Patent Publication Number: US-2021162154-A1

Title: A Supraglottic Airway Device for intermittent Positive Pressure Ventilation

Description:
RELATED APPLICATION 
     This application is a continuation-in-part of co-pending application Ser. No. 16/163,501. The co-pending application Ser. No. 16/163,501 filed on Oct. 17, 2018 entitled “A Supraglottic Airway Device for Intermittent Positive Pressure Ventilation” in its entirety is hereby incorporated by reference. Claims  1 - 15  are based on the Ser. No. 16/163,501 patent application and the remaining claims are based on new materials within this application. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to medical airway management devices and methods that can be used as an independent supraglottic airway device for positive pressure mechanical ventilation and spontaneous ventilation to replace traditional endotracheal intubation in many cases. 
     BACKGROUND OF THE INVENTION 
     It is standard practice of requiring endotracheal intubation on a patient when positive mechanical ventilation is planned. Using different type of supraglottic airway devices such as different type of LMAs, I-gel, air-Qsp, Baska mask, laryngeal tube and others for spontaneous ventilation has been widely accepted, but not for mechanical ventilation which can result in significant air leakage to make positive pressure mechanic ventilation ineffective and has other complications. 
     The present invention is intended to improve effectiveness and safety of supraglottic ventilation without using an endotracheal intubation for many currently intubated cases and also to be used for spontaneous ventilation. The present invention is easy to use and can be used in multiple medical specialties without waiting for a sub-specialty trained physician in many emergency airway cases. 
     SUMMARY OF THE INVENTION 
     The device may be constructed from any suitable plastics, silicones, rubbers polymers, or other suitable materials or combinations with sufficient flexibility that allows insertion into a patient&#39;s throat without damaging throat tissues. The present invention can be sized to accommodate different gender and age group of patient. 
     As will be realized, the invention is capable of other and different embodiment and its several details are capable of modification in various respects, while still attaining the beneficial results of the present invention all without departing form the invention. These components can be modified in different configurations and combinations, and re-arrangement of the basic components, or omission of some components of this invention, or these components can be made of different type of materials. However they are still within the scope of this invention. Accordingly, the drawings and descriptions are to be regarded as illustration to nature of the device and not in a restrictive or limitation sense. 
     For purpose of description, the use the word of “distal” refers to the device&#39;s end that first enters into a patient&#39;s mouth. The term “proximal” is the opposite end. The term “patient” refers to any person or animal requiring the use of the device. The use of word “posterior” refers to a back side of the device or a patient or animal. The word “anterior” is the opposite side. Further, the use of the term “communication” is used to mean a path for air, gas, or fluid to flow. For purpose of easy describing, if not otherwise specified, the device is assumed in a semi-horizontal or diagonal position as illustrated in  FIG. 1  with the air sac opening toward upside and the air sac bottom wall toward the downside. Therefore when tongue lifting plate is pulled up by pulling band, it will be described as “pulled up, moving up, rising” and so on. And if the device has inserted into a patient&#39;s throat, it will be assumed that patient or animal is in supine position unless specified otherwise. 
     Please note, term “couple” or “attach to” between different parts include but not limited to the use of glue, thermo-adhesive, fasteners or other suitable techniques, or combination thereof or any other suitable technologies. 
     The present invention can be sized to accommodate different gender and age group of human and selected groups of animals. All components are made with biocompatible materials. These include but not limited to plastics, silicones, polymers, rubbers, metals, a combination thereof, or a combination with other types of materials. 
     The following three embodiments can be derived from the same basic principle of this invention. 
     The first embodiment: comprises an air tube, an air sac, a tongue lifting means, and a pulling unit  60  with optional one or more drainage tubes. 
     In first embodiment the air tube outside shape is different with its inside shape. The drainage passage  100  is configured to “invade” inside air tube lumen  12  at Y point and couple to the air tube middle bottom wall longitudinally therefore to divide or reshape the air tube lumen into a top tube airflow channel  30 , a right tube airflow channel  32  and a left tube airflow channel  31  respectively. 
     The air tube lumen  12  in cross section view from Y point to the air tube distal opening  29  is a sum of cross sections of all three tube airflow channels. 
     After passing beneath the air tube distal edge  29 , the drainage passage  100  continues with the distal drainage tube  109  to form a sac central protruding surface  39  which includes an upward ramp  22  and a downward ramp  23 . The upward ramp can provide guidance for airflow or passing a stylet into laryngeal inlet. 
     Air sac include air sac bottom wall, a right sac airflow channel  78  and a right sac wall  81 , a left sac airflow channel  79  and a right and a left sac wall  81 , and a sac distal pocket. 
     The air sac bottom wall has the sac central protruding surface  39  which is “sandwiched” by a right sac airflow channel  78  on its right side and a left sac airflow channel  79  on its left side. The right and left sac wall include a right and a left holding zone  85  which are bent inward toward each other and couple to the air tube top wall. The right and left sac proximal attachment of the air sac is to attach to the air tube distal segment  15 . 
     The right and left sac airflow channels are smoothly continue proximally with the right and left tube airflow channel respectively and continue to extend distally to form a sac distal pocket  99 . The airflow from inside the right or left tube airflow channel will flow into the right and left sac airflow channel  78 , 79  respectively and continue to flow distally into the sac distal pocket  99 . Finally the airflow flow out the sac distal pocket  99  from the beneath of the sac distal pocket cover  89  into the air sac chamber. The airflow in the top tube airflow channel  30  will flow toward the vocal cords opening. 
     The whole air sac is made of the materials with certain compressibility and elasticity. The shape of the right and left sac airflow channel  78 , 79  and the sac distal pocket can be compressed during insertion of the device. The flexibility and elasticity also allow the air sac being pulled by a mechanical force and pushed by inspired airflow to open further especially during Intermittent Positive Pressure Ventilation 
     These channeled airflows are able to push the air sac to form seals with pharyngeal walls or surrounding tissues during inspiration phase of a respiration cycle after the pulling unit  60  pull up the tongue base and open up more the sac chamber. And the pushing force is the inspiratory pressure dependent and is proportion to the inspiratory pressure. 
     The tongue lifting means can be configured as a lifting plate  51 , or a bar lifting assembly  95 . The both are pulled by the pulling unit  60 . 
     An operator will have to pull the pulling band tail to lift up tongue lifting means to change physical position of the tongue lifting means before the device can perform its functions. 
     The lifting plate has a plate distal edge and right and left plate side edges and is couple to the air tube distal edge  29 . An indentation line  25  is configured at connection between the lifting plate  51  and the top edge of the air tube distal edge  29  to make the lifting plate easily to be bent. And therefore the lifting plate  51  can use the indentation line  25  as a bending “joint” to form a dull angle with the top wall of the air tube distal end  29  when the lifting plate is pulled up diagonally. 
     Before the lifting plate  51  is pulled, right and left inward strip  86  of the air sac are toward to each other obliquely. When tongue lifting plate  51  is pulled up diagonally by the pulling bands, the right and left sac wall  81  are pushed further apart by the right and left lifting plate side edge  52 , and the right and left inward strip  86  are to be pushed up by the lifted plate distal edge  53 . At same time the lifted plate distal edge will form the seal with the tongue base and the raising lifting plate  51  will push right and left the sac wall holding zone  85  toward proximal direction which consequently will stretch the inward strip  86  in proximal direction. Then right and left inward strip  86  will stretch right and left sac wall descending edges  82  to keep the right and left sac airflow channels open to be expanded by incoming inspired airflow and pull the sac distal pocket cover to form a seal with posterior laryngeal wall. And the right and left sac wall descending edges are also able to meet the right and left side structures of the laryngeal inlet therefore to stop further advance the device during insertion. 
     Each of two epiglottis elevation plates on right and left side of the plate distal edge  53  or only one epiglottis elevation plate epiglottis in the middle of the plate distal edge can been configured to push up the epiglottis to open the laryngeal inlet when the lifting plate  51  is pulled up. 
     In an alternative design, when the bar lifting assembly  95  is pulled up diagonally the bar lifting assembly will be unfolded to form seal with tongue base. The right and left side fold  96  will also unfold to form seal with the sac wall holding zone  85  and prevent the air escape from the air sac chamber. 
     The enhanced sealing means has been configured which include the sac sealing belt  90 , the right and left plate sealing petals  55 , the right and left plate sealing bumps  57 , the right and left corner sealing folds  56  and the right and left sac wall holding zone angles  83 , all of them are configured to enhance the sealing between the right and left sac wall holding zone  85  and the lifting plate  51 . 
     The pulling unit  60  are one or more bands and are designed to pull up the tongue lifting means, and consequently the tongue lifting means will push up the base of tongue. And the pulling unit  60  can pull up the tongue base independent of action of pulling the tongue lifting means and hold and stabilize the tongue in an elevated position. 
     The right and left pulling bands  66  pass through the space between the right and left side of the sac wall holding zone and touch the sac wall proximal edges  88 . When the right and left pulling bands  66  are pulled and tightened, the pulling bands  66  will push right and left sac wall holding zone further apart. 
     One or more hooks can be configured on the wall of the air tube or the drainage passage to hold the band hole. Therefore, operator can free a hand while operating the device. 
     A band sliding pad  65  has been configured to convey an operator&#39;s pulling force to right and left band distal ends  68 . 
     In a preferred embodiment, the right or left band distal end  68  separately attach to the right and left side of the tongue lifting means. 
     In the first embodiment, the drainage passage  100  is configured to include a first drainage tube  101  and a second drainage tube  102 . After passing beneath of the air tube distal opening  29  the first drainage tube  101  continues distally with the distal drainage tube  109  with its distal opening positioned under the sac distal pocket to drain the fluid from the upper esophagus. 
     The function of the second drainage tube  102  is to drain fluid or secretion cumulated under the fluid groove  77 . 
     Alternatively, the drainage passage can be configured as a central drainage tube  111 . The central drainage tube  111  divides the air tube lumen and passes beneath the air tube distal end  29  to drain cumulated fluid under the fluid hood  115 . 
     The Second Embodiment 
     The second embodiment comprises an air tube, an air sac, a tongue lifting means, a pulling unite and an optional drainage system which includes optional one or more drainage tubes. In addition the divergent plate  28   a  the distal airflow bottom wall  29   a  distal airflow tunnel, the band anchor  65   a  and band stick  66   a  are newly added structures. 
     Same as in first embodiment, the air tube outside shape in the second embodiment is changeable and its lumen is reshaped by drainage passage  100  starting at the Y point  18 . Therefore the air tube lumen starting from the Y point  18  is divided longitudinally or reshaped into a top tuber airflow channel  30 , a right tube airflow channel  32  and a left tube airflow channel  31  respectively. At the split point  18   c , a length of the air tube distal segment  15  form its own distal airflow bottom wall  29   a  and extends further into air sac. This length segment of the air tube distal segment  15  can be configured as either the distal airflow tube  38  or the distal airflow channel  15   a . The both have up-curved shape and extend distally close to the vocal cords opening. 
     In the distal airflow bottom wall  29   a  is configured to have a central groove  29   c  to guide a stylet for a tracheal intubation. 
     Preferably a right and a left divergent plate  28   a  are configured to divergent more airflow from right and left tube airflow channel  32 ,  31  into the distal airflow tube  38  or the distal airflow channel  15   a  and create the pressurized focused or jet like airflow toward the vocal cords opening. The ability of the divergent plate  28   a  able to be pushed and to change its position automatically according to changes of the airflow pressure inside air tube lumen has created an airflow self-control mechanism which can automatically adjust amount of airflow into the distal airflow tunnel in positive mechanic ventilation. 
     After passing beneath the split point  18   c  distally, the first drainage tube  101  of the drainage passage  100  continues with the distal drainage tube  109  which forms a sac central protruding surface  39  same ways as the first embodiment except no the upward ramp  22  and the downward ramp  23  configuration. The rest of the sac bottom wall would be same as in the first embodiment. The air sac in the second embodiment also includes, a right sac airflow channel  78  and a right sac wall  81 , a left sac airflow channel  79  and a right and a left sac wall  81 , and a sac distal pocket same configurations as in the first embodiment. 
     The right and left sac wall include a right and a left sac wall holding zone  85  which the most proximal portion of the sac wall and are bent inward toward each other and couple to the air tube top wall same as in the first embodiment. 
     The tongue lifting means and pulling unite are also configured same the lifting plate  51 , or a bar lifting assembly  95  as in the first embodiment. But a sac lifting plate  99   a , a new alternative, has been configured to be pulled and to lift tongue base. The all three are pulled by the pulling unit  60  and also use the indentation line  25  as a bending “hinge” or joint” when the lifting plate is pulled up diagonally same as in the first embodiment. 
     One or more pairs of band anchor  65   a  have been configured in right and left side of the air tube side wall as alternative of the band sliding pad  65 . The pulling band can slide back and forth underneath the band anchor  65   a  therefore to transfer an operator&#39;s pulling force to the right and left band distal ends  68  and to the tongue lifting means. 
     The rest of structure, such as the enhanced sealing means, the drainage system and alternative design of the central drainage tube  111  can be optionally configured in the second embodiment the same as in the first embodiment. 
     Third Embodiment 
     The third embodiment comprises the same tongue lifting means and the pulling unit But the air tube and air sac have some different modifications. 
     In the third embodiment, a distal portion of the air tube distal segment  15 , called distal airflow segment  118  will extend inside the air sac and curves up same as in second embodiment. On the distal airflow segment  118 , one or more air holes  116  holes have been configured on right and left side walls, or bottom wall, or corners of the bottom wall and right and left side walls of the distal airflow segment  118 . The air holes  116  are to let a portion of an incoming airflow from the air tube flow into right and left side of the air sac chamber. 
     A central thinking area  39   a  in the sac bottom wall is to reinforce the rigidity of the air sac bottom wall and to form the right and left sac airflow channel  118   a ,  118   b . The right and left sac airflow channel in this embodiment will be shallower than the first and second embodiments but still able to accommodate the airflow from the right and left tube airflow channels and able to function same as the right and left sac airflow channel in the first and second embodiments. The airflow will be divergent by a pair or more air holes into right and left sac airflow channel of the air sac  119 . Then airflow inside of the right and left sac airflow channel will also flow toward the distal end which will cause the sac distal pocket cover  121  expand therefore to create a seal with posterior laryngeal wall same way as in the first and second embodiments. However in third embodiment, the central thinking area  39   a  and the right and left sac airflow channel  118   a , 118   b  can be omitted therefore the airflow inside the air sac will not be divided. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1 —Left side oblique view of the device  10  of the first embodiment, including the air tube which includes an air tube proximal segment  13  and an air tube distal segment  15 , the air sac  80 , the lifting plate  51  and the pulling unit  60  an and the drainage passage  100 . The lifting plate  51  has not been pulled up and is in a relaxed un -pulled position. For illustration purpose, visible portion of the pulling unit  60  are painted as the darker area and grey area of the pulling unit  60  represent segments which are behind other structures and cannot be directly visualized. 
         FIG. 2 —Left side oblique view of  FIG. 1  in the first embodiment, an operator is pulling the band tail  63  of the pulling unit. The lifting plate  51  is being pulled up by an operator. The lifting plate  51  is in pulled up position. The sac top opening  70  is wide open therefore the air tube distal opening  29 , the sac central protruding surface  39 , the upward ramp  22  and the downward ramp  23  are also shown. 
         FIG. 2 a   —Left side oblique view of the second embodiment, an operator is pulling the band tail  63  of the pulling unit. The lifting plate  51  is being pulled up. by an operator same way as in the first embodiment. The sac top opening  70  is wide open. The air tube distal opening  29 , central groove  29   c  and a left distal airflow side wall  29   b  are shown. A new alternative design of right and left pulling sticks  66   a  have been replaced the pulling bands  66  and are pulled by an operator same way as in the first embodiment, and are sliding along beneath right and left band anchors  65   a.    
         FIG. 3 —Left side view of a cutting-through from the middle of the device in the first embodiment, the pulling bans has been pulled and the lifting plate  51  is pulled up. Please note that the drainage passage top wall  35  is configured to continue with the central longitudinal protruding surface  39  which includes the upward ramp  22  and the downward ramp  23 . And the first drainage tube  101  continues after passing beneath the air tube distal end  29  and become the distal drainage tube  109 . 
         FIG. 3 a   —Left side view of a cutting-through from the middle of the device of the second embodiment, the pulling bands have been pulled and the lifting plate  51  is pulled up. Please note that the drainage passage top wall  35  is configured to continue with the top wall of the distal drainage tube  109  which form the central longitudinal protruding surface  39 . 
       In this draining, right pulling band touch and pass right sac wall proximal edges  88 . The distal airflow channel  15   a  has the incomplete top wall  29   d  therefore the air tube distal opening  29  is enlarged as shown. The distal airflow bottom wall  29   a  branch out from the drainage passage top wall  35  and curve up therefore from the split point  18   c  and the split angle  18   b . The left distal airflow side wall  29   b  is painted as grey area. 
         FIG. 4 —Left side view after the device being inserted into a patient&#39;s throat. 
         FIG. 5 —Left posterior oblique view the first embodiment, the pulling bands are not shown in order to better demonstrate the drainage system. The second drainage tube distal opening  108  is terminated at or shortly after passing the split point  18   c  to drain the left bottom fluid groove  77 . 
         FIG. 6 a   —Explored view, the air sac has been de-attached from the air tube, viewing from left side of the air sac. Please note that the sac horizontal attachment edge  72  is curved structure and is painted in thicker darker line. The sac wall holding zone  85 , inward strips  86 , the sac wall descending edges  82 , the sac distal pocket cover  89 , the sac distal edge  87 , and the distal drainage tube  109  are shown. 
         FIG. 6 b    Explored oblique distal view after the air sac being detached in the second embodiment , the divided three airflow channels viewed from the distal direction in comparison with the first embodiment in  FIG. 6 c   . The first drainage tube  101 , and distal opening of the right and left tube airflow channel  32 , 31  are shown. The tongue lifting plate  51  has been pulled up by the pulling bands  66 , the pulling bands  66  are anchored underneath the band anchor  65   a . The inferior surface of the tongue lifting unite now is facing to distal direction and the air tube distal opening  29  is seen. The distal airflow bottom wall  29   a  and the central groove  29   c  are shown. The left distal airflow side wall  29   b  and the incomplete top wall  29  are painted as striped areas. 
         FIG. 6 c   —Explored oblique distal view after the air sac being detached in the first embodiment, the divided three airflow channels viewed from the distal direction, the first drainage tube  101  is configured to continue with the distal drainage tube  109 , but continuality has be cut in the drawing. The tongue lifting plate  51  has been pulled up by the pulling bands  66 . The inferior surface of the tongue lifting unite now is facing to distal direction. 
         FIG. 7 a   —Explored view of Left side view of the first drainage tube  101  and the distal drainage tube  109 , the first drainage tube is continuing with the distal drainage tube  109 , the distal drainage tube  109  has a distal drainage tube distal opening  105 . The upward ramp  22  and the downward ramp  23  are configured on the top surface of the sac central protruding surface  39 . 
         FIG. 7 b   —Posterior view of the drainage system the first drainage tube  101  and the second drainage tube  102 , and the distal drainage tube  109 . The second drainage tube distal opening  108  terminates early. 
         FIG. 8 a   —n oblique view of a new design of the sac lifting plate  99   a  in the second embodiment from a proximal direction. The sac lifting plate  99   a  has been pre-manufactured in a semi-horizontal folded toward distally in un-pulled position. The right and left sac walls  81  have been pushed down or folded down toward bottom of the sac chamber. The left the sac airflow channel side wall  76 , the pulling bands  66  and the band anchors  65   a  are shown. 
         FIG. 8 b   —An oblique view of the  FIG. 8 a    from a distal direction, an alternative design. The sac lifting plate  99   a  has been pulled up. The inferior surface of the sac lifting plate  99   a  is facing distally. The sac lifting plate  99   a  pulls the inward strip  86  and the sac wall descending edge  82  in tense. The sac walls  81  have also been pulled and stood up. Left sac wall  81  is painted grey area. The sac top opening  70  is wide open therefore the distal airflow tube  38  and the air tube distal opening  29  can be seen. 
         FIG. 8 c   —an alternative design of the lifting plate, the bar lifting assembly  95  is configured as “umbrella” like, and is in relaxed un-pulled position. The bar lifting assembly  95  is painted as a grey area and it folded like an “umbrella” inside of the air sac. 
         FIG. 9 a   —Oblique view of the an alternative design of the first embodiment, showing connection of the sac proximal attachment couple to the air tube distal segment  15 , in which the sac vertical attachment edge  71  couples to the left air tube side wall  16  and the sac horizontal attachment  72  couples to the air tube top wall. The corner sealing fold  56  is shown. The lifting plate  51  has not been being pulled up, but the pulling unit  60  and the drainage tubes are not shown for better illustrating the corner sealing fold. 
         FIG. 9 b   —zoom up view of the sac vertical attachment edge  71 , the sac horizontal attachment edge  72  and indentation line  25  (as painted double line). The sac horizontal attachment edge  72  and the sac vertical attachment edge  71  couple to the air tube distal segment. The sac horizontal attachment edge  72  curves back distally to reach the indentation line  25  to form the sac wall holding zone angle  83 . 
         FIG. 9 c   —showing the sac sealing belt  90  as one of the enhanced sealing means. The upper horizontal edge  92  and lower horizontal edge  91  of the sac sealing belt  90  are shown. 
         FIG. 9 d   —Left oblique view from back of an alternative design of the first embodiment, no configuration of the second drainage tube  102 , and no the distal drainage tube  109 . The central drainage tube  111  with its central drainage tube distal opening  113  terminating at the fluid hood  115 . The esophageal fluid can enter the fluid hood  115  through the fluid entrance  112 . 
         FIG. 10 a   —Top view of the lifting plate  51  and the pulling unit  60  in a relaxed un-pulled position. Two epiglottis elevation plates  58  are configured as two protruding structures toward distally. The right and left plate sealing bump  57  are shown. 
         FIG. 10 b   —Top view of an alternative design of the pulling unit  60  with one single band distal converged end  69  attach to the lifting plate. The central epiglottis elevation plate  59  is shown. 
         FIG. 10 c   —Top view of an alternative of the enhanced sealing means, the right and left plate sealing petal  55 , and an alternative design of the pulling unit  60  with a band bridge  64  connecting the right and left band bands  66  are shown. The epiglottis elevation plates  58  are shown. 
         FIG. 11 —Multiple cross-sectional view lines of the device, the pulling unit not shown. 
         FIG. 1 a   —A cross sectional view through the sac distal pocket  99 . 
         FIG. 11 b     1 —A cross sectional view through the sac wall descending edge of the air sac. A cross section of the semi-circled semi-opened right and left sac airflow channel are not yet being further opened before the lifting plate is pulled to cause the sac wall descending edge to be pulled and stretched. 
         FIG. 11 b     2 —A view of the  FIG. 11 b     1  showing after the lifting plate  51  is pulled up to initiate the “chain reaction” to cause semi-circled semi-opened right and left sac airflow channel being further opened by the tightened sac wall descending edge. 
         FIG. 11 c     1 —A cross sectional view through the air tube distal end  29 , the lifting plate  51  is in a relaxed un-pulled position. 
         FIG. 11 c     2 —A view of the  FIG. 11 c     1  after the lifting plate  51  being pulled up. Consequently, the right and left edge of the lifting plate  51  are contacting the inner surface of the air sac wall and pushing right and left sac wall  81  toward the right and left side. 
         FIG. 11 d   —Cross sectional view through the air tube, showing the top tube airflow channel  30 , the right tube airflow channel  32  and the left tube airflow channels  31 , and a cross section of the first drainage tube  101  and second drainage tube  102 . 
         FIG. 11 e   —Cross sectional view through of an alternative design of the air tube, showing how a semi-ellipse shaped air tube lumen can be divided by the drainage passage which includes the first drainage tube  101  and second drainage tube  102 . 
       In similar fashion the air tube lumen can be divided as a top tube airflow channel, a right tube airflow channel and a left tube airflow channel. 
         FIG. 12 —Multiple cross-sectional view lines of the device, the pulling unit not shown. 
         FIG. 12 a   —A cross sectional view through the sac distal pocket  99 . 
         FIG. 12 b     1 —A cross sectional view through the sac wall descending edge of the air sac. A cross section of the semi-circled semi-opened right and left sac airflow channel  78 , 79  are not yet being further opened before the lifting plate is pulled to cause the sac wall descending edge to be pulled and stretched. The sac airflow channel side walls  76  are pained darker line. The bottom fluid grooves  77  are shown in a cross section. 
         FIG. 12 b     2 —A view of the  FIG. 12 b     1  showing after the lifting plate  51  is pulled up to initiate the “chain reaction” to cause semi-circled semi-opened right and left sac airflow channel  78 , 79  being further opened by the tightened sac wall descending edge. 
         FIG. 12 c     1 —A cross sectional view through the airflow distal edge  29 , the lifting plate  51  in un-pulled position, The left tube airflow channel  31  and the right tube airflow channel  32  have already transitioned to the right and left sac airflow channel  78 , 79 . The cross section of the bottom fluid grooves the distal drainage tube  109  are shown. The sac airflow channel side walls  76  is painted darker. The sac airflow channel middle wall  73 , the sac airflow channel bottom wall  75  and the bottom fluid groove  77  are also shown. The lifting plate  51  is in a relaxed un-pulled position. The distal airflow bottom wall  29   a , the distal airflow side wall  29   b  and the central groove  29   c  are shown. 
         FIG. 12 c     2 —A view of the  FIG. 12 c     1  after the lifting plate  51  being pulled up. Consequently, the right and left edge of the lifting plate  51  are contacting the inner surface of the sac wall  81  and pushing right and left sac wall  81  further toward the right and left side. The right and left sac airflow channel  78 , 79  are further opened. The spilt space  18   b  is labeled. 
         FIG. 12 d   —Cross sectional view through the air tube distal segment  15 , showing outside shape of air tube as square like, the top tube airflow channel  30 , the right tube airflow channel  32  and the left tube airflow channels  31 , and a cross section the drainage passage  100  which is combination of the first drainage tube  101  and second drainage tube  102 . 
         FIG. 12 e   —Cross sectional view through the air tube proximal segment  13  distal to the y point  18 , showing how a circle shaped air tube lumen can be divided by the drainage passage. As similar fashion as the air tube distal segment  15 , the air tube lumen can be divided as a top tube airflow channel  30 , a right tube airflow channel  32  and a left tube airflow channel  31 . 
         FIG. 13 —Posterior view of the device, Show the right and left bottom fluid grooves  77 , the distal drainage tube  109 , alternative design of having two the band anchors  65   a  and having two the hooks  28 , one on the back of the air tube and another on the back of the drainage passage  100 . 
         FIG. 14 a   , left side view of a simplified drawing of alternative design, focus on showing the alternative design of the distal airflow tube  38  is painted as striped area. The distal airflow tube  38  is pre-made as an up-curved. The device is in process of an insertion and the air tube distal segment has been bent by an operator&#39;s hand, the split space  18   b  which is space between the distal airflow bottom wall  29   a  and the sac central protruding surface  39  become very small. The divergent plate lower edge  28   c  is suspension in the air. The divergent plate stopper  28   d  is on the air tube bottom wall in this drawing, but it can be configured on the air tube side walls. The left band anchor  65   a  the left pulling band  66  and the un-pulled lifting plate  51  are shown. 
         FIG. 14 b   —left side view of  14   a , after the device has been inserted into throat and the lifting plate  51  has been pulled up by the pulling bands  66 . The bent air tube distal segment has been relaxed in some degree, the distal airflow bottom wall  29   a  is away from the sac central protruding surface  39 . The split angle or space  18   b  is greater. Increased the airflow pressure inside the right and left tube airflow channel during the intermittent positive pressure ventilation has pushed the divergent plate  28   a  to swing distally, the divergent plate lower edge  28   c  has reach the divergent plate stopper  28   d  and been stopped by the divergent plate stopper  28   d.    
         FIG. 14 c    Top view simplified drawing to show the distal airflow bottom wall  29   a , the central groove  29   c , and the right and left divergent plates  28   a , the divergent plate lower edge  28   c  and the divergent plate upper edge  28   b  which is painted as double lines. The rest of related structures using dotted lines. Please note that width of the right and left divergent plate  28   a  are narrower than the right and left tube airflow channel  32 ,  31 . 
         FIG. 15 a   —showing the third embodiment configuration, no any type of drainage tubes are configured. The lifting plate  51  is pulled up and the air sac  119  is wide open. The sac bottom wall is optionally configured to have the sac central thickening zone  39   a  on the sac bottom wall therefore the sac bottom wall is divided into the right and left sac airflow channel  118   a ,  118   b . The inward strip  86 , sac wall descending edge  82 , sac distal pocket cover  121 , the air tube distal opening  117 , the tube groove  118   c  and the sac distal plug  122  are shown. The pulling unit is same as in the first and second embodiment. 
         FIG. 15 b   . Simplified drawing of a distal portion of the third embodiment focus on showing the distal airflow segment  118  and air holes  116 . The air tube distal opening  117  becomes smaller in cross section area than its beginning at where the distal airflow segment  118  transitions into the air tube distal segment  15 . 
     
    
    
     LEGEND LABELS 
     First Embodiment  10 —device  12 —air tube lumen  13 —air tube proximal segment  15 —air tube distal segment  16 —right or left air tube side wall  17 —air tube bottom wall  18 —Y point  19 —air tube anterior or top wall  20 —air tube proximal opening  21 —upward ramp central groove  22 —upward ramp  23 —downward ramp  25 —indentation line  28 —hook or hooks  29 —air tube distal opening or air tube distal edge  30 —top tube airflow channel  31 —left tube airflow channel  32 —right tube airflow channel  33 —drainage passage shared middle wall  35 —drainage passage top wall  36 —right or left drainage passage side wall  37 —drainage passage bottom wall  39 —sac central protruding surface 
       51 —lifting plate  52 —right or left plate side edge  53 —plate distal edge  55 —right or left plate sealing petal  56 —right or left corner sealing fold  57 —right or left plate sealing bump  58 —right and left epiglottis elevation plates  59 —central epiglottis elevation plate  90 —sac sealing belt  83 —right or left sac wall holding zone angle ( 55 —right or left plate sealing petal,  56 —right or left corner sealing fold ,  57 —right or left plate sealing bump,  90 —sac sealing belt,  83 —right or left sac wall holding zone angle, all together collectively called enhanced sealing means) 
       60 —pulling unit  61 —band proximal junction  62 —band hole  63 —band tail  64 —band bridge  65 —band sliding pad  66 —right or left pulling band  68 —right or left band distal end  69 —band distal converged 
       70 —sac top opening  71 —sac vertical attachment edge  72 —sac horizontal attachment edge (sac vertical attachment edge  71  and sac horizontal attachment edge  72  together collectively called sac proximal attachment)  73 —sac airflow middle wall  75 —sac airflow channel bottom wall  76 —sac airflow channel side wall  77 —right or left bottom fluid groove  78 —right sac airflow channel  79 —left sac airflow channel 
       80 —air sac  81 —right or left sac wall  82 —right or left sac wall descending edge  83 —sac wall holding zone angle  85 —sac wall holding zone  86 —right or left inward strip  87 —sac distal edge  88 —sac wall proximal edge  89 —sac distal pocket cover 
       90 —sac sealing belt  91 —lower horizontal edge  92 —upper horizontal edge  93 —umbrella distal edge  95 —bar lifting assembly  96 —right or left side fold  97 —central fold  98 —right or left lifting bar  99 —sac distal pocket 
       100 —drainage passage  101 —first drainage tube  102 —second drainage tube  104 —second drainage tube proximal opening  108 —second drainage tube distal opening  103 —first drainage tube proximal opening  105 —distal drainage tube distal opening  106 —right or left distal drainage tube side wall  107 —distal drainage tube bottom wall  109 —distal drainage tube  111 —central drainage tube  114 —central drainage tube proximal opening  113 —central drainage tube distal opening  112 —fluid entrance  115 —fluid hood 
     Second Embodiment 
       15   a —distal airflow channel  18   b —split angle or split space  18   c —spit point  28   a —right or left divergent plate  28   b —divergent plate upper edge  28   c —divergent plate lower edge  28   d —divergent plate stopper  29   a —distal airflow bottom wall  29   b —right or left distal airflow side wall  29   c —central groove  29   d —incomplete top wall  38 —distal airflow tube  65   a —right or left band anchor  66   a —right or left pulling stick  99   a -sac lifting plate 
     Third Embodiment 
       39   a —sac central thickening zone  116 —air holes  117 —air tube distal opening or air tube distal edge  118 —distal airflow segment  118   a —right sac airflow channel  118   b —left sac airflow channel  118   c —tube groove  119 —air sac  119   a —air tube proximal segment  119   b —air tube distal segment  120 —air tube lumen  121 —sac distal pocket cover  122 —sac distal plug  123 —sac distal pocket 
     DETAIL DESCRIPTION OF THE INVENTION 
     First Embodiment 
     The first embodiment comprises an air tube, an air sac, a tongue lifting means, and pulling unit  60  with a drainage system,  FIG. 1-11, 13 . 
     Air Tube: 
       FIG. 1, 2, 3, 4, 5, 6   a ,  6   c ,  7   a ,  7   b ,  8   c ,  9   a ,  9   b ,  9   c ,  9   d ,  10   a ,  10   b ,  10   c ,  11 ,  11   a ,  11   b   1 ,  11   b   2 ,  11   c   1 ,  11   c   2 ,  11   d ,  11   e ,  13 , the air tube is a hollow tube includes an air tub proximal segment  13  and an air tube distal segment  15 , and is opened at the air tube proximal opening  20  and at air tube distal opening  29 , also interchangeably called air tube distal end or edge  29 . The air tube  11  can be subjectively divided into an air tube proximal segment  13  and an air tube distal segment  15 . Preferably the air tube distal segment  15  is curved anteriorly. The air tube proximal opening  20  is configured to be connected with any currently used respiratory equipment. 
     A cross section of outside shape of the air tube can be configured in different geometric shapes. The air tube lumen cross section can be in a circle, semicircle, ellipse, semi-ellipse, oval, squares, rectangles, trapeziums, or a combination. Preferably, the air tube distal segment  15  in the present invention is configured as a rectangle-like shape, with rounded corners where it would contact soft tissues of pharynx,  FIG. 11   d.    
     In first embodiment of the present invention the air tube outside shape is different from its inside shape. The air tube outside shape in cross section can be configured as horizontal rectangle and is surrounded by an air tube bottom wall also called posterior wall  17 , an air tube top wall also called anterior wall  19 , and a right and left air tube side walls  16 . 
     Shape of the air tube lumen varies along the air tube length. A drainage tube, called drainage passage  100 , has smaller cross section area than air tube and is configured inside the air tube lumen  12  and couple to the air tube middle bottom wall longitudinally fora length starting from the air tube distal end  29  toward the air tube proximal opening  20 . About three to eight centimeters from the air tube proximal opening  20 , the drainage passage separates from the air tube and bends posteriorly away from the air tube bottom wall  17 , or the air tube bends anteriorly away from the drainage passage  100 , thereby forming a “Y” shaped separating point, called a Y point  18 . Or in other words, at the Y point  18  the drainage passage  100  “invade” longitudinally into the air tube lumen and follows the air tube in same direction passing beneath the air tube distal opening  29  and share the middle strip of the air tube bottom of air tube bottom wall  17  in side of the air tube lumen. From they point to the air tube proximal opening  20 , the shape of the air tube inside and outside lumen can converge and gradually becomes circular to be connected with industrial standard respiratory equipment. 
     The cross section of the drainage passage  100  can be configured as different geometric shapes same as a cross section of the air tube, and preferably is a rectangle or square shape. The drainage passage  100  can be configured differently in different embodiments but they all do not communicate with air tube lumen. In the first embodiment, the drainage tube  100  includes a first drainage tube  101  and a second drainage tube  102 . The both tubes are hollow fluid drainage tubes, share a common wall  33  and do not communicate with each other. 
     Therefore from the Y point  18  to the air tube distal opening  29 , the actually cross section area of the air tube lumen has is reduced, and the drainage passage is divided or reshaped the air tube lumen to an inverted “U” shape with a top bar and two legs on right and left side in a cross section. In other words, in a cross section view, outside shape of the air tube looks like a rectangle, but inside shape of the air tube lumen looks like an inverted “U” shape. The top bar or upper part of the air tube lumen is called top tuber airflow channel  30 , right and left legs on right and left side of the drainage passage  100  are called right tube airflow channel  32  and left tube airflow channel  31  respectively. Please note that there is no completely physical dividing line among the three airflow channels and they are in fluid communication. In one configuration, all three airflow channel stop just at the conjunction between the air tube and the air sac, or the right and left tube airflow channel  32 , 31  can extend further distally. The end of the top tube airflow channel is called the air tube distal opening  29 . Therefore the cross section of the air tube lumen prior to the Y point  18  has very different shape than at the air tube distal opening  29 . The air tube lumen in cross section view at the air tube distal opening  29  is a sum of cross sections of the top tube airflow channel  30 , the right tube airflow channel  32  and the left tube airflow channel  31 . The air tube lumen in cross section view at the air tube proximal opening  20  is circular-like shaped  FIG. 11   e.    
     AS shown in the  FIG. 3, 6   b ,  11   c   1 ,  11   c   2 ,  11   d , the drainage passage top wall  35  will be at the bottom of a tube top airflow channel  30 . The right tube airflow channel  32  is surrounded incompletely by the air tube right side wall  16 , the right drainage passage side wall  36  and a right strip of the air tube bottom wall  17 . A left tube airflow channel  31  is incompletely surrounded by the left drainage passage side wall  36 , the air tube side wall  16  and a left strip of the air tube bottom wall  17 . 
     When an airflow enters into the air tube proximal end  20 , after passing the Y point  18 , the airflow will be divided and flow into these three channels toward the air tube distal end opening  29 . The right tube airflow channel  32  is configured to continue with the right sac airflow channel  78 , and the left tube airflow channel  31  is configured to continue with left sac airflow channel  79 . They will be discussed more later. 
     The air tube distal segment  15  is preferably flexible and resilient so that the tubes can be flexed to follow the curvature of the back of the person&#39;s or animal&#39;s tongue without requiring excessive force during insertion. In a preferred embodiment, the air tube distal segment  15  can have a preformed upward curve. And this preformed upward curve can be curved more under a force. The air tube distal segment  15  can be constructed by same material as the air tube proximal segment  13  or by different materials. Preferably the air tube is formed from a type of material that is preferably transparent and can provide operator visualization through the walls of the air tube. 
     The air tube is of sufficient length to extend from the laryngeal opening to beyond the lips of a human or animal. Preferably the air tube can be configured with a bite guard on the air tube proximal segment just distal from the Y point. The bite guard is sufficiently rigid to prevent a patient or an animal&#39;s teeth biting down or cutting off or excessively restricting lumens of the air tube. 
     After passing the air tube distal opening  29 , the drainage passage top wall bends upward forming a short upward segment, called an upward ramp  22 , then bends down to it original level, called a downward ramp  23   FIG. 2, 3, 7   a . Alternatively, the upward ramp and the downward ramp can be configured as a convex arch without an angle. In the middle of the upward ramp  22 , preferably a groove like depression is configured longitudinally, called an upward ramp groove  21 . The upward ramp groove  21  can provide guidance for passing a stylet, or a suction catheter into laryngeal inlet. If intubation is needed, an operator can manipulate a stylet tip to follow the upward ramp groove  21  into a laryngeal inlet. Once the stylet is inside of the tracheal, the operator can follow commonly used intubation steps to finish intubation. In an alternative design the upward ramp groove can be omitted, the upward ramp can still help to guide the tip of a stylet into the vocal cords opening. 
     The upward ramp  22  is a structure inside of the air sac and can guide the tube top airflow toward the laryngeal inlet once the airflow exits the air tube distal end  29  and therefore creates a direct airflow. The downward ramp  23  is configured to not obstruct the airflow from the sac distal pocket  99 . After the drainage passage  100  pass beneath the air tube distal end  29 , it continue with the distal drainage tube  109 . The distal drainage tube terminates at the air sac distal edge  87   FIG. 3, 6   a ,  8   c.    
     The directed air flow can create a more laminar air flow and reduces turbulent flow, therefore reduces airway resistance and work of the breathing which can play an important role during ventilation. In case of positive pressure ventilation, the direct air flow requires less inspiratory pressure to achieve same tidal volume. Subsequently possibility of air leakage and the air being forced into the stomach are also reduced. Therefore fewer complications and more effective positive pressure ventilation are achieved. This is one of important advantages of the present invention over currently used supraglottic airway devices. 
     Air Sac 
     The air sac, also called a sac, is a structure that “extended” distally beyond air tube distal opening  29 . The air sac  80  is configured like a “shoe” with “cutting off” posterior portion of the “shoe”. Space inside of the “shoe” is called air sac chamber. Top opening of the “shoe” is called sac top opening  70 . The “toe box” of the shoe is called sac distal pocket  99 . The most front end of the “toe box” is called air sac distal edge  87 . The proximal end of the air sac is coupled to the air tube distal segment  15 ,  FIG. 1, 2, 3, 6   a ,  8   c ,  9   a ,  9   c ,  9   d . Bottom of the “shoe” is called sac bottom wall. 
     The surface of the sac bottom wall is not even. On the surface of the air sac bottom wall, a central longitudinal protruding structure protrudes into the air sac chamber starting from the air tube distal opening  29 , and extending to the air sac distal edge  87 , called sac central protruding surface  39  which include the upward ramp  22  and the downward ramp  23 . The sac central protruding surface  39  is “sandwiched” by two depressed semi-circled like structures along its right and left side longitudinally, respectively called a right sac airflow channel  78  on its right side and a left sac airflow channel  79  on its left side. The shape of the sac central protruding surface  39  is configured to accommodate the distal drainage tube  109 . Preferably the sac central protruding surface  39  of the sac bottom wall shares the top wall of the distal drainage tube  109 . Or alternatively the sac central protruding surface  39  has its own separated layer above the top wall of the distal drainage tube  109 . 
     In a cross section view  FIG. 11 b     1 ,  11   b   2 ,  11   c   1 ,  11   c   2 , the sac airflow channel is a semi-circled or semi-ellipse like semi-open structure and has a convex side wall laterally, wall called a sac airflow channel side wall  76 , and has a curved bottom wall, called sac airflow channel bottom wall  75 , and has a sac airflow channel middle wall  73  which bends obliquely form the sac airflow channel bottom wall  75  to the sac central protruding surface  39 . 
     Longitudinally, the sac airflow channel side wall  76  extends up vertically further to form a trapezoid shaped plate on top of the sac airflow channel side wall  76 , called a sac wall  81 . Or in other words the right or left sac wall  81  fuses or transitions into the right or left sac airflow channel side wall  76  smoothly. The right or the left the sac walls  81  has a concave shaped inner surface toward each other. The right and left sac airflow channel  78 , 79  and the right and the left sac wall  81  are preferably molded together during manufacture. 
     The right and left most proximal edge of the sac wall are called sac wall proximal edge  88 . A proximal portion of right or left sac wall  81  is extend proximally 0.5-3 centimeter above the air tube top wall and beyond the air tube distal end  29 , this portion of the right and left of the sac wall  81 , either on right or left side called sac wall holding zone  85 . The right and left sac wall holding zones  85  are “standing” on the air tube top wall  19  vertically or almost vertically. The right and left sac wall holding zones are bent toward the middle and are vertically perpendicularly or near perpendicularly attaching to the air tube top wall. Therefore 0.5-3 centimeter length of the bottom line of the sac wall holding zone  85  is called sac horizontal attachment edge  72 . The right and left the sac horizontal attachment edge  72  are coupled to top wall of the air tube distal segment  15  starting at right and left of the corner of the air tube distal edge  29  toward to the middle. Accordingly the right and left of the sac wall holding zone  85  start to bend toward to each other at right and left side converged corner of the air tube top wall  19  and the right and left air tube side wall  16  at the air tube distal edge  29 . After the right and left sac wall holding zone  85  bend toward each other, the right and left sac wall proximal edge  88  are getting closer to each other but do not touch each other in the middle. The right and left sac wall proximal edge  88  are perpendicular or almost perpendicular to the air tube top wall  19  and are also the proximal edges of the right and left sac wall hold zone  85 ,  FIG. 6 a , 9 a   . There is a space between the right and left sac wall proximal edge  88 . The right and left pulling band  66  pass through the space between the right and left side of the sac wall proximal edges  88  and touch right and left sac wall proximal edges  88  respectively during the passing. When the pulling band  66  are pulled in tension, the band distal segment will push the right and left sac wall proximal edges  88  further apart. The most proximal end of the sac airflow channel side walls  76  of the sac airflow channel  78 , 79  is firmly attaching to the right or left air tube side wall  16  respectively, called sac vertical attachment edge  71 ,  FIG. 6 a , 8 a , 9 a , 9 b   . The sac vertical attachment edge  71  and the sac horizontal attachment edge  72  together function as an attachment tool to connect the air sac to the air tube distal segment  15 . The right sacs vertical attachment edge  71  and the right sac horizontal attachment edge  72  together constitute a right sac proximal attachment. The left sacs vertical attachment edge  71  and the left sac horizontal attachment edges  72  together constitute a left sac proximal attachment. They are collectively called sac proximal attachment. 
     In one embodiment the right or left the sac vertical attachment edge  71  continue with right and left air tube side wall at the air tube distal edge  29 , so there are no physical attachment lines visible. Alternatively the air sac vertical attachment edge  71  can be configured to extend beyond the air tube distal end  29  and firmly attach the air tube side wall  16  of the air tube distal segment  15 ,  FIG. 9 a , 9 b   . The attachment line of sac vertical attachment edge  71  preferably is within  3  centimeter distance from air tube distal edge  29 . Accordingly the sac horizontal attachment edge  72  will attach further proximally from the air tube distal end  29  on the air tube top wall  19 . In this alternative design,  FIG. 9 b   , the right or left the sac horizontal attachment edge  72  attaches the air tube top wall  19  first and then turns backward to the indention line  25  at where a lifting plate  51  couples with the air tube distal end  29 . The right or left sac horizontal attachment edge  72  will form an angle with right or left side edge line of the air tube top wall  19 , called the sac wall holding zone angle  83 ,  FIG. 9 b   . Therefore the right and left sac holding zone  85  will perpendicularly couple to the air tube top wall  19  and bending obliquely facing to each other. When the lifting plate  51  is pulled up and upper surface of the lifting plate will contact with right and left of the sac wall proximal edges  88  to form a seal to prevent the air leaking out from inside the air sac. The right and left sac wall holding zone angle  83  are one of enhanced sealing means or mechanism. 
     The function of the right and left sac wall holding zone  85  are that when a tongue lifting means is pulled up by the pulling unit  60  the right and left the sac wall holding zone  85  will contact and hold the lifting means to prevent the lifting plate  51  from being pulled too far proximally. Therefore the right and left of the sac wall holding zone  85  create a resistance to the lifting plate  51  when the tongue lifting means is fully pulled up. At same time the pulled the tongue lifting means will form a seal with the sac wall holding zone  85  to prevent air leakage. And at same time the sac wall holding zone  85  will be pushed by the tongue lifting plate means toward proximal direction. 
     The right and left sac airflow bottom walls  75  of the right and left the sac airflow channel  78 ,  79  are smooth continuation and transition to the right tube airflow channel  32  and left tube airflow channel  31  respectively. The right and left sac airflow channel  78 ,  79  are curving outward away from air tube distal opening  29  and then curving toward the middle to merge together. And the right and left the sac airflow channel bottom walls  75  turn up to fuse in the middle on the top of the distal portion of the distal drainage tube  109 . Preferably the right and left the sac airflow channel  78 , 79  have same cross section area and are shaped symmetrically. The semi-circle shaped right sac airflow channel  78  and the left sac airflow channel  79  are smoothly changed to the square-like shaped right tube airflow channel  32  and the left tube airflow channel  31  respectively. The smooth changes in physical structure would make the airflow from the right or left tube airflow channel smoothly flow into right and left sac airflow channel  78 , 79  without meaningfully increasing the airflow resistance. The air or gases inside of right and left sac airflow channel  78 , 79  are freely communicating with the air sac chamber. 
     The right and left distal portion of the sac airflow channel  78 , 79  bend up and merge in the middle to form a pocket like structure with an opening toward the air sac chamber, called the sac distal pocket  99 . Top wall of the sac distal pocket  99  is preferably configured as a thinner layer and extends more proximally, called a sac distal pocket cover  89 . The sac distal pocket cover  89  is preferably thin plastic or silicone like material with more flexibility and compressible. The sac distal pocket cover  89  can be compressed down during the device insertion and can be pushed up by airflow inside of the sac distal pocket  99  during inspiration phase. 
     The sac distal pocket  99  is positioned on top of the distal portion of the central longitudinal protruding surface  39  or the distal drainage tube  109 . The distal side of the sac distal pocket  99  is closed. The airflow cannot flow out the distal end of the sac distal pocket  99 . The airflow can only flow out from beneath of the sac distal pocket cover  98  toward the air sac chamber. Therefore airflow inside the sac distal pocket  99  can cumulate and then push up the easily flexed sac distal pocket cover  89  therefore to make the sac distal pocket cover  89  forming a tighter seal with the posterior laryngeal wall during the inspiratory phase of the respiratory circle, especially in intermittent positive pressure ventilation. The sac distal pocket cover  89  is the top wall and an integrated part of the sac distal pocket  99 , but preferably it can be manufactured as a thinner layer therefore to have more flexibility and expandability than rest of the sac distal pocket. 
     Top edges of right and left sac wall  81  are bent inward toward each other but do not touch each other, and form a right and a left smooth bending narrow strip longitudinally on top of the right and left sac wall  81 , called a right or a left inward strip  86 . Longitudinally, when the right and the left sac wall&#39;s inward strip  86  are going distally and descend diagonally down to form right and left distal edges of the sac wall  81 , called a right or a left sac wall descending edge  82 . The right and left sac wall descending edge  82  are smoothly continuing and transition to the sac distal pocket cover  89 . 
     The right and left inward strip  86  are obliquely positioned toward each other in a relaxed state before being pushed up by a tongue lifting means, such as the lifting plate  51 . And their oblique positions will be turned upward when the right and left inward strip  86  are pushed up or “turned up” by the distal end of the rising lifting plate  51  therefore to open the sac top opening  70  further. 
     Since the right and left sac wall inward strips  86  are structurally continuing with the right and left sac wall holding zone  85  when the sac wall holding zone  85  are pushed proximally by the lifted lifting plate  51 , the sac wall holding zone  85  will pull the inward strip  86 . And since the inward strip  86  is continuing with right and left sac wall descending edges  82 , the sac wall descending edges  82  are continuing with the sac distal pocket cover  89 . The pulled inward strip  86  will pull the right and left sac wall descending edges  82 , the right and left sac wall descending edges  82  will pull the sac distal pocket cover  89 . When the sac distal pocket cover  89  is pulled tight and intense, it will form a tighter seal with posterior laryngeal wall. At same time, the tensed the right and left sac wall descending edges  82  will keep the right and left sac airflow channel  78 , 79  open and prevent it being compressed by surrounding pharyngeal tissues. All these reactions together form like a “chain reactions” than will keep the right and the left sac airflow channel  78 ,  79  and the sac distal pocket  99  open, and form the seals at differently regions around the laryngeal inlet, and prepare the right and left sac airflow channel  78 , 79  and the sac distal pocket  99  to be expanded by the incoming airflow. 
     The right and left sac wall descending edges  82  are significantly vertical or perpendicular in relation to right and left inward strip  86  and the sac distal pocket cover  89 . After the device is inserted into a patient throat, the sac distal pocket cover  89  is to be under the posterior wall of the larynx, the right and the left sac wall descending edges  82  are to contact right and left side structures of the laryngeal inlet and create a resistance which can be felt by an operator&#39; hand and therefore giving a stopping signal to stop insertion. This is another function of the right and left sac wall descending edges 
     The airflow in the tube top airflow channel  30  will flow toward the vocal cords opening. Airflow in the right and the left tube airflow channel will flow into the right and left the sac airflow channel  78 , 79  of the air sac  80  respectively. Then the airflow inside of the right and left sac airflow channel  78 , 79  will continue to flow distally into the sac distal pocket  99  to “inflate” the sac distal pocket  99 . Finally the airflow flow out the sac distal pocket  99  from the beneath of the sac distal pocket cover  89  into the air sac chamber to participate in the air exchange. This channeled airflow will play important role to push the air sac to form a further conformal seal with pharyngeal walls and tissues around the laryngeal inlet during inspiration phase of a respiration cycle. And the pushing force is the inspiratory pressure dependent and is proportion to the inspiratory pressure. The pushing force will subside during the expiratory phase of a respiratory circle. 
     This channeled airflow can also dissipate the excessive pressure to make a further seal if an excessive pressure applied accidently by an inexperienced operator. 
     The sac distal pocket cover  89  is a thin plastic or silicone or other compatible material film on top of the sac distal pocket  99 . Preferably it is made same material as the sac distal pocket  99  but manufactured thinner. The sac distal pocket cover  89  will be pushed up by inspired airflow inside of the sac distal pocket  99  especially during positive pressure ventilation to form a seal with posterior wall of the larynx, and also help to form a seal with upper esophagus opening. The seal, provided by sac distal pocket, can prevent the regurgitated esophageal fluid to ingress into the air sac, and at same time can prevent the ventilating gases from ingressing into the stomach or being pushed into stomach when spontaneous ventilation or positive pressure ventilation is applied. 
     The whole air sac is made of the materials with certain compressibility, elasticity and plasticity, such as plastics, polymers or other alike. The shape of the right and left sac airflow channel  78 , 79  and the sac distal pocket  99  can be compressed to a certain extent to accommodate local anatomy and during insertion of the device. The air sac would evenly distribute the sealing pressure on the surrounding tissues and not put too much pressure on a specific area of the pharynx or the larynx during forming the seal. The flexibility and elasticity of the air sac also makes the right and the left sac airflow channels and the sac distal pocket  99  able to be pulled or pushed for more opening and can be expandable when pressured airflow flow into the right and the left sac airflow channels and the sac distal pocket  99 . All these features will accommodate each individual anatomy variations well and establish a seeming “self-sealing” mechanism. 
     Inside the space between the right and left sac wall  81  and the sac wall holding zone  85 , a tongue lifting means and a portion of the pulling bands  66  are configured. 
     Tongue Lifting Means 
     The tongue lifting means is a structure can be pulled up and consequently push up the tongue base. The tongue lifting means and pulling unit  60  are two different elements. They are connected or coupled to each other and working together. 
     The tongue lifting means can be configured as a lifting plate  51 , or a bar lifting assembly  95 . The both can be configured at the upper edge of the air tube distal end  29  and are lifted by the pulling unit  60 . The both are used as a lifting means to push up the tongue base and can be collectively called the tongue lifting means. 
     The lifting plate  51  is a plate can be made of plastic, silicone, polymers and other like materials or even metal materials with some flexibility and elasticity features. The lifting plate  51  is preferable a distal extension of the air tube top wall  19  at the air tube distal end  29 . Or alternatively an independent of plate couples with the top wall of air tube distal opening  29 . 
     The lifting plate  51  can be different geometric shapes, such as: square, rectangle, trapezoid, round, elliptic or half elliptic, hexagon and so on, and can be flat, curved as concave or convex shapes at different regions of the lifting plate  51 , angled or not angled and so on. In a preferred embodiment, the lifting plate  51  has trapezoidal shaped without sharp angles. The wider base side of the trapezoid of the lifting plate  51  is coupled to top edge of the air tube distal opening  29 . The most distal edge of the lifting plate  51  in general is parallel to the top edge of the air tube distal edge  29 , called plate distal edge  53 , and is configured to be bent down when meeting a resistance from above. The right or left side of the lifting plate  51  is called right or left plate side edge  52 . In relaxed un-pulled position, the lifting plate  51  is parallel or almost parallel with bottom wall of the air sac with its lower surface facing to the air sac bottom wall. One or two distal ends of the pulling bands  66  are coupled to upper surface of the lifting plate. When the pulling unit  60  is being pulled by an operator, the pulling bands  66  will pull the lifting plate  51 , the lifting plate  51  will move up diagonally in which the plate distal edge  53  will move in a arch curved trajectory. Preferably the lifting plate  51  is manufactured as extension of the air tube top wall but is thinner than the air tube top wall  19 . And the connection between the lifting plate  51  and the top edge of the air tube distal edge  29  is preferably configured to have a shallow indentation line, called the indentation line  25 ,  FIG. 8 c , 9 b   . The indentation line  25  is to make the connection between the lifting plate  51  and the top edge of the air tube distal edge  29  “weaker” therefore easy to be bent. The lifting plate  51  can use the indentation line  25  as a bending “joint” to form a dull angle with the air tube top wall  19  at the air tube distal end  29  when the lifting plate  51  is pulled up diagonally. The indentation line  25  is a part of the lifting plate  51 . 
     The right and left plate side edges  52  are also configured to bend down slightly when the lifting plate is in a relaxed un-pulled position and can be bent more. When the lifting plate  51  is pulled up the right and left lifting plate side edges  52  will push the right and left sac wall to further outward, and at the same time the right and left lifting plate side edges  52  will be bent by the right and left sac side walls  81  further therefore to increase contact area with the concave inner surface of the right and left sac wall  81  to form seal which can prevent the airflow inside of the air sac chamber escaping from the proximal side of the air sac. The diagonal upward movement of the lifting plate  51  will make the lifting plate distal edge  53  contacts with the tongue base and be bent further and therefore forms a seal with the tongue base. 
     In a preferred embodiment, two round protrusions extending from the lifting plate distal edge  53  can be configured, called epiglottis elevation plates  58   FIG. 6 c , 8 b , 9 b , 10 a , 10 c   . Each of the two epiglottis elevation plates  58  is positioned on right and left side of the plate distal edge  53 . Alternatively only one epiglottis lifting plate can be configured in the middle of the plate distal edge, called a central epiglottis elevation plate  59 ,  FIG. 10 b   . Both types of the epiglottis elevation plates can be configured in many different shapes, preferably like round protrusions from the plate distal edge  53 . They may or may not be on same horizontal plane as the lifting plate  51 . The epiglottis elevation plates  58  and the central epiglottis elevation plate  59  are collectively called epiglottis elevation means. During the tongue lifting plate  51  being pulling up, the epiglottis elevation means will move up diagonally and contact the lower surface of the epiglottis either on the right and left side or center of the epiglottis, and then push up the epiglottis to open the laryngeal inlet. And they also are able to keep the epiglottis elevated while the lifting plate  51  is being kept at an elevated position. Therefore the laryngeal inlet will be kept open during ventilation. This mechanism will greatly facilitate laminar airflow. If the epiglottis elevation plates misses contact with the epiglottis, the epiglottis elevation plates will contact with the tongue base or nearby tissues. In ether situations, the epiglottis elevation plate will help increase the portion of the laminar airflow and effectiveness of intermittent positive pressure ventilation or spontaneous ventilation. 
     The epiglottis elevation plates are preferably made same materials as the lifting plate  51 , and the lifting plate  51  s preferably is made same material as the top wall of the air tube distal segment. But they can be constructed with different materials. In an alternative embodiment, the epiglottis elevation plates  58  and the central epiglottis elevation plate  59  can be omitted. 
     In one embodiment,  FIG. 8 c   , the tongue lifting means is configured like an “umbrella”. It is configured as two or more bars with three or more folds, called bar lifting assembly  95 . The bars are belt shaped rod, called lifting bar  98  and have certain flexibility but less than the flexibility of the folds. When the bar lifting assembly  95  is in relaxed un-pulled state, the bar lifting assembly  95  has its proximal edge couples to the air tube distal end  29 , and its distal end free in the air, called umbrella distal edge  93 . And in this configuration, the right and left sac wall holding zone  85  are configured to extend more toward the middle of the air tube top wall  19  which make the right and left sac wall proximal edges  88  further close to each other. The bar lifting assembly  95  is horizontally or almost horizontally facing down the air sac bottom wall when it is in relaxed un-pulled position. Preferably two lifting bars are configured to separate further as the both bars extending distally further. Therefore the when lifting bars  98  are pulled up diagonally the each bar will contact inner surface of the sac wall  81  to push the sac wall  81  toward right and left side, and also the each bar will contact the sac wall holding zone  85  to push the sac wall holding zone  85  toward proximal direction. At same time the pulling band of the pulling unit  60  will be tightened and push the right and left sac wall proximal edges  88  to right and left side to further open the sac top opening  70 . One fold is configured between the two lifting bars  98  and connects the two lifting bars  98 , called a central fold  97 . Another two folds connect the lateral edge of each lifting bar  98  to the inner surface of the right and left sac wall holding zone  85 , called right or left side fold  96 . The central fold  97  is shaped like a vertically wedge shaped without bottom triangle. The central fold  97  and the right and left fold  96  are thin film like and all of them can be easily folded expanded with more flexibility than the lifting bar  98 . The umbrella distal edge  93  is flexible and bendable. when the bar lifting assembly  95  is pulled up diagonally, the umbrella distal edge  93  which includes the distal ends of the lifting bar  98  is to form a seal with the tongue base. The pulling unit  60  will have two distal ends and each of them will couple to a lifting bar  98 . When the pulling unit  60  pulls the lifting bar  98 , the bars will be diagonally moved up, the central folds  97  will be unfolded in the middle to the touch and to be easily bent to accommodate shape of the tongue base therefore to form a conformable seal with the tongue base. The right and left side fold  96  will accordingly unfold and prevent the air escape from the air sac chamber. The whole the bar lifting assembly  95  will function like previously described the lifting plate  51  to form seal with the sac wall holding zone  85  and prevent ventilation gases leaking out from the air sac chamber. 
     In one embodiment, a horizontal rectangle shaped plate, called sac sealing belt  90 , is configured to connect lower portion of the right ad left sac wall proximal edges  88  which also are edges of the right and left sac wall holding zone  85 ,  FIG. 9 c   . The sac belt  90  has upper horizontal edge  92  and lower horizontal edge  91 . The right and left side edge of the sac sealing belt  90  is connect or smoothly fuses or transitions into the lower portion of the right and left the sac wall proximal edges  88  which are about ¼-¾ height of sac wall proximal edges  88 . The lower horizontal edge  91  can be curved and straight line and is coupled to the air tube top wall  19  just proximal to the air tube distal opening  29  or the indentation line  25 . The sac sealing belt  90  is to seal the space between the lifting plate  51  and right and left sac wall holding zone  85 . 
     Alternatively, a portion of the lifting plate  51  along it&#39;s the right or left side edge area within 2 centimeter distance from the right or left plate side edge  52  respectively, can be configured like a round bulging-up column longitudinally, like a “speedy bump” on a driveway, called right or left plate sealing bump  57 ,  FIG. 10 a   . When the lifting plate  51  is pulled by the pulling bands, the plate sealing bump  57  will move up diagonally with lifting plate and contact and form a seal with sac wall holding zone  85 . 
     In another alternative design, portion of the lifting plate  51  on its the right and left side can be shaped like a half petal of a rose with its convex surface bulging toward upside during relaxed un-pulling horizontal position,  FIG. 10 c    called plate sealing petal  55 . When the lifting plate  51  is pulled by the pulling unit  60 , the plate sealing petal  55  will move up diagonally too, and the right or left plate sealing petal  55  will contact and form a seal with the right and left sac wall  81  or the sac wall holding zone  85 . 
     Further alternatively,  FIG. 9 a   , a similar wedge-shaped thin film or alike with folding and unfolding capability like a “folding hand fan” has been configured to connect right and left side of the lifting plate  51  to the right and left the sac wall holding zone  85  the sac wall proximal edge  88 , called right or left corner sealing fold  56 . The both attachment lines are within 0.3-1.5 centimeter from the right or left side of the lifting plate side edge  52 . The right or left corner sealing fold  56  is connecting the lower portion of sac wall holding zone  85  or lower portion of the sac wall proximal edge  88 . The lower portion is about ½-¾ height of sac wall holding zone  85  when the lifting plate  51  is pulled up. The right and the left the corner sealing folds  56  also tightly attach to the air tube top wall  19  near air tube distal opening  29 . The right and left corner sealing folds  56  are configured to seal the space between sac wall holding zone  85  and right and left lateral area of the lifting plate  51 . 
     In above described five designs or alternative designs, the sac sealing belt  90 , the plate sealing bump  57 , the plate sealing petal  55 , the corner sealing fold  56  and the sac wall holding zone angle  83 ,  FIG. 9 b   , all of them are to enhance the sealing between the right and left sac wall holding zone  85  and the right and left side lateral are of the lifting plate  51 , therefore they are collectively called enhanced sealing means. The enhanced sealing means serve as an important tool to prevent the gases leakage from the air sac chamber in the present invention and intends to seal the space between the tongue lifting means and the right and left sac wall holding zones  85 . However the enhanced sealing means can be omitted. 
     Pulling Unit 
     The pulling unit  60   FIG. 1, 2, 2   a ,  3 ,  3   a ,  4 ,  10   a ,  10   b ,  10   c ,  13 ,  15   a  are one or more bands and are designed to pull up the tongue lifting means, and consequently the tongue lifting means will push up the base of tongue. At the same time the pulling band  60  can pull up the tongue base independent of action of pulling the tongue lifting means. When the base of the tongue is raised, laryngeal inlet surrounding area will be open up more to allow the air flow more directly toward laryngeal inlet to generate a more laminar airflow. Because the pulling force is coming from an operator&#39;s hand, the operator can feel and adjust the puling force, such as in an obese patient who may need more force to push the tongue base to exposure the laryngeal inlet. Finally the right and left pulling bands  66  of the pulling unit  60  are positioned on right and left side of the tongue base. Therefore when they are tightened, the right and left pulling band  66  can hold and stabilize the tongue in an elevated position. With flexibility and elasticity, the right and left pulling bands  66  are able to accommodate the shape of the tongue base well for each individual. 
     There are many different ways to configure different pulling unit  60  to achieve a same goal. But basic concept of using an operator hand generated mechanical force to lifting the tongue base is same and an essential, and is within scope of the protection of this invention. 
     In one embodiment, the pulling unit  60  are two belt shaped flexible strips or bands which merge together at their proximal ends, in the middle and in the distal ends. Or in another way to describe, one long band is divided into two narrower strips a couple of times during its longitudinal course. The pulling unit  60  can be made by many different materials, such as plastic, silicone, other polymers, metals or even fabric, but plastic or silicone are preferred materials. Preferably the pulling unit  60  has certain elastic and flexible property which can limit the possibility of tissue damage. 
     The configuration of pulling band  60   FIG. 1, 2, 3, 10   a ,  10   b ,  10   c ,  13 , includes a band tail  63 , one or more band holes  62  on the band tail  63 , a bands proximal junction  61 , right and left pulling band  66 , the band sliding pad  65  and one or two band distal ends. In one embodiment, the right and left pulling bands  66  converge at their distal end to form a single distal end to attach to the lifting plate  51 , called the band distal converged end  69 . In a preferred embodiment, the two distal ends of the right and left pulling bands  66  will be separately attach to right and left side of the lifting plate  51 , called the right or left band distal end  68 ,  FIG. 8 b , 9 b , 10 a   . Alternatively, at close to the end of right and left bands distal end, a band bridge  64  can be configured to connect the right and left pulling bands  66  before finally attach the right and left side of the lifting plate  51 ,  FIG. 10   c.    
     Proximal to the Y point  18 , on posterior wall of the air tube or on the anterior wall of the drainage passage  100 , a hook  28  is configured for holding the band holes  62  or the band proximal junction  61 . Alternatively two hooks  28  can be configured on right and left air tube side wall  16  and one or more band holes  62  can be configured on the pulling band  66  of the pulling unit  60  respectively. Therefore the hooks  28  on the right or left air tube side walls  16  will hold the band holes  62  on the right or left pulling band  66  separately. The hook  28  or the hooks are to hold one of the band holes  62  or the band proximal junction  61 . Therefore an operator can free a hand. And the distance from each band hole to its distal end is premeasured and predetermined. Therefore an operator can make an estimate for each patient and make an appropriate adjustment during operation. The more that the pulling distance is pulled, the more pulling force on the lifting plate  51  which will push up the tongue base further. And at same time the pulling force of the pulling unit  60  will also lift up the tongue base. Up lifting of the tongue base will open up more space around laryngeal inlet. Therefore the operator can adjust the pulling distance to change the tongue&#39; position by putting different band holes or the bands proximal junction  61  on the hook  28  or the hooks in different clinical scenarios. Also respiratory parameters, such as tidal volume, airway resistance and so on can be used as references to achieve a balance between an individually optimized openness of the laryngeal inlet and unnecessary pressure on the tongue base or surrounding tissues. 
     The band sliding pad  65  is configured to slide against the air tube posterior wall to convey operator&#39;s pulling force to the right and left pulling bands  66  and to the lifting plate  51 . And also the band sliding pad  65  is to keep the right and left pulling band  66  on the right and left side of the air tube to avoid being bitten by a patient&#39;s or animal&#39;s teeth. The band sliding pad  65  will slide against the air tube posterior wall and move proximally when the pulling tail  63  is pulled by an operator. However, alternatively the band sliding pad  65  can be omitted. 
     In a preferred embodiment, the right or left band distal end  68  separately attach to the right and left side of the lifting plate  51 . The right and left pulling bands  66  are touching the sac wall proximal edges  88  when the pulling unit  60  are in a relaxed un-pulled state. When pulling band  66  is pulled the pulling band  66  will be tightened in tension and will push the right and left sac wall proximal edges  88  aside therefore to push the right and left sac wall holding zone  85  aside and to further open the sac top opening  70  and the tightened right and left pulling bands  66  will also directly lift the tongue in addition to pulling up the lifting plate  51 . And the pull bands  66  on the right and left side can help to stabilize the tongue&#39;s position during the tongue being elevated. 
     In summary, an operator will have to pull the pulling unit  60  to change physical position of some parts of the device before the device can perform its functions. Before the lifting plate  51  is pulled, right and left inward strip  86  of the air sac are configured towards each other. But they are not in contact in the middle and there is gap between right and left inward turning. When tongue lifting plate  51  is pulled up diagonally by an operator, the right and left sac wall  81  are pushed outward by raising the lifting plate  51  to enlarge the sac top opening  70 ,  FIG. 2, 2   a ,  11   c   1 ,  11   c   2 ,  12   c   1 ,  12   c   2 . And the plate distal edge  53  will also push up the right and left inward strip  86  which will open the sac top opening  70  further. At same time raising the lifting plate  51  will push right and left the sac wall holding zone  85  toward proximal direction which consequently will stretch and pull the inward strip  86  in proximal direction. The right and the left inward strip  86  will stretch and tighten the right and the left sac wall descending edges  82  and then the right and left sac wall descending edges  82  will keep the right and left sac airflow channel open to be expanded further by incoming airflow and to form seal with right and left pharyngeal wall. This chain reaction also will tighten and encourage the sac distal pocket cover  89  to further contact posterior laryngeal wall to form a seal. This mechanical force generated sealing mechanism is a major mechanism of the present invention to form seal with surrounding structures and is to set a stage for function of a second sealing mechanism. 
     The second mechanism to make the air sac  80  to form further seal with the surrounding tissue is when the divided airflow from the air tube enter into right and left sac airflow channel  78 , 79  during inspiration phase of a respiratory cycle, especially during intermittent positive pressure ventilation, the pressurized airflow from the right and the tube airflow channel  32 , 31  into the right and left sac airflow channel  78 , 79  will push and expand the right and left sac airflow channel  78 , 79  and push right and left sac airflow channel side wall  76  further laterally to make further seal with right and left pharyngeal wall. Then the airflow flow into the sac distal pocket  99  to push up sac distal cover  89  to form a seal with posterior wall of the larynx. This is an airflow sealing mechanism which is synchronized with respiration circle. During inspiration, the airflow pressure is increasing inside the sac airflow channel  78 , 79  and the sac distal pocket  99  to form the seal. During expiration the airflow pressure is decreasing in side the sac airflow channel  78 , 79  and the sac distal pocket  99  to avoid constant pressure on surrounding tissues and to reduce chance of tissue damage. Finally the airflow flow out from the sac distal pocket  99  into the air sac chamber. This second sealing mechanism is that the inspiratory airflow pressure drive the divided airflow to follow specific route to create pressure to the sac airflow channel  78 , 79  and the sac distal pocket  99  to form seals. 
     The hand generated mechanical force by an operator to cause these deformation changes of the device as described above is essential prior to the device to perform its functions. 
     Drainage System At the present invention, drainage system  FIG. 2, 2   a ,  3 ,  3   a ,  5 ,  6   c    7   a ,  7   b ,  9   d ,  11   d ,  11   a ,  12   a ,  12   d ,  13  can be reconfigured few different ways in different embodiments. They can include the drainage passage  100 , a distal drainage tube  109 . Or the drainage system can be configured to have one or two drainage tubes inside the drainage passage  100  with or without the distal drainage tube  109 . And the drainage passage  100  can be configured different ways. All these arrangements and re-arrangements are within protection scope of the present invention. 
     In the first embodiment, the drainage passage is configured to include a first drainage tube  101  and a second drainage tube  102 . The first drainage tube  101  continues distally with the distal drainage tube  109  therefore the both constitute the major drainage system in the first embodiment. The second drainage tube  102  can be omitted. 
     The first drainage tube  101  and the second drainage tube  102  are both hollow tubes and have their own proximal opening and their own distal opening, called the first drainage tube proximal opening  103 , second drainage tube proximal opening  104 , and second drainage tube distal opening  108 . 
     At the proximal end of the drainage passage  100 , there are a second drainage tube proximal opening  104  and a first drainage tube proximal opening  103  to be connected to an outside suction separately. The drainage passage  100  has a top wall, called drainage passage top wall  35 , right and left drainage passage side wall  36 . And its bottom wall shares the middle portion of the air tube bottom wall longitudinally. The both travel together inside the air tube lumen and are positioned next to each other and are sharing a common middle wall  33 , collectively called the drainage passage  100 . At the present invention the second drainage tube  102  is on left side of the first drainage tube  101 , but this position can be switched. 
     Cross sections of the first drainage tube lumen and the second drainage tube lumen can be formed in different geometric shapes and their variations, such as: square, rectangle, circle or semicircle and so on. In present invention, the both lumens are a rectangle or square alike. And preferably the lumen size of the second drainage tube is smaller than the first drainage tube  101 . Alternatively the both lumen size can be same. The total cross section area of the both lumens is smaller than air tube lumen cross section area. 
     After passing beneath of the air tube distal opening  29 , the first drainage tube  101  continues distally with the distal drainage tube  109 . Or the first drainage tube  101  and the distal drainage tube  109  can be described as one drainage tube and just change the name to the distal drainage tube  109  after passing underneath the air tube distal opening  29 . A distal opening of the distal drainage tube  109 , called distal drainage tube distal opening  105 , terminates at the air sac distal edge  87  under the sac distal pocket  99 . 
     Function of the first drainage tube  101  is together with the distal drainage tube  109  to drain the fluid from the upper esophagus. Once the first drainage tube  101  passes the air tube distal end  29 , the distal drainage tube  109  travels beneath the air sac bottom wall and protrudes into the air sac chamber longitudinally to form the sac central protruding surface  39  as previously described. In cross section the distal drainage tube  109 , square or rectangle shaped the distal drainage tube  109  has a distal drainage tube bottom wall  107 , a distal drainage tube right and left side wall  106  and a top wall. The top wall of the distal drainage tube  109  shares the longitudinal middle portion of the air sac bottom wall which is on the top of the central longitudinal protruding surface  39 . When the air sac is in a horizontal position, the distal drainage tube right or left side wall  106  is vertically positioned and the sac airflow middle wall  73  is obliquely traveling from the sac central protruding surface  39  down to the sac airflow channel bottom wall  75 . Therefore viewing form the bottom of the air sac, there are two longitudinal gaps along the right and left the distal drainage tube side wall  106 , called the right or left bottom fluid groove  77 . The right or left bottom fluid grooves  77  are formed by the right and the left distal drainage tube side walls  106  and the right and left sac airflow middle walls  73 . The right or left bottom fluid groove  77  are like a triangle shaped hood in a cross section to let fluid or secretions on the posterior pharyngeal wall cumulated there and to be suctioned out by the second drainage tube  102 . The rhythmic expansion of the right and left sac airflow channel  78 , 79  during respiratory circle can facilitate accumulation of the fluid or secretion under the right or left bottom fluid groove  77 . The distal drainage tube bottom wall  107  may or may not reach same lowest level of the sac airflow channel bottom wall  75 . 
     Alternatively the sac airflow middle wall  73  can share the vertically positioned the right and left distal drainage tube side walls  106  which will make the right and the left sac airflow channel  78 , 79  become square like in a cross section. Therefore in this alternative design there will be no the right and left bottom fluid groove  77 . 
     The lumen of the first drainage tube  101  and the distal drainage tube  109  can be configured big enough to allow a fiber-optic-scope-probe or a currently used smaller oral-gastric tube passing through into a patient&#39;s stomach. 
     The second drainage tube  102  has its second drainage tube distal opening  104  passing beneath the air tube distal end  29  and terminates at the right or left bottom fluid groove  77 . The second drainage tube  102  is to drain the fluid or secretion cumulated under the right or left bottom fluid groove  77  where the fluid cumulate between the air sac bottom wall and patient&#39;s posterior wall of the throat. At present drawings the second drainage tube  102  is on the left side of the drainage passage  100 . The fluid cumulated under the bottom fluid groove  77  can easily enter into the second drainage tube distal opening  108  and then to be suctioned out by an outside suction device. In an alternative embodiment, second drainage tube  102  can be omitted. 
       FIG. 9 d   , in another alternative embodiment, the second drainage tube  102  and the distal drainage tube  109  are omitted. The drainage passage is configured as a single hollow drainage tube, called central drainage tube  111 . A central drainage tube  111  has replaced the drainage passage  100 . The central drainage tube  111  has a central drainage tube proximal opening  114  and a central drainage to be distal opening  113 . The central drainage tube distal opening  113  terminates shortly after passing beneath the air tube distal end  29 . The central drainage tube distal opening  113  is totally separated from the air tube distal opening  29  by the air sac bottom wall. Otherwise the configuration of the air tube lumen, outside shape of the air tube, the air sac and tongue lifting means, and the pulling unit  60  are all completely the same as described previously described. But in the  FIG. 9 d   , the pulling unit  60  is not shown for the purpose of a better showing the central drainage tube  111 . Viewing from the bottom surface of the air sac will have a longitudinal central vacant area, called fluid hood  115 , which used to be occupied by the distal drainage tube  109 . The distal end of the fluid hood  115  is an entrance for fluid from the upper esophagus, called fluid entrance  112 . When the patient is in supine position, the fluid from the upper esophagus passes through the fluid entrance  112  and enters the area under the fluid hood  115  at where the fluid cumulate and then flow into the central drainage tube  111  via the central drainage tube distal opening  113  to be sanctioned out. An outside suction device can be connected to the central drainage tube proximal opening  114  as usual. The expanding and un-expanding of the sac airflow channel  78 , 79  by inspired gases during a respiratory circle can have some propelling effect to move the fluid on surface of the surrounding tissues into area under the fluid hood  115  when a patient is in a supine position. 
     The Second Embodiment 
     In second embodiment, if an element is configured with the same function as in the first embodiment, the same name and number label will be assigned. If an element has same function but configuration is not completely same as in the first embodiment, then a same name but a different number label will be assigned. 
     The second embodiment has the same configuration of the tongue lifting means, the pulling unit, and the drainage system as in the first embodiment. But few new alternative designs have been configured, which are a distal airflow tunnel, divergent plate  28   a , sac lifting plate  99   a , pulling stick  66   a , and band anchor  65   a . Structures of the upward ramp  22  and the downward ramp  23  have been deleted. The rest of configuration of the air sac will be same as in the first embodiment,  FIG. 2 a , 3 a , 6 b , 8 a , 8 b   ,  12 ,  13 ,  14   a ,  14   b ,  14   c . 
     The air tube outside shape in cross sections in the air tube distal segment  15  is same as in the first embodiment also preferably configured as horizontal rectangle or alike, and is also surrounded by same air tube bottom wall also called posterior wall  17 , same air tube top wall  19 , and same right and left air tube side walls  16 . And inside of the air tube lumen shape will be divided into three channels, starting from the Y point  18 , same as in the first embodiment. However, at in the air tube distal segment  15 , a distal airflow tube  38  or a distal airflow channel  15   a  and divergent plates  28   a  have been added. 
     The top tube airflow channel is becoming a tube-like structure with completely physically surrounding walls after separating from the right and left tube airflow channel  32 ,  31 , and is extending further distally into the air sac, called the distal airflow tube  38 . The distal airflow tube  38  is a length of a tube structure and is preferably configured as a rectangle-like shaped tube with an upper wall, two side walls and a bottom wall. The distal airflow tube  38  can also be configured as square, trapezoid, ellipse or semi-ellipse, circle or semi-circle or other geometric shape or combinations, or its shape can be changed over its course. 
     The distal airflow bottom wall  29   a  is a sheet of thin plastic material with similar property as the air tube distal segment  15 , preferably with more flexibility. Distal airflow bottom wall  29   a  starts and extends from the drainage passage top wall  35  in the air tube distal segment  15  toward distally. Its right and left side edges couple with inside of right and left air tube side wall  16  and therefore to constitutes a complete and independent bottom wall of the distal airflow tube  38 . The starting point of the distal airflow bottom wall  29   a  is physically and completely separating point between the between the distal airflow channel  38  and right and left tube airflow channels  32 ,  31 , called split point  18   c . The distal airflow tube  38  is a continuation of the top tube airflow channel  30 . Two side walls of the distal airflow tunnel  38  are continuation of the air tub side walls  16  but become narrower, called right and left distal airflow side wall  29   b . The upper wall of the distal airflow tube  38  is continuation of the air tube top wall  19 . All these surrounding walls extend distally same length and stop at same time to constitute the most distal opening of the entire air tube, called air tube distal opening  29 , or air tube distal edge  29 . The right and left tube airflow channels  32 ,  31  will terminate at or near the split point  18   c  and smoothly transition to the right and left sac airflow channels  78 ,  79  respectively. 
     Alternatively, at the air tube distal opening  29 , a distal portion of the top wall of the distal airflow tube  38  can be deleted structurally, rest of the top wall is called incomplete top wall  29   d ,  FIG. 3 a , 6 b   . Therefore, the air tube distal opening  29  becomes an irregular shaped and enlarged. This configuration is called distal airflow channel  15   a . The distal airflow channel  15   a  will have same distal airflow bottom wall  29   a , right and left distal airflow side walls  29   b  as the distal airflow tube  38  but have a incomplete top wall  29   d . The distal opening of the distal airflow channel  15   a  is also called the air tube distal opening  29 , or interchangeably called the air tube distal edge  29 . 
     The distal airflow tube  38  and the distal airflow channel  15   a  both preferably are configured to bend up in a smooth curve therefore the distal airflow bottom wall  29   a  forms a sharp angle with the distal drainage tube  109 , or in other words with sac central protruding surface  39 . This angle is called split angle  18   b , or interchangeable called split space  18   b ,  FIG. 3 a , 6 b , 14 a , 14 b , 12 c     1 ,  12   c   2 . The distal airflow tube  38  and the distal airflow channel  15   a  both are configured to guide airflow and deliver the airflow closely toward the vocal cords opening. The both are collectively called the distal airflow tunnel. 
     The tube -shaped distal airflow tube  38  is also configured to create a focused, restricted, or jet-like airflow and direct this airflow to the vocal cords opening during intermittent positive pressure ventilation (IPPV). In contrast the distal airflow channel  15   a  is also to create a focused, restricted or jet-like airflow but is able to deliver the jet-like airflow in a wider spectrum toward vocal cords opening due to its enlarged distal opening. 
     The split space  18   b  is configured to be changeable for its angle degree. Before being inserted into a patient or animal&#39;s throat, the split space  18   b  is a small space, during insertion of the device because the operator need to bend the air tube distal segment  15  and the air sac  80 , therefore the distal airflow bottom wall  29   a  will contact or even press on the distal drainage tube top wall or the sac central protruding surface  39 . The distal airflow bottom wall  29   a  will be forced to contact the distal drainage tube top wall or the sac central protruding surface  39  therefore the split space  18   b  become smaller or disappear. After the device is inserted in a proper position, the operator&#39;s hand remove the bending force, the air tube distal segment  15  and the distal airflow bottom wall  29   a  will resume their original angularity because of the elasticity of the materials of the device, therefore the split space  18   b  become bigger again. This ability of changing degree or space of the split space  18   b  is configured to facilitate the device insertion,  FIG. 14 a   ,  14   b.    
     In a preferred embodiment, in the middle of the distal and in long axis of the device the distal airflow bottom wall  29   a  is configured to have a groove like longitudinal depression, called central groove  29   c . The central groove  29   c  is like a guide groove for a stylet, and is to guide a stylet easily toward the vocal cords opening in a case of an intubation is needed after the device inserted in a proper position. And also because the distal airflow bottom wall  29   a  is curved up toward the vocal cords opening and the distal airflow tunnel opening or edge  29  is in proximity with the vocal cords opening, an operator can use a stylet to follow the central groove  29   c  and to push the stylet into the vocal cords opening during the intubation. 
     In one embodiment, a right and a left divergent plate  28   a  have been configured,  FIG. 14 a , 14 b , 14 c   . Each of the divergent plate  28   a  is trapezoid or rectangle or ellipse or semi-ellipse like shaped thin bendable plates with its width substantially narrower than width of the left tube airflow channel  31  or right tube airflow channel  32  therefore airflow can pass through right or left side of the divergent plate  28   a  toward distal direction. The divergent plate  28   a  can be configured as many other different geographic shapes, but preferably is configured as trapezoid shape with its wider side, called divergent plate upper edge  28   b , connected with proximal edge of the distal airflow bottom wall  29   a . The narrower side of the divergent plate  28   a  is suspended in the air, called the divergent plate lower edge  28   c . The right and left divergent plate lower edge  28   c  will not touch the air tube bottom wall  17  when are in naturel position and are not being pushed by a force. Alternatively the divergent plate  28   a  is extension of the distal airflow bottom wall  29   a  therefore the divergent plate upper edge  28   b  would be omitted. Therefore in this configuration, a fixed amount airflow will be diverted into the distal airflow tunnel. 
     The divergent plate  28   a  are diagonally or semi-vertically positioned inside the right or left tube airflow channel  32 ,  31 . The divergent plate  28   a  are design to be narrower than the right or left tube airflow channel  32 , 31  and are narrow enough to allow enough amount airflow pass around the right or left side of the divergent plate  28   a . The amount of the passed airflow allow can be predetermined during manufacture therefore divergent plate  28   a  would only “block” a portion of the airflow. 
     Consequently the divergent plate  28   a  will “block” a certain amount of airflow in the right or left of the tube airflow channel  32 ,  31  and divert these “blocked” airflow into the distal airflow tube  38  or the distal airflow channel  15   a . However, a maximum amount of the airflow can be divergent into the distal airflow tunnel can be predetermined during manufacture. The larger total area of the divergent plate  28   a , the more airflow will be “blocked”, especially in IPPV. The more airflow is diverged into the distal airflow tunnel during intermittent positive pressure ventilation or during spontaneous ventilation, the more airflow pressure will be increased inside of the distal airflow tunnel. Therefore, a focused, restricted or a jet-like airflow is created especially during intermittent positive pressure ventilation. The pressure increased focused or restricted or jet-like airflow will be directed to the vocal cords opening. Additionally, the distal opening of the distal airflow tunnel is designed to near the vocal cords opening; therefore the present device can be effectively used to perform mechanic ventilations. 
     In another embodiment, the divergent plate upper edge  28   b  is configured similarly like indentation line  25  which is “hinge” like or thinner linear structure and is readily to be bent under a force. The right and left side  28   b  have similar “hinge” function. During inspiration phase of intermittent positive pressure ventilation, an increased inspiratory airflow pressure inside of the right and left tube airflow channel  32 ,  31  will push the divergent plate  28   a  swinging distally by using the divergent plate upper edge  28   b  as bending hinge, therefore the divergent plate  28   a  will become more vertical position and divergent more airflow flowing into the distal airflow tunnel. Ability of how much force to bend the divergent plate upper edge  28   b  can be pre-determined. Even though the divergent plate upper edge  28   b  is readily bendable, the divergent plate upper edge  28   b  is also configured strong enough only to be bent by predetermined amount of pushing force, and also is strong enough to resume the divergent plate  28   a  original position after the airflow force stopped during expiration phase of IPPV. During the expiration, the divergent plate  28   a  can resume their original positions to let airflow freely venting out. Therefore, the divergent plate  28   a  is like self-adjustable valve. 
     A control mechanism of swing distance or moving distance of the divergent plate  28   a  has been configured and can be designed in different ways. However, the concept is within protection of present invention. 
     To control the moving distance, a divergent plate stopper is configured on the air tube bottom wall  17 , or on the right or left drainage passage side wall  36 , or on the inside of the right or left air tube side wall  16 , all called the divergent plate stopper  28   d    FIG. 14 a , 14 b   . The divergent plate lower edge  28   c  is a free edge suspending in air if not being pushed by an incoming positive pressure airflow inside the right or left tube airflow channel  32 ,  31  and stay a predetermined distance from the divergent plate stopper  28   d . The divergent plate stopper  28   d  will stop distal movement of the divergent plate lower edge  28   c  once the divergent plate lower edge reaches the divergent plate stopper  28   d  in predetermined moving distance. Alternatively, the right or left divergent plates  28   a  can be simply configured longer enough to reach and be stopped by air tube bottom wall  17  without configurations the divergent plate stopper  28   d . No matter by using the divergent plate stoppers  28   d  or the air tube bottom wall  17  as a tool to stop the movement of the divergent plate  28   a , they are collective called the divergent control means. 
     If a positive airflow pressure to push the divergent plate  28   a  is not very strong and can only swing the divergent plate lower edge  28   c  half way to reach the divergent control means, the less amount of the airflow will be divergent by the divergent plate  28   a  into the distal airflow tunnel. Therefore the “selective” bendability of the divergent plate upper edge together divergent control means have established self-adjustable capability for diverging a predetermine amount of the airflow, or an automatic self-adjusted airflow division mechanism, called airflow self-control mechanism. The airflow self-control mechanism can “automatically” choose to divide and guide more or less amount incoming airflow inside of the right and left tube airflow channel  32 ,  31  into the distal airflow tunnel according the airflow pressure during intermittent positive pressure ventilation. 
     When the device is used for a spontaneous respiration, during inspiration airflow in from proximal to distal along the air tube lumen is due to a negative inhale pressure generated by a patient or animal, the negative inhaled pressure is much less powerful and may not strong enough to move the divergent plate  28   a  significantly. 
     The distal airflow channel  15   a  has an enlarged the air tube distal opening  29  and can deliver the pressured focused or jet-like airflow toward the vocal cords opening in a wider angle. In contrast, the distal airflow tube  38  has narrow the air tube distal opening  29  and can direct pressurized focused or jet-like airflow towards the vocal cords opening more precisely manner, during IPPV. 
     The upward ramp  22  inside of the air sac in the first embodiment is to guide the airflow toward the vocal cords opening, the upward ramp central groove  21  is to guide a stylet into the vocal cords opening. The both function have been replaced by the distal airflow tunnel in the second embodiment. The rest of air sac configurations in the second embodiment are same as in the first embodiment. 
     An alternative design of the tongue lifting means, called sac lifting plate  99   a  has been configured. When being pulled, the sac lifting plate  99   a  can lift the tongue base in the same fashion as the lifting plate  15  or the bar lifting assembly  95 . And the sac lifting plate  99   a  can also be constructed in the first embodiment in replacing function of the lifting plate  15  or the bar lifting assembly  95 . The sac lifting plate  99   a  is a thin plate made with plastic, or silicon or other materials with similar properties. The sac lifting plate  99   a  fuses with right and left the sac wall proximal edge  88  and close the gap between the sac wall proximal edge  88 . The lower edge of sac lifting coupling to the air tube top wall  19  via the indentation line  25  in same fashion as in the first embodiment. The right and left pulling bands  66  or the pulling stick  66   a  will attach to the sac lifting plate  99   a  via the right and left band distal ends  68 , and pull up the sac lifting plate  99   a  in same fashion as the lifting plate  15  or the bar lifting assembly  95 . In this configuration the sac wall  81  would be configured more flexible and foldable. When the sac lifting plate  99   a  is in relaxed un-pulled position, the sac lifting plate  99   a  will be manufactured as “pushed” down position in which the sac lifting plate  99   a  is positioned more horizontally than vertically positioned. The sac lifting plate  99   a  is semi-facing down to the sac bottom wall. Therefore, the sac lifting plate  99   a  will make the right and left sac walls bend or fold partially into the air sac chamber. When the sac lifting plate  99   a  is pulled up by the pulling band  66 , the sac lifting plate  99   a  will stretch the inward strips  86  and the sac wall descending edges  82  intense and same time pull up the right and left sac walls  81  and therefore open up the sac top opening. The sac lifting plate  99   a  also can be used in the first embodiment in combination with other elements. 
     The pulling unit  60  can be configured same as in the first embodiment. However, an alternative of the pulling stick  66   a  are configured with same function of the pulling band  66 . Also the pulling anchors  65   a  have been configured as alternative of the band sliding pad  65 . 
     At the right and left air tube side wall  16 , or the air tube bottom wall  17 , or air tube top wall  19 , or the corner of the right or left air tube side wall  16  and the air tube bottom wall  17  or corner of the right or left air tube side wall  16  and the air tube top wall  19 , one or more pair of prominent or tubercle-like structures are configured on right and left symmetrically along the air tube, called band anchors  65   a . The band anchors  65   a  can be shaped as a smooth protruding tubercle with a groove beneath, or a face down semi-opened hook. The band anchors are used as anchor to allow the right and left pulling bands  66  or the pulling sticks  66   a  to move back and forth easily, and to convey the pulling force to the right and left band distal end  68 . 
     The pulling stick  66   a  is a curved shape with semi-rigidly thin rod, and the curve can be bent further or straighten under a force in certain extent. The curvature can be variable. A portion curvature of the pulling stick  66   a  is preferably manufactured with similar curvature of the air tube distal segment  15 . The right and left pulling bands  66  or the pulling sticks  66   a  can also use the right and left band anchors  65   a  as anchors to move back and forth and to be kept on right and left side of the air tube. The distal end of the right and left pulling stick  66   a  are also attach to the tongue lifting means same way with same function as described in the first embodiment, so also called the right and left band distal ends  68 . The pulling stick  66   a  is an alternative design of the pulling band  66 , therefore all concept and claim of the pulling bands  66  will be fully apply to the pulling stick  66   a.    
     Further alternatively, the pulling stick  66   a  can be configured as a portion as semi-rigid stick and a portion as more flexible bans or string, or curved spiral like. These variable configurations can perform similar functionalities as the pulling band  66  and belong to variation of same concept, are all protected in the present invention. 
     All above those alternative designs, such as but not limited, the band anchor  65   a , the sac lifting plate  99   a  and the pulling anchor  66   a  are to be optionally used to replace their counterpart&#39;s function in the first embodiment. 
     The drainage system in the second embodiment would be same as in the first embodiment and can choose or omit one or more drainage tubes or different combinations. 
     The Third Embodiment 
     Same as previously, if an element is configured same with same function as in the first embodiment, the same name and number label will be assigned. If an element has same function but configuration is not completely same as in the first embodiment, then a same name but a different number label will be assigned. 
     The third embodiment will comprises an air tube, an air sac, the tongue lifting means and the pulling unit  60  without any drainage tube configuration which will simplify the manufacture process. 
     Referring to  FIG. 15 a , 15 b    the air tube include an air tube proximal segment  119   a  and an air tube distal segment  119   b  and is a hollow tube as no structure inside the air tube lumen  120 . Therefore, the outside shape of the air tube is same as inside. The air tube has proximal opening  20  and an air tube distal opening  117  or the air tube distal edge  117 . The tongue lifting means and the pulling unit  60  are completely same as in the first and the second embodiments. However, the  FIG. 15 a    only uses the lifting plate  51  as a representative for the tongue lifting means. And all three designs of the tongue lifting means are couple to the top wall of the air tube distal segment  15  via the indentation line  25  in the same fashions as in the first and second embodiments. The pulling unit  60  and hook or hooks  11  are configured in the same as in the first and second embodiment,  FIG. 15   a.    
     A distal portion of the air tube distal segment  119   b  is configured to extend distally inside the air sac  119 . This portion of the air tube distal segment  15  is a tube like structure, called distal airflow segment  118 . A cross section area of the distal airflow segment  118  can be same as the air tube distal segment  119   b , but preferably is smaller. The smaller cross section area is more likely to create a focused, directed or a jet-like airflow same principle as the distal airflow tunnel in the second embodiment. The distal airflow segment  118  bends up as a smooth curve and has a distal opening which is the air tube distal opening  117 , also called the air tube distal edge  117 . 
     The air tube distal opening  117  is the most distal end of the whole air tube same concept as in the first and second embodiments. The preformed bend-up shape of the distal airflow segment  118  is configured to guide airflow toward the vocal cords and to deliver the airflow close to the vocal cords opening for the same purpose as the distal airflow tunnel in second embodiment. 
     Proximally 0.2-3 cm from the air tube distal edge  117 , a pair of hole or few pair of holes have been configured on the right and left side wall of the distal airflow segment  118  or right and left side of the bottom wall of the distal airflow segment  118 , or combination of the both, called air holes  116 ,  FIG. 17 b   . The air holes  116  can be different geometric shapes, rectangle, triangles, ellipse or circle, preferably circles. Diameter of these holes can be from 0.1 cm to 2.5 cm. Because the distal airflow segment  118  has been preformed bend-up, the up-curve shape can make the airflow not easily flow into the right and left sac airflow channel  118   a ,  118   b . The air tube holes  116  are configured to let a portion of incoming airflow from the air tube easily flow into right and left sac airflow channel  118   a ,  118   b . The airflow entering the right and left sac airflow channel  118   a ,  118   b  are to inflate the right and left sac airflow channel same mechanism as described in the first and second embodiments. Therefore, the air holes  116  at distal end area the air tube are served as a tool to divide the airflow. Please note that just like in the first and second embodiments, even though an incoming airflow is divided into three airflows, but these three airflows once get out from there physically structured airflow channel, they are still able to meet and mix inside of the air sac. Even though design or mechanism of how dividing the airflow by the air holes is different from the first and second embodiment, the essential concept of dividing incoming one airflow into three directions, one toward to vocal cords opening, other two toward to the right and left sac airflow channel respectively, is same and is within scope of protection of the present invention. 
     However the air sac  119  is configured differently. In the third embodiment, the airflow inside the air sac may or may not be divided. In one design, the sac central protruding surface  39  is replace by a central longitudinal belt shaped thickening protruding area, called sac central thickening zone  39   a . Along right and left side of the sac central thickening zone  39   a  a right sac airflow channel  118   a  and a left sac airflow channel  118   b  have been configured to function similarly as the right and left sac airflow channel  78 ,  79  in the first and second embodiment. However, the right and left sac airflow channel  118   a ,  118   b  will be configured shallower than previously described the right and left sac airflow channel  78 ,  79 . Alternatively, the sac central thickening zone  39   a  can be omitted therefore the sac airflow channels  118   a ,  118   b  would be omitted too. 
     The distal portion of the air sac can be configured to have a sac distal pocket  123 . On top of the sac distal pocket  123  there is also a thinner top film or plate, called sac distal pocket cover  121 . The distal end of the air sac  119  is configured as a plug shaped with a round enclosed end to block the upper esophagus opening, called sac distal plug  122 . The sac distal pocket cover  123  is configured similar as the sac distal pocket  99  in the first and second embodiments. Similarly the inspired airflow enters inside the sac distal pocket  123  can push up the sac distal pocket cover  121  to form a seal with the posterior laryngeal wall. 
     A portion of inspired airflow during inspiratory phase of a respiratory circle will flow into the air sac  119  and a portion of the airflow will flow into the sac distal pocket  123  which can expand the sac distal pocket  123  therefore to further enhance the seal with the upper esophagus in addition to a plugging function of the sac distal plug  122 . The sac central thickening zone  39   a  will strengthen the air sac  119  and make the device easier to be inserted into throat and not easily twisted or folded. The rest of element of the air sac, such as the sac wall descending edges  82 , the inward strip  86 , the sac wall holding zone  85  the sac vertical attachment edge  71 , the sac horizontal attachment edge  72  and the sac airflow channel side wall  76  have same configurations as in first and second embodiments. 
     In an alternative design, the air holes  116  can be omitted to further enhance the increasing airflow pressure inside of the distal airflow segment and deliver more airflow toward the vocal cords opening. 
     At the bottom wall of the distal airflow segment  118 , a groove like indentation is configured to guide a stylet for an intubation same purpose as the upward ramp central groove  21  and the central groove  29   c . Therefore, all three grooves are collectively called stylet groove. 
     As previously mentioned, all elements of all three embodiments can easily be exchanged and create a new combination of design, but these new configurations are based on same concepts and are completely protected by the present invention. 
     OPERATIONAL EXAMPLE 
     The present device is to be used as a supraglottic airway device for spontaneous or intermittent positive pressure ventilation, and can be used as a conduit to guide a stylet into the vocal cords opening during an endotracheal intubation. The device is first prepared for insertion. Outside surface of the distal and middle portion of the device are well lubricated. 
     An operator will use one hand to open a patient&#39;s or animal&#39;s mouth by using a standard technique. The other hand holds the device and inserts the sac distal edge  87  into a patient or animal&#39;s against the roof middle line of the mouth. The operator continue to push the device and same time make the device bend more anteriorly for more easily sliding down around the curvature of the back of the tongue. When the device is inserted in a certain depth, the operator&#39;s hand will feel increased resistance and is difficult to advance more. This is indication that the device is in a proper position. The depth marks on the air tube wall can also be used as a reference. 
     After the device is in the proper position, an operator will start pulling the band tail  63  of the pulling unit  60 . The pulling band  66  will pull up the lifting plate  51  or its alternative design of the bar lifting assembly  95  or the sac lifting plate  99   a . The plate distal edge  53  of pulled the lifting plate  51  will touch the tongue base and be bent to form seal with the tongue base. The epiglottis elevation plates  58  or the central epiglottis elevation plate  59  will also be raised and most likely touch and push the epiglottis up to further open the laryngeal inlet. The plate distal edge  53  also will push up the right and left inward strip  86 . At same time the right and left plate side edges  52  will further touch the inner surface of the sac wall  81  and push right and left sac wall  81  aside to open up more of the sac top opening  70 . The pulling bands  66  or the right or left pulling sticks  66   a  will pull the right and left sac wall proximal edge  88  further apart. Then the operator can dock one of the band holes on the hook  11  or hooks  11  so the operator can free one hand. And then operator connects respiratory equipment to the air tube proximal opening  20 . 
     The first and second drainage tube&#39;s proximal openings can be connected suction device separately or their common outlet as needed. In a long surgical case, after the device is inserted and the above processes are completed, the operator should reexam and adjust the tightness of the pulling bands by docking different band hole on the hook  11  according each specific patient condition. This can further limit pressure on the pharynx tissue and the tongue base, and diminish a chance of tissue damage. A proper sized oral gastric tube can be passed through the first drainage tube  101  and the distal drainage tube  109  into esophagus and into stomach to suction out the fluid and small particles. If the central drainage tube  111  is configured in the alternative design  FIG. 7 b   , an outside suction device can be connected with the central drainage tube proximal opening. 
     If an endotracheal intubation is needed, a commercially available stylet with a bent tip, such as, not limited, a Bougie, can be used and an operator just follow a currently standard maneuver to do intubation. However in the present invention, the central groove  29   a  or the tube groove  118   c  in the third embodiment can provide a guide for the stylet toward the vocal cords opening. Any currently available fiber-optic-scope-probe can be inserted into proximal opening of the air tube and advance all the way to the air tube distal opening  29  or the distal airflow outlet opening  117  in the third embodiment to help intubation under vision.