Patent Publication Number: US-2020275830-A1

Title: Medical device with an airway insertion member

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 15/747,132, filed Jan. 23, 2018, now allowed, which is a National Stage Entry of International Application No. PCT/US2016/045299, filed Aug. 3, 2016, which also claims priority to and the benefit of U.S. Provisional Patent Application No. 62/201,545, filed Aug. 5, 2015, each of which is hereby incorporated by reference herein in its entirety. 
    
    
     FIELD 
     The present invention relates to medical devices with an airway insertion member such as, for example, devices for performing a laryngoscopy. 
     BACKGROUND 
     The following description includes information that may be useful in understanding the present invention. It is not an admission that any of the information provided herein is prior art or relevant to the presently claimed invention, or that any publication specifically or implicitly referenced is prior art. 
     Laryngoscopy is a medical procedure that is us to obtain a view of the vocal folds and the glottis. Laryngoscopy is an examination of the larynx (voice box) using a small mirror held just below the back of the palate, or a rigid or flexible viewing tube called a Laryngoscope placed in the mouth of the patient. Laryngoscopy may be performed to facilitate tracheal intubation during general anesthesia or cardiopulmonary resuscitation or for procedures on the larynx or other parts of the upper tracheobronchial tree. 
     There are two types of laryngoscopy including both (1) indirect laryngoscopy and (2) direct fiber-optic (flexible or rigid) laryngoscopy. Indirect laryngoscopy is performed whenever the provider visualizes the patient&#39;s vocal cords by a means other than obtaining a direct line of sight. For example during intubation, this may be facilitated by fiberoptic bronchoscopes, video laryngoscopes, fiberoptic stylets and mirror or prism optically-enhanced laryngoscopes. 
     Fiber-optic or direct laryngoscopy examinations allow doctors to see deeper into the throat by using either a flexible or rigid laryngoscope. Direct laryngoscopy is carried out usually the patient lying on his or her back; the laryngoscope is inserted into the mouth on the right side and flipped to the left to trap and move the tongue out of the line of sight, and, depending on the type of blade used, inserted either anterior or posterior to the epiglottis and then lifted with an upwards and forward motion (“away from you and towards the roof”). This move makes a view of the glottis possible. The doctor will examine the throat area through the scope&#39;s eyepiece. 
     There are at least ten different types of laryngoscope used for this procedure, each of which has a specialized use for the otolaryngologist and medical speech pathologist. This procedure is most often employed by anesthetists for endotracheal intubation under general anesthesia, but also in direct diagnostic laryngoscopy with biopsy. 
     Tracheal intubation using a laryngoscope has been demonstrated to fail in up to 35% of patients with an unpredicted difficult airway. Problems in securing the airway are still the main contributors to anesthesia-related morbidity and mortality. 
     SUMMARY 
     During laryngoscope use in uncontrolled settings such as helicopters or ambulances, the flight nurse, paramedic, or the emergency physician may need to provide suction to the oropharynx before being able to visualize the target vocal cords for intubation, whether a direct visualization method or an indirect video assisted fiberoptic technique is used. Suctioning the airways requires the use of the right hand during the intubation procedure. The right hand toggles between the endotracheal tube and the suction catheter and causes delays in procedure completion. Moreover, the fiberoptic camera may become covered with blood during trauma intubation, which can render the technology useless. 
     Therefore, in the present state there is a need for an art to develop a laryngoscopy instrument that can be used together with suction and video enabled features, for better visualization. Accordingly, disclosed are laryngoscopes and other devices that include both a visualization feature and a suction component, to eliminate debris and bodily fluids and secretions that may accumulate on the visualization component. 
     For instance, an example device may include one or more internal visual-aid components, such as for example, lighting, video cameras or associated components to facilitate either direct or indirect visualization of, for example, the glottis and/or vocal cords, using the device. Additionally, the device may include one or more of the fluid intake ports that may be sized and located proximate to the operational ends of the visual-aid components, e.g., the camera lens or LED, to maintain a clean field of view for operation of the component. Application of the negative pressure or suction at the various ports may be controlled by a fluid control valve assembly or arrangement incorporated in the handle having, for instance, manually operated device, push-button, or controller for operating the fluid control assembly. 
     To provide for the fluid communication between the outlet and the various fluid ports of the blade and housing visual components, the device may include one, two or more internal passageways between the fluid ports and the outlet. 
     As a fluid conduit or flow path of the device, the internal passageways of the device are configured, dimensioned and/or shaped to facilitate desired fluid flow characteristics, flow rate, and/or pressure rates. For instance, non-circular channels (and especially square shaped channels) have been shown to be optimal for fluid flow of the secretions removed with suction in the present disclosure. Accordingly, in some examples, it was determined that a large square or elliptical channel proved to be the most optimal in terms of fluid flow in relation to the surface area or cross sectional area utilized by the fluid channels. 
     Moreover, the internal passageways of the device are located or arranged within the device to provide for the geometries or profiles of the blade previously described in order to facilitate preferred insertion and viewing of the glottis and/or vocal cards as described herein. Accordingly, as there is a limited amount of space in the airway for the laryngoscope, breathing tube, and space to view the trachea. The L-shape (rotated 90 degrees clockwise) of the laryngoscope blade, in some examples, has proven to be the best shape to maximize the viewing/tube passing “window” in the airway. To maintain that shape while integrating suction, the shape/location of the channels and inlets are rectangular channels in some embodiments, to maximize the cross sectional area usage efficiency that run through the blade and the bottom of the flange. 
     Additionally, the configurations, profiles, dimensions, shape and/or location of the passageways facilitate methods of formation and/or manufacturing of the device. Embodiments of the device may be made in a molding process in which two injection molded elements are formed and joined together. In most examples, it is difficult to injection mold the current blade shape and suction channels without splitting it into two halves along the longitudinal axis. Accordingly, the design of the device included lining up the suction channels so that at least one edge of the channel would line up with the split line. In some examples, the split line crosses the centerline of the scope in a couple places, which increases strength in critical areas. Additionally, “drafts” are included on all the walls, which are slight angles (0.5-1.5 deg) to allow the parts to easily exit the molds. For the suction channels, this results in greater channel height at the split lines relative to the outer walls of the channels. These features can also be included in the pathway for the electronic components. 
     In one preferred aspect, the device is configured for single use. Accordingly, the device  10  is preferably formed in a manner and from a material such that the device  10  is disposable. 
     In some examples, disclosed is a light switch that is integrated into the valve and suction control for the channels. For instance, the light switch may be a one-time use switch that requires the user to push the suction valve once to turn on the LED. 
     Additionally, disclosed is a handle design that is optimized to push the user&#39;s hand into a position where they can easily have leverage using just the palm of their hand and their four fingers, leaving the thumb free to operate the valve as needed. This also keeps the user from using the patient&#39;s teeth as leverage for lifting the top of the blade and generally makes the handle more comfortable to the user. 
     Many laryngoscopes have a semi-circular shape on the dorsal side of the tip of the blade to allow the user to better control the patient&#39;s tongue in the airway. However, in some examples, because the device includes integrated suction and the semi-circular shape could not fit, the device may include a roughened surface texture to give the physicians better control. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated herein and constitute part of this specification, illustrate exemplary embodiments of the invention and, together with the general description given above and the detailed description given below, serve to explain the features of the preferred embodiments of the invention. It should be understood that the preferred embodiments are some examples of the invention as provided by the appended claims. 
         FIG. 1  is a perspective view of an embodiment of a laryngoscope device. 
         FIG. 1A  is a perspective partial cross-section view of the device  10  in  FIG. 1 . 
         FIG. 1B  is a side-view of the device of  FIG. 1 . 
         FIG. 1C  is a distal end view of the device of  FIG. 1 . 
         FIGS. 1D-1G  are schematic cross-sectional views of the blade for use in the device of  FIG. 1 . 
         FIGS. 1H-1I  are plane views of the blade of  FIG. 1B  along lines II-II. 
         FIG. 2  is a partial cross-sectional schematic view of the device  10  of  FIG. 1  along plane P. 
         FIG. 2A  is a cross-sectional view of the blade in  FIG. 1B  along line IIA-IIA. 
         FIG. 2B  is schematic a cross-sectional view of the blade in  FIG. 1B  along line IIB-IIB. 
         FIG. 2C  is a schematic cross-sectional view of the blade in  FIG. 1B  along line IIC-IIC. 
         FIG. 2D  is a detailed cross-sectional view of a portion of the blade in  FIG. 2  at IID. 
         FIGS. 3A-3E  are various and alternate schematic assembly views of handle or blade portions of the device  10 .  FIG. 3A  is a cross-sectional view of the assembly components of handle portions of the device  10 .  FIGS. 3B-3E  are cross-sectional view of the assembly components of handle portions of the device  10 . 
         FIGS. 4A-4F  illustrate various embodiments of a fluid control assembly for use in the device of  FIG. 1 .  FIGS. 4A-4C  illustrate cross sectional views of an embodiment of a control assembly embodied as a gate valve.  FIG. 4D-4F  illustrate cross sectional views of embodiments of a control assembly embodied as a rotatable disc valve. 
         FIG. 5  is an illustration of using the device of  FIG. 1 . 
         FIG. 6A  is a side view of an embodiment of a laryngoscope device. 
         FIG. 6B  is a front view of an embodiment of a laryngoscope device. 
         FIG. 6C  is a cross sectional view of an embodiment of a laryngoscope device of  FIG. 6A  along the B-B axis. 
         FIG. 7A  is a cross sectional view of an embodiment of a laryngoscope device. 
         FIG. 7B  is a cross sectional view of an embodiment of a laryngoscope device. 
         FIG. 7C  is a cross sectional view of an embodiment of a laryngoscope device. 
         FIG. 7D  is a cross sectional view of an embodiment of a laryngoscope device. 
         FIG. 7E  is a cross sectional view of an embodiment of a laryngoscope device. 
     
    
    
     DETAILED DESCRIPTION 
     Overview 
       FIGS. 1, 1A, and 1B  illustrate an embodiment of a laryngoscope device  10  providing for direct and indirect visualization of the glottis, vocal cords in, for example, an intubation or post-intubation process. In some examples, the device  10  includes a handle  12  and a blade  14 . The handle  12  extends axially along a first axis A-A having a first end portion  12   a  and a second end portion  12   b . The blade  14  has a proximal end portion  14   a  and a distal tip portion  14   b  at the opposite end of the blade. The proximal end portion  14   a  extends from the first end portion  12   a  of the handle with the proximal end portion  14   a  and the distal tip portion  14   b  spaced apart from one another in the direction of a second axis B-B perpendicular to the first axis to define a first plane P bisecting the handle  12 . 
     The device  10  may have a proximal-to-distal overall length L 1  of about 162 mm with the blade  14  having a proximal-to-distal axial length of L 2  ranging from 105 mm to 110 mm. In a direction of a third axis C-C perpendicular to each of the first and second axes (A-A &amp; B-B) the device  10  has lateral surfaces  15   a ,  15   b  disposed about the bisecting plane P. When viewed in the proximal-to-distal direction, the lateral surfaces of the device  10  may define an outer lateral surface  15   a  and an inner lateral surface  15   b.    
     The laryngoscope device  10  can be inserted into the mouth and airway of a patient to view the glottis and/or vocal cords of the patient. The blade  14  preferably has a generally curved or arcuate profile as seen, for example, in the side view of  FIG. 1B ; and may have an outer curved profile like a Mac blade. Accordingly, the blade  14  has a concave upper or dorsal surface  16   a  and may have a convex lower or anterior surface  16   b  which are spaced apart to define a height H of the blade  14  between the dorsal and anterior surfaces  16   a ,  16   b  as shown in  FIG. 1C . 
     The height H of the blade  14  varies and preferably decreases in the proximal-to-distal direction. In a preferred embodiment, the blade varies from a maximum height of 35 mm. to a minimum height of 3 mm. over the preferred axial length L 2  of the blade  14 . The height H is defined at least in part by difference between the first radius of curvature R 1  of the dorsal surface  16   a  and the second radius of curvature R 2  of the anterior surface  16   b  of the blade  16 . The respective centers of curvatures D 1 , D 2  of the dorsal and anterior surfaces  16   a ,  16   b  are preferably offset from one another. The first radius of curvature is may be constant over the length L 1  of the blade  16  and in an embodiment, the first radius of curvature R 1  is about 105 mm. The second radius of curvature R 2  preferably varies and may decrease in the proximal-to-distal direction. In some embodiments, the second radius of curvature R 2  ranges from about 132 mm to about 80 mm. 
     Moreover, the second radius of curvature R 2  preferably varies in the lateral direction of the device  10  over the third axis C-C. In some examples, the second radius of curvature R 2  decreases in the outer-to-inner lateral direction. Accordingly, the height H of the blade  14  varies and may decreases in the outer-to-inner lateral direction as seen for example in  FIG. 1C . In some embodiments described herein, the height H of the blade  14  defines a step transition from a first height H 1  to a second smaller height H 2 . 
     In the lateral direction of the third axis C-C, the step transition may define a transition in the blade  14  from an outer flange portion  17   a  to an inner flange portion  17   b . For some embodiments described herein, the outer flange portion  17   a  has a greater height H 1  than the height H 2  of the inner flange portion  17   b . In some aspects, the outer flange portion  17   a  defines a maximum height of 35 mm over the length of the blade. Additionally or alternatively, the outer flange portion  17   a  ranges in height from a maximum height of 35 mm. to a minimum height of 3 mm. Moreover, the inner flange portion  17   b  can define a maximum height of 17 mm over the length of the blade and may range in height from a maximum height of 17 mm to a minimum height of 5 mm. 
     Blade Cross Section Profile for Viewing 
     When inserted within the mouth and viewed from the proximal end  14   a  of the device  10 , the height differential defines an asymmetric blade profile to frame a viewing notch or window W for direct viewing of the glottis and/or tongue. For example, schematically shown in  FIG. 1D  the blade  14  defines a substantially L-shape in cross-section with a viewing window W. 
     Another asymmetric blade  14 ′ is shown in  FIG. 1E  that includes multiple height transitions in the lateral direction of the blade  14 ′ in direction of the third axis C-C. Alternatively, the blade can define a symmetrical cross-sectional profile in manner described herein. For example, shown in  FIGS. 1F and 1G  are symmetric blades  14 ″,  14 ′″ having a central window W framed respectively by either a substantially U-shaped or V-shaped anterior surface  16   b . In each of the symmetrical embodiments, the height of the blade is maximized at the outer and inner portions  17   a ,  17   b  with a central portion having a decreasing height that is minimized at the center of the blade. 
     Fluid Ports 
     To facilitate proper insertion and positioning of the blade  14  and view of the glottis and/or vocal cords, the device provides for integrated and controllable suction to remove bodily fluids, e.g., blood, saliva, secretions, etc. in and around the blade  14 . Thus, the blade  14  may include at least one, two, or more than two fluid ports for the intake fluid. In an alternative arrangement and/or application, the two fluid ports may be used for discharge of fluid such as for example, air. More specifically with reference to  FIG. 1A , the device  10  includes an outlet  18  at the second end  12   b  of the handle  12  for coupling preferably to a negative pressure or vacuum source  19 . 
     The outlet  18  can be embodied as a suction outlet  18  having a standard hose barb for connection to a vacuum source. At the distal tip portion  14   a  of the blade  14  is an inlet  20 , which is placed in fluid communication with the outlet  18  for the intake and removal of fluid. Formed between the proximal end  14   a  and distal tip portion  14   b  of the blade  14  are one or more intermediate fluid intake ports  22  that are in fluid communication with the outlet  18  for the removal of fluid proximate preferred locations along the blade  14 . 
     As described herein, the device  10  provides for one more internal visual-aid components, such as for example, lighting, video cameras or associated components to facilitate either direct or indirect visualization of, for example, the glottis and/or vocal cords, using the device  10 . One or more of the fluid intake ports  22  are preferably sized and located proximate the operational ends of the visual-aid components, e.g., the camera lens or LED, to maintain a clean field of view for operation of the component. Application of the negative pressure or suction at the various ports is preferably controlled by a preferred fluid control valve assembly or arrangement  25  incorporated in the handle  12  having a preferably manually operated device, push-button, or controller  102  for operating the fluid control assembly  25 . 
     Passageways 
     To provide for the fluid communication between the outlet  18  and the various fluid ports of the blade  14  and housing visual components, the device  10  includes one, two or more internal passageways between the fluid ports and the outlet  18 . 
     As a fluid conduit or flow path of the device  10 , the internal passageways of the device  10  are configured, dimensioned and/or shaped to facilitate desired fluid flow characteristics, flow rate, and/or pressure rates. Moreover, the internal passageways of the device  10  are located or arranged within the device  10  to provide for the preferred geometries or profiles of the blade  14  previously described in order to facilitate preferred insertion and viewing of the glottis and/or vocal cards as described herein. 
     Additionally, the preferred configurations, profiles, dimensions, shape and/or location of the passageways facilitate methods of formation and/or manufacturing of the device  10 . Embodiments of the device  10  are preferably made in a preferred molding process in which two injection molded elements are formed and joined together in a preferred manner. In one preferred aspect, the device  10  is configured for single use. Accordingly, the device  10  is preferably formed in a manner and from a material such that the device  10  is disposable. 
       FIG. 2  illustrates an embodiment of the device  10  including a handle  12  and blade  14 . In this example, handle  12  includes a first internal (or handle) passageway  24   a  and at least a second internal (or handle) passageway  24   b  each extending from the first end portion  12   a  toward the second end portion  12   b  for fluid controlled communication with the outlet  18 . 
     The blade  14  includes a first internal (or blade) passageway  26  formed therein having a length extending from the proximal end portion  14   a  to the distal tip portion  14   b  to provide fluid communication with each of the first internal passageway  24   a  of the handle  12  and the inlet  20  of the distal tip portion  14   b  of the blade  14 . The blade  14  also includes a second internal (or blade) passageway  28  formed therein having a length extending from the proximal end portion  14   a  to at least one intermediate fluid port  22  for fluid communication with the second internal passageway  24   b  of the handle  12  and the intermediate fluid port  22 . 
       FIG. 2A , a cross sectional view of the blade in  FIG. 1B  along the line IIA-IIA, illustrates an embodiments where each of the first and second internal passageways  26 ,  28  in the blade have a floor  30  and a ceiling  32  spaced apart in the direction of the first axis A-A from one another to respectively define a height HH 1 , HH 2  and width WW 1 , WW 2  in each of the internal passageways. Moreover, the floor  30  and ceiling  32  define a non-circular geometry for each of the first and second passageways  26 ,  28  in a cross-section of the blade  14  perpendicular to the second axis B-B. The respective heights HH 1 , HH 2  of the first and second internal passageways  26 ,  28  vary over the length of each of the first and second passageways  26 ,  28 . In some cases, each of the first and second internal passageways taper narrowly in the proximal-to-distal direction of the blade. In some embodiments of the device  10 , the widths WW 1 , WW 2  of the passageways remain constant over the length of the blade in the proximal-to-distal direction. Alternatively, the widths WW 1 , WW 2  of the internal passageways  26 ,  28  can vary and may narrow in the proximal-to-distal direction of the blade. 
     As seen in  FIG. 2 , each of the first and second internal passageways  26 ,  28  may define an arcuate flow path within the blade  14 . Accordingly, each of the floor  30  and the ceiling  32  define a radius of curvature that is preferably different from one another to provide the preferred tapering heights HH 1 , HH 2  in each of the first and second internal passageways  26 ,  28  as previously described. In one example, the floor  30   a  of the first internal passageway  26  defines a radius of curvature RR 1  of 120-125 mm and the ceiling  32   a  defines a radius of curvature RR 2  of 115-120 mm. The radius of curvatures RR 1 , RR 2  of the first internal passageway  26  are constant over its proximal-to-distal length LL 1  within the blade  14 . 
     The length LL 1  of the first internal passageway  26  may range, in some examples, from 100 mm to 105 mm for fluid communication with the distal tip end  14   b  and its inlet  20 . The floor  30   b  of the second internal passageway  28  defines a radius of curvature RR 3  of 125 mm and the ceiling  32   b  defines a preferred radius of curvature RR 4  of 110 mm. The radius of curvatures R 1 , R 2  of the first internal passageway  26  may be constant over its proximal-to-distal length LL 2  within the blade  14 . The length LL 2  of second internal passageway  28  may ranges from 55%-85% of the total blade length for fluid communication with a fluid port  22  for clearing the field of view of a visual aid component, such as for example, a camera lens or LED. In some embodiments of the blade  14 , the internal passageway  26 ,  28  may have a variable radius of curvature over their length. 
     In some embodiments described herein, the internal passageways are positioned relative to one another and relative to one or more external surfaces of the device  10  to provide a desired blade geometry or facilitate manufacture or formation of the device  10 . As shown in  FIG. 2 , the first and second internal passageways  26 ,  28  are axially spaced apart in the direction of the first axis A-A and concentric with one another. Accordingly, the floors  30   a ,  30   b  and ceilings  32   a ,  32   b  of each of the first and second passageways  26 ,  28  have respective centers of curvatures DD 1 , DD 2 , DD 3 , DD 4  which are preferably off-set from one another in either the first or second axes A-A, B-B. In one aspect as shown in  FIG. 2 , the centers of curvature DD 1 , DD 2  of the first internal passageway  26  are more distal than the centers of curvature DD 3 , DD 4  of the second internal passageway  28 . 
     When viewed in the proximal-to-distal direction, each of the first and second internal passageways  26 ,  28  define, in some examples, a cross-section that is non-circular, for example oblong, elliptical, or rectangular area for fluid to flow through. As schematically shown, for example in  FIGS. 2B and 2C , each of the first and second internal passageways  26 ,  28  includes a planar outer wall  34  and a planar inner wall  36  relative to the respective inner and outer lateral surfaces  15   a  of the blade. 
       FIG. 2B , a cross-sectional view of the blade in  FIG. 1B  along line IIB-IIB, schematically shows the passageways  26 ,  28  proximate the handle  12  at the proximal end of the blade  14 .  FIG. 2C , cross-sectional view of a portion of the blade in  FIG. 2  at IID, schematically shows the passageways  26 ,  28  proximate the fluid port  22  at the distal end of the second internal passageway  28  in the blade. Each of the inner and outer walls  34 ,  36  are spaced apart at the passageway width WW 1 , WW 2  with each of the inner and outer walls extending parallel to the bisecting plane P to their floor-to-ceiling height HH 1 , HH 2 . Accordingly for each passageway, the inner and outer walls  34 ,  36  may have the same height. Alternatively, in either passageway, the inner and outer walls  34 ,  36  may have different heights, for example, wherein the first passageway the height of the outer wall  34   a  is greater than the height of the inner wall  36   b.    
     In one embodiment of the device  10 , the first internal passageway  26  may have a constant width WW 1  of 10-15 mm and or about 12 mm over the proximal-to-distal length of the passageway with a height HH 1  ranging from about 4-6 mm at the proximal end and narrowing to about 2 mm at the distal end of the passageway. Accordingly, in one aspect, the first internal passageway  26  defines a preferred width-to height-ratio ranging from about 2.5:1 to 7.5:1 in the direction from the proximal end portion to the distal tip portion. 
     Additionally or alternatively, the second internal passageway  28  may have a constant width WW 2  of 2-5 mm and more preferably about 4.75 mm over the proximal-to-distal length of the passageway with a preferred height HH 2  ranging from about 4-8 mm at the proximal end and narrowing to about 2.5 mm at the distal end of the passageway. Accordingly in one aspect, the second internal passageway  28  defines a width-to height-ratio ranging from 0.5:1 to 2:1 in the direction from the proximal end portion to the distal tip portion. 
     Generally, the first and second internal passageways  26 ,  28  are substantially located in the outer flange portion  17   a  of the blade  14 . For example, with reference to  FIG. 2B , the first internal passageway  26  extends across the bisecting plane P with at least 90% disposed in the outer flange portion  17   a . Alternatively, the inner wall  36   b  of the first internal passageway  26  can be aligned with the bisecting plane P. 
     The first internal passageway  26  may be formed with its outer wall  34   a  spaced from the outer lateral surface  15   a  to define a minimum outer wall thickness TH 1  of the outer flange portion  17   a . The minimum outer wall thickness TH 1  may range from about 4.5-5 mm and may be 4.75 mm and may be constant over the length of the outer flange portion  17   a  in the proximal-to-distal direction of the blade  14 . The preferred minimum outer wall thickness TH 1  provides for a preferred flange member  15   c  to be formed anteriorly of the first internal passageway  26  in the distal region of the blade distal of the end of the second internal passageway  28 , as seen for example in  FIG. 1I . The outer flange member  15   c  preferably ranges in thickness from 2 mm-6 mm. The inner lateral surface  36   a  of the first internal passageway defines the thickness TH 2  of the inner flange portion  17   b . Where the inner lateral surface  15   b  tapers toward the bisecting plane P, as seen for example in  FIG. 1H , the inner flange thickness TH 2  defines a narrowing thickness from the proximal end portion to the distal tip portion. 
     The outer and inner lateral surfaces  15   a ,  15   b  of the blade  14  are disposed about the bisecting plane P to define the width WTH of the blade. The width WTH of the blade  14  varies along the length of the blade, and may taper narrowly in the proximal-to-distal direction. In one embodiment, the width WTH of the blade at the distal tip portion  14   b  ranges from about 16-24 mm or 21.8 mm and the width WTH of the blade  14  at the proximal end portion  14   a  is about 25-33 or 31.75 mm. 
     In one embodiment, the inner lateral surface  15   b  tapers toward the bisecting plane P at a preferred angle β of about three to five degrees (3-5°). In another embodiment, the outer lateral surface  15   a  includes one portion extending parallel to the bisecting plane P with another portion tapering toward the bisecting plane P. In another embodiment, the inner lateral surface  15   b  tapers toward the bisecting plane P angle with respect to the first plane P and another portion extending parallel to the bisecting plane P. The inner lateral surface can transition from its taper to extending parallel to the plane P at the location of the operative end  40  of a visual aid component  40 . 
     For example, where the blade  14  include a camera lