camera for the image guiding system, and to the light source for the light guiding system. Therefore, the light guiding system and image guiding system extending from the handle of the laryngoscope for insertion into the guide tube of the blade typically comprise flexible coherent fiber optic bundles. However, when changing blades, the bundle must be carefully inserted or withdrawn from the opening of the guide tube at the proximal end of the blade. This may take an unacceptable amount time for the physician to thread the bundle into the tube if the blade must be changed in the middle of the intubation process.  
      The light and image guiding systems have typically been permanently attached to the handle to ensure the system will reliably transmit the illuminating light and reflected images. To utilize a detachably connectable light and image guiding system, the attachment means would have to rigidly hold the member in place such that the light and image guiding systems did not become misaligned. In addition, the attachment means must be easy and quick to operate, making it possible to perform the coupling procedure with as little close attention as possible, but nevertheless reliably. Provision must therefore be made for the coupling elements to be keyed to each other so that the coupling cannot be incorrectly joined and so that close attention by the operation is not required.  
      In addition, the flexible bundles may easily be damaged and will wear over time, degrading or rendering the system inoperable. As a visual inspection of the device often will not indicate whether the bundles are damaged, it is conceivable that a physician may obtain a damaged or malfunctioning laryngoscope not realizing that it is damaged. The time involved with determining that the instrument is malfunctioning, withdrawing it, finding another laryngoscope, and then intubating the patient may have severe adverse effects upon the patient under anesthesia.  
      Further, laryngoscopes, as with most medical equipment, must be sterilized after use. Because the light and image guiding systems are permanently attached to the handle, they are exposed to extremely high temperatures, which also cause wear and/or failure of the flexible bundles. Also, because the light and image guiding systems are subjected to the sterilization process with the handle and blades, the handle must be hermetically sealed which may greatly add to the cost in manufacturing such a device.  
      It is therefore desired to provide an improved endotracheal device, specifically for use with a LMA that allows for visual feedback to a user during insertion.  
      It is further desired to provide an improved portable endotracheal device for field use that allows a medical worker located remotely from the patient to view images of the insertion by a user.  
      It is still further desired to provide an improved portable endotracheal video device that may be detached from for example, a disposable LMA and an image light guide system to allow for sterilization and the reuse with the supra laryngeal device (SLD).  
     SUMMARY OF THE INVENTION  
      These and other objectives are achieved by providing a video endotracheal device that may be used in connection with a SLD. The endotracheal device may in one embodiment be detachably connectable to or insertable in the LMA or alternatively, may be integrally formed in or with the LMA.  
      The endotracheal device may comprise flexible image and light guides, which may advantageously continue into a rigid performed tube with an outside diameter of for example, approximately 3 mm. The endotracheal device may be attached to the LMA via an additional tube attached to the LMA or may be inserted into a cavity formed in the LMA for receiving the endotracheal device. The tip of the endotracheal device may be positioned in front of the mask opening toward the vocal cord for displaying the positioning of the mask on a video screen. Near the top of the tube of the LMA, the light and image guides may continue in a rigid tube and connected to a coupling mechanism. The coupling mechanism that connects the endotracheal device, for example a camera.  
      Accordingly, the coupling mechanism is provided with a first cylindrical stem of specific diameter and specific length, in whose interior is received a proximal end segment of the light guiding system, and which projects from one coupling end of the endotracheal device in the coupling direction. Further, a second cylindrical stem is provided whose length and diameter are greater than the length and diameter of the first stem, having a proximal end segment of the image guiding system being received in the interior of the second stem, and which projects from one coupling end of the endotracheal device in the coupling direction. The second stem coacts with an interlock system arranged in the laryngoscope handle forming a rigid mechanical coupling, the first and second stems extending at a distance next to one another. Complementary receptacles corresponding to the two stems, into which the stems penetrate, are provided in the laryngoscope handle. The base of the receptacle into which the second stem penetrates is optically connected to the camera, and the receptacle in which the shorter first stem is receivable is connected to the light source.  
      The mechanical, light-guiding, and image-guiding coupling is accomplished by way of a single simple linear displacement operation, in which specifically the two stems are pushed into the corresponding receptacles of, for example, a camera or a laryngoscope handle. Because one of the two stems is thicker and longer than the other, incorrect (i.e. reversed) insertion is not possible. Because the thicker stem is also simultaneously the longer one, it is possible, without undue attention, to feel for the correspondingly larger receptacle on the camera module with this thicker and longer stem, and then to close the coupling with an insertion movement. Incorrect attachment is thus no longer possible, since the thicker and longer stem cannot be attached to the smaller-diameter receptacle for the smaller and shorter stem.  
      The mechanical interlock or coupling is affected simultaneously with this insertion. Because the larger stem is also the longer stem, and it carries the image guiding system, the image-guiding connection occurs at an axial spacing from the light-guiding connection. This feature has the advantage that any stray light that might emerge from the light connection cannot directly come into contact with the image-guiding connecting point located at an axial distance therefrom. The disadvantages of connecting image and light at the same level, or those, for example, of a coaxial arrangement, are thus eliminated.  
      Because the coupling mechanism is keyed, the user can therefore, for example, sense the camera or laryngoscope handle and its precise grasped position in the coupling region with one hand, and with the other hand can easily sense the light and image guiding attachment and its grasped position as well, so that the two elements to be coupled can then be inserted into one another without visual contact.  
      An interlock system is displaceable transversely to the coupling direction that can be engaged into a recess on the second stem. This feature has the advantage that in order to close and/or release the coupling, the locking element is displaced transversely to the coupling direction and is engaged into or disengaged from the recess on the second stem. These are all procedures that can be controlled, without visual contact, with the fingers of one hand; the snapping of the locking element into and out of the recess on the stem indicates to the operator whether the coupling is closed or open. If the locking element needs to be pushed into the recess, for example to close the coupling, this can be done by simply inserting the stems into their corresponding receptacles; precise locking can be ascertained by an audible sound that the locking element has been engaged. The locking element may comprise for instance, ball catches, hooks, snap lugs, or the like.  
      The locking element is acted upon by the force of a spring, and radially projects into the receptacle for the second stem. This is advantageous because, the force of the spring presses the locking element into a defined position, and the coupling may be disengaged by the application of a force opposite the coupling direction, namely withdrawing the stems from their respective receptacles. These are all procedures that can be sensed and controlled with the hand&#39;s sense of touch, so that no visual attention or observation is necessary when closing and opening the coupling.  
      The second stem may have a conical segment at the end that is followed by an undercut. The conical segment constitutes an insertion aid upon insertion of the stem into the receptacle, so that exact insertion is guaranteed with even approximate placement. At the same time, the conical surface can be utilized to displace the locking element radially upon insertion.  
      In addition, the undercut in the second stem may be configured as an annular groove. This forms a relatively large engagement surface with the locking element, so that the mechanical forces acting on the coupling will be dispersed over the entire area, which contributes to mechanical stability and less wear through use.  
      In addition, the first and second stems along with the receptacles receiving them each have a window. The windows thereby provide a sealed closure for the light and image guiding systems.  
      The endotracheal device may in one advantageous embodiment, be provided entirely or in part with a stainless steel outer casing, or some other suitable rigid enclosure, for protecting the endotracheal device. As the endotracheal device is detachable from the camera or handle, only the endotracheal device need be subjected to sterilization or can be disposable.  
      The camera may be provided with a built in light transmitter and optical lens system that is coupled to the endotracheal device by means of the coupling mechanism previously described. The camera may be advantageously used as a handle to position or reposition the SLD to an optimal position during insertion and use.  
      In the case where a patient has suffered a severe trauma, the SLD may be utilized by semi-trained Medic Corpsman or first-aid personnel in a field setting. The LMA may be provided as a disposable device, whereas the video-image light guide may be re-sterilized for future use.  
      As the Medi-Corp or first-aid personnel have limited training, it is contemplated the video image may be transmitted via for example, a tele-metering device to a remote station and the procedure may be directed by a well-trained doctor in the remote field hospital or an emergency medical physician. In this manner, a relatively large number of individuals with limited training may be able to perform medical procedures with a relatively high degree of accuracy, even a relatively difficult procedure, under the direct supervision of highly trained medical personnel. This is highly desirable on for example, a battle field or in an area where a catastrophic event has occurred.  
      In one advantageous embodiment an endotracheal device for use with a SLD and attachable to a camera is provided comprising, a light guide, an image guide, and a first connector associated with the endotracheal device, the first connector terminating the light guide and the image guide and engagable with a second connector on the camera. The endotracheal device further comprises, an outer housing enclosing the light and image guides. The endotracheal device is provided such that the outer housing has a flexible portion that may be bent by a user, and a rigid portion that substantially maintains a rigid preformed shape.  
      In another advantageous embodiment an endotracheal device for use with a SLD is provided comprising, a light guide and an image guide. The endotracheal device further comprises, a first connector terminating the light guide and the image guide, and an outer housing enclosing the light and the image guides. The endotracheal device is provided such that the outer housing has a flexible portion that may be bent by a user, and a rigid portion that substantially maintains a rigid preformed shape. The endotracheal device still further comprises a camera for generating image data, the camera having a second connector that is engagable with the first connector along a path of movement.  
      In another advantageous embodiment an endotracheal device for assisting in the intubation of a patient is provided, the endotracheal device connectable to a camera having a camera connector and comprising, a light guide, an image guide, and an endotracheal device connector terminating one end of the light guide and the image guide. The endotracheal device further comprises an outer housing enclosing the light and said image guides. The endotracheal device is provided such that the outer housing has a flexible portion that may be bent by a user, and a rigid portion that substantially maintains a rigid preformed shape, and the endotracheal device connector is engagable with the camera connector along a path of movement.  
      It is understood that the features mentioned above and those yet to be explained below can be used not only in the respective combinations indicted, but also in other combinations or by themselves, without leaving the context of the present invention. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1  is an illustration of the video laryngoscope with a curved blade and the endotracheal device engaged with the handle;  
       FIG. 2  is an illustration of a curved blade detached from the handle;  
       FIG. 3  is a perspective view of the handle depicting the housing containing the receptacles for the endotracheal device;  
       FIG. 4  is an illustration of the curved endotracheal device as detached from the handle;  
       FIG. 5  is a cross-sectional view of the housing containing the receptacles for the endotracheal device;  
       FIG. 6  is a cross-sectional view of the coupling element utilized in conjunction with the endotracheal device;  
       FIG. 7  is an illustration of the video laryngoscope with a straight blade and the endotracheal device engaged with the handle;  
       FIG. 8  is an illustration of a camera having light and image guiding receptacles at one end and light and image cables connected at the other end;  
       FIG. 9  is an illustration of a Laryngeal Mask (LMA);  
       FIG. 10  is an illustration of the LMA according to  FIG. 9  including an exterior attached guide tube;  
       FIG. 11  is an illustration of the image light guide with the optical coupler device according to one advantageous embodiment of the present invention; and  
       FIG. 12  is an illustration according to  FIG. 11  illustrating one advantageous embodiment of the connection of the endotracheal device with the LMA.  
    
    
     DETAILED DESCRIPTION OF THE DRAWINGS  
      The video laryngoscope  10 , along with the attached blade  12  and endotracheal device  14  is illustrated in  FIG. 1 .  
      The handle  16  is typically cylindrical with a knurled outer surface  18  thereby facilitating a secure gripping surface. As is shown in  FIG. 1 , the handle  16  is detachably joined to a blade  12 , which in this instance is curved, by a joinder  20 .  
      The joinder  20  includes a pair of conventional hinge socket  22  and connector  24  respectively mounted to the lower end of the handle  16  and to a proximal end  34  of the blade  12 . Socket  22  further includes a crossbar  26 . Connector  24  includes a hook  28  in a block  30  that fits into socket  22  and is more clearly seen in  FIG. 2 . The hook  28  engages the crossbar  26 , and the handle  16  is rotated 90 degrees so that the blade will be rigidly held to the handle  16 . This is a common joinder  20  used in this type of instrumentation and is useful for all blade forms, of which the two illustrated forms are merely examples. A ball detent  32  detachably retains the handle  16  and blade  12  together and erect in the assembled configuration. The assembled instrument is rigid during the procedure.  
      Blade  12  has a distal end  36  which may be smoothed by a bulb-like edge  38 . It has a curved top surface  40  extending from the distal end  38  toward the proximal end  34 . This top surface  40  is used to elevate the tongue and permit the visualization of the vocal cords beneath it.  
      Referring back to  FIGS. 1 and 2 , blade  12  additionally includes an hole  42  at the distal end  36  of the blade  12 . The hole  42  is designed to allow passage of a distal end  43  of endotracheal device  14 .  
      The handle is provided with means for obtaining an image of the field located beyond the tip of the blade  12 , and for providing illuminating light to that field. In one embodiment, a camera (not shown) is mounted in a chamber inside the handle  16 .  
      An image cable  44  to conduct image data from the camera exits from the top of the handle  16 . It is connected to a video set (not shown), which provides data for an image on a video screen (not shown), for observation by the anesthesiologist. In addition, in some embodiments an illumination cable  46  conducts illuminating light to the handle  16 .  
      In one embodiment, light for illumination of the field ahead of the distal end  36  of blade  12  is obtained from a separate light source (not shown) that can be placed in any convenient nearby location. An illumination cable  46 , which may comprise a fiber optic bundle extends from the light source (not shown) to the handle  16 . The illumination cable  46  need not be coherent, because it does not transmit an image—it transmits only illuminating light. Both the image cable  44  and the illumination cable  46  may enter the top of handle  16 .  
      The actual construction of image cable  44  depends on the arrangement of the camera. In a preferred embodiment, the camera (not shown), customarily a CCD chip, is mounted in the handle  16 . In this case, the image cable  44  comprises a electrical cable, which extends from the camera output (not shown), out the top of the handle and to a video display (not shown). The image guide extending through the endotracheal device  14 , through the handle  16  and terminating at the camera input (not shown) comprises a bundle of coherent fiber optic cables to transmit the reflected light from the area ahead of the blade  12  to the camera (not shown).  
      In an alternative embodiment, the camera (not shown) may be located remotely from the video laryngoscope  10 . In this case, the image guiding cable  44  would comprise a bundle of coherent fiber optic cables extending through the endotracheal device  14 , through the handle  16  and terminating at the camera, which is located remotely from the video laryngoscope  10 .  
      The light guiding system receptacle  52  and the image guiding system receptacle  48  are both contained in housing  50  as illustrated in  FIGS. 3 and 5 . The light guiding system receptacle  52  has an inner surface  54  defining a cross-sectional diameter of the receptacle opening corresponding to a diameter of a first stem  56  shown in  FIGS. 4, 5  and  6 . Further, the image guiding system receptacle  48  has an inner surface  58  defining a cross-sectional diameter of the receptacle opening corresponding to a diameter of a second stem  60  also shown in  FIGS. 4, 5  and  6 .  
       FIG. 4  shows the endotracheal device  14  detached from the handle  16 . The endotracheal device  14  may in one advantageous embodiment comprises a rigid curved shaft  62  and a coupling element  64 . The coupling element  64  further comprises a first stem  56  and a second stem  60  along with a housing  66 . The rigid curved shaft  62  is preferably made of stainless steel but may be manufactured on any rigid non-corroding material. The rigid curved shaft contains both, the light guiding cable  46  for transmitting illuminating light ahead of the distal end  36  of the blade  12 , and the image guiding cable  44  for receiving the reflected light and transmitting it to the camera (not shown) located in the handle  16 . The rigid curved shaft  62  also has a window  66 , located at the distal end  68 , which acts to seal the endotracheal device  14 . While it is contemplated that the light guiding cable  46  and the image guiding cable  44  are detachably connectable with the handle  16  via the coupling element  64 , it is further contemplated that the light guiding cable  46  and the image guiding cable  44  associated with blade  40  may or may not be detachable from blade  40 .  
      Referring back to the coupling element  64 , an approximately cylindrical second stem  60 , protrudes at one coupling end  70  of housing  66 . The length and inside diameter of image guiding system receptacle  48  are selected so that second stem  60  can be received snugly therein. A window  72  is provided at the end of the second stem  60  to provide a seal for the image guiding cable  44 . A first approximately cylindrical stem  56  extends from one coupling end  70  of housing  66  parallel to second stem  60 . The first stem  56  is smaller in diameter and length than the second stem  60 . Also window  74  is provided at the end of the first stem  56  to provide a seal for the light guiding cable  46 .  
      Second stem  60 , comprises a cylindrical segment  76 , and annular groove  78 , and a terminal conical segment  80 . Both stems  56  and  60  extend in a coupling direction to mate with receptacles  52  and  48  respectively.  
      A locking element  82 , displaceable radially with respect to the coupling direction, is located in housing  50 . Locking element  82  may be approximately the shape of a two-tined fork that is bent inward in a circular shape at the outer end, the radius of curvature corresponding approximately to the radius of curvature of image guiding system receptacle  48 . The outer ends of locking element  82  project slightly into image guiding system receptacle  48  as shown in  FIG. 5 .  
      Conical segment  80  of second stem  60  thereby encounters the ends of locking element  82  projecting into image guiding system receptacle  48  and displaces them radially outward.  
      When second stem  60  has been pushed into image guiding system receptacle  48  to the point that the ends of locking element  82  come to rest at the level of annular groove  78 , they snap into annular groove  78 .  
      In this position the coupling is now closed, i.e. coupling system  10  is coupled and mechanically interlocked. In this state, window  72  of second stem  60  and window  84  in the base of image guiding system receptacle  48  lie congruently with one another, thus creating an image-guiding coupling. Window  74  of first stem  56  comes to rest in front of window  86  of light guiding system receptacle  52 , so that a light-guiding coupling is also created.  
      All that is necessary to release the coupling is withdraw the endotracheal device  14  outward with enough force to overcome the locking element  82  as engaged in annular groove  78 .  
      It is now seen that joining the blade  12 , which may integrally include the endotracheal device  14 , to the handle  16  is a swift process. The portions of the joinder  20  are engaged and the handle  16  is then rotated, locking the blade  12  into place. The endotracheal device  14  may further engage with coupling element  64  in a coupling direction.  
      Having a detachably connectable endotracheal device  14  means that the endotracheal device  14  may be detached from the handle  16  for sterilization. This further means that the handle  16  must no longer be hermetically sealed for sterilization. This provides the distinct advantage of lowering the cost involved with manufacturing the handle  16  as now they do not have to be subjected to the extremely high temperatures associated with the sterilization process. Further, any electronic components located in the handle  16  will no longer be subjected to the high temperatures of sterilization, which could prematurely age or damage them. While it is contemplated that endotracheal device  14  is detachably connectable with the handle  16 , it is further contemplated that endotracheal device  14  associated with blade  40  may or may not be detachable from blade  40 . It is further contemplated that while both light guiding system receptacle  52  and the image guiding system receptacle  48  are illustrated in the Figures as located on the side housing  50 , it understood that the receptacles may be located at any convenient on housing  50  to match up with blade  40 , such as for instance, when endotracheal device  14  is provided integral with blade  40 .  
      Instead of the camera and illumination arrangements already described, there are other alternatives, which can be used in any combination.  
      For example, instead of employing a separate light source (not shown), a battery and light bulb may be contained in the handle  16 , and the light from this bulb focused onto light guiding cable  46 . This eliminates the need for a fiber optic bundle from a light source, and also eliminates the separate light source itself.  
      The video laryngoscope  10 , along with the attached blade  110  and endotracheal device  112  is illustrated in  FIG. 7 .  
      The blade  12  illustrated in  FIGS. 1 and 2  is a curved blade  12 , which is used to elevate the patients tongue in some circumstances. It is the well-known McIntosh blade  12 . However, a different blade  110  for a different anatomical configuration is a straight blade  110  adapted for use in other circumstances. It is illustrated in  FIG. 7 . This is the well-known Foregger-Magill blade  110 . These are the two most common blade shapes. Their configuration is not a limitation on the invention. The configurations of this handle  16  and these blades are completely conventional. They are standard equipment utilized by anesthesiologists trained to intubate the trachea. An advantage of this invention is that it does not require any additional training or re-training of anesthesiologists who have used these well known blades and will utilized them in the future.  
      The curved blade  12  illustrated in  FIGS. 1 and 2  differs from the straight blade  110  illustrated in  FIG. 7  only by its shape. The straight blade  110  in  FIG. 7  has a straight upper surface  114  instead of a curved surface  40  for use when such a surface is preferred for lifting the tongue of the individual patient. In all cases the objective is to lift the tongue to permit visualization of the vocal cords and to enable the endotracheal tube to be accurately placed without harming surrounding tissue in the process.  
      In addition, the endotracheal device  112  as shown in  FIG. 7 , differs from the endotracheal device  14  as depicted in  FIGS. 1 and 4  only by its shape. The endotracheal device  14  is curved to match the curved blade  12  as depicted in  FIGS. 1 and 4 , whereas the endotracheal device  112  is a straighter configuration corresponding to the straight blade  110  as shown in  FIG. 7 .  
      As the handle  16 , the blade  110  and the endotracheal device  112  operate in the same manner as the aforedescribed curved blade  12  and endotracheal device  14 , they will not be re-described.  
      A camera  300  according to one advantageous embodiment of the present invention is illustrated in  FIG. 8 . The camera  300 , customarily comprising a CCD chip, has a housing  302  that is generally rectangular but may be any shape. At one end, an image guiding cable  304  and light guiding cable  306  are connected to the camera  300 .  
      Image guiding cable  304  may comprise an electrical cable, which extends from the camera output to a video screen  274  ( FIG. 12 ). Image guiding cable  304 , may utilize any suitable format and protocol for the transmission of video images. Image guiding cable  304  may be permanently attached to camera  300  as illustrated in  FIG. 8 , or may be detachably connectable to camera  300 .  
      Also shown attached to camera  300  is light guiding cable  306 . Light guiding cable  306  may comprise any suitable cable (typically fiber optic) for the transmission of illuminating light from an illumination source to a location to be illuminated. Light guiding cable  306  may comprise coherent or non-coherent fiber optic cables and be permanently attached to camera  300  as illustrated in  FIG. 8 , or may be detachably connectable to camera  300 . While image guiding cable  304  and light guiding cable  306  are each shown separate from each other, it is contemplated that both may be enclosed in a protective jacket as a single cable.  
      At the end opposite to where image guiding cable  304  and light guiding cable  306  attach to camera  300 , image guiding receptacle  308  and light guiding receptacle  310  are provided. These receptacles are more readily seen as previously illustrated in  FIG. 5 .  
      It can be seen from  FIG. 8  that housing  302  of camera  300  is contoured, which allows easy gripping and manipulation of camera  300  by a user even without having to look at the device. Rather, based on the contour of housing  302 , a user will be able to determine by feel, how to position camera  300  to connect it with various pieces of equipment. Housing  302  may comprise any rigid material, such as for instance, stainless steel, that will protect the camera unit in a cost effective and durable manner.  
      Also illustrated in  FIG. 8  is coupling element  312 . Coupling element  312  comprises coupling element housing  314 , along with image guiding stem  316  and light guiding stem  318 . The image guiding system extending through light guiding stem  318  comprises a bundle of coherent fiber optic cables to transmit reflected light from an area where illuminated light is be supplied to. Image guiding stem  316  and light guiding stem  318  are more readily seen as previously illustrated in  FIG. 6 .  
      Coupling element housing  314  may comprise any suitable rigid material, such as for instance, stainless steel or a rigid plastic. Coupling element  312  is designed to detachably engage with image guiding receptacle  308  and light guiding receptacle  310 .  
      While coupling element  312  illustrated in  FIG. 8  is not specifically shown connected to a particular instrument, it may be used in connection with practically any medical instrument using an illuminating system and an image guiding system. The coupling mechanism is universal and may be easily adapted depending upon the quality and resolution of image desired. It is further contemplated that although camera  300  is illustrating with image guiding cable  304  and light guiding cable  306  attached thereto, it is contemplated that wireless communication of generated camera data may be utilized.  
       FIG. 9  is an illustration of a Laryngeal Mask (LMA)  200  that includes a Supra Laryngeal Device (SLD)  202 , a tube  204  and attached to a ventilator  206  to initiate air exchange. Typically SLD  202  comprises a flexible tube having an 18-20 mm OD. The LMA comprises a relatively small inflatable mask, which is insertable through the mouth and into the hypo-pharynx. Ventilator  206  is may be inflated so as to block the esophagus to avoid air-oxygen inflation of for example, the stomach. Ventilation may be provided through tube  204  connecting the opening of ventilator  206  into the trachea. Ventilator  206  may be adjusted according to the physiological parameters of the patient.  
       FIG. 10  again illustrates LMA  200  including an attached guide tube or sheath  208 . Sheath  208  may comprise a relatively flexible material and be formed substantially to the shape of tube  204  and may further be deformable according to tube  204 . In this illustration, sheath  208  is show as attached to the exterior of tube  204 ; however, it is contemplated that an opening integral to tube  204  may also be provided. It is further contemplated that sheath  208  may be attachably and detachably connectable to LMA  200 .  
      At a lower end portion  210  of sheath  208 , an opening  212  is provided in ventilator  206  to which sheath  208  extends. At an upper end  214  of sheath  208  and opening  216  is provided.  
       FIG. 11  illustrates one advantageous embodiment of the present invention depicting endotracheal device  250 . In this embodiment, endotracheal device  250  comprises an outer housing  252  and a connector  254 . Endotracheal device connector  254  is similar to coupling element  64  as previously described in connection with  FIG. 4  and will not be re-described here.  
      Outer housing  252  comprises a flexible portion  256  and a substantially rigid portion  258  within which a light and image guide (not shown) is maintained. The light and image guides are similar to those previously described in connection with alternative embodiments.  
      In this particular embodiment, approximately two-thirds the length of outer housing  252  is provided as flexible and approximately one-third is provided as substantially rigid, although these measurements may easily be adjusted based upon the application or other variables. It is contemplated that outer housing  252  may comprise stainless steel. At a distal end  260  of flexible portion  256  a window  262  seals outer housing  252 .  
       FIG. 12  illustrates the insertion of endotracheal device  250  into sheath  208 . Also illustrated in securing clip  218  for securing endotracheal device to LMA  200 . In this advantageous embodiment, securing clip  218  is attached to rigid portion  258  of outer housing  252  to maintain endotracheal device  250  in rigid relationship relative to LMA  200 .  
      Also illustrated in  FIG. 12  is camera  300 . Camera  300  may be any type of camera as previously discussed in connection with the alternative embodiments. Camera  300  is further provided with coupling element (camera connector)  312  that is engagable with endotracheal device connector  254 . Coupling element  312  is similar to the light guiding system receptacle  52  and the image guiding system receptacle  48  described in connection with the previous Figures. Once camera  300  is rigidly attached to endotracheal device  250 , it is contemplated that due to the robust connection between endotracheal connector  254  and coupling element  312 , the user may grip the entire structure by camera  300 , using camera  300  essentially as a handle for manipulation of the device.  
      It is contemplated that camera  300  may further comprise a light source for generating illuminating light to be transmitted to an area ahead of LMA  200 . Reflected light is then transmitted back to camera  300  for generation of image data. Camera  300  may further be provided as a self-contained portable unit including a power source.  
      Camera  300  is coupled to video screen  274  by means of connection  276 . It is contemplated that video screen  274  may be directly attached to camera  270  for local visualization of the area ahead of the LMA  200  during insertion. Alternatively, it is contemplated that video screen  274  may be remotely located from the patient and that connection  276  may comprise a wireless connection. This configuration is especially advantageous when, for example, a Medic Corpsman or first aid personnel need to intubate a patient in the field. Highly trained medical personnel that are not or cannot be at the location may visually see the intubation process on a video screen providing direction to the field medical personnel.  
      It is still further contemplated that both a local video screen and a remotely located video screen, via for example, an attachable telemetering unit, may be utilized for receiving images from camera  300  to facilitate intubation of the patient. This system is especially advantageous in for example a battlefield setting or at the scene of a disaster in which medical personnel with limited training can receive direct instruction from relatively highly trained medical personnel located remotely who are virtually transported to the scene and can provide highly specific instructions based on the image data they are receiving.  
      Connection  276  may comprise any type of wired or wireless connection for sending the image data to video screen  274 . It is contemplated that connection  276  may further comprise a both a wired and a wireless connection, such that image data is transmitted to a transmitting unit, via for example a wired connection, which is then transmitted wirelessly to the remote video location. However, it is contemplated that many different communication schemes may be effectively utilized without deviating from the invention.  
      Although the invention has been described with reference to a particular arrangement of parts, features and the like, these are not intended to exhaust all possible arrangements or features, and indeed many other modifications and variations will be ascertainable to those of skill in the art.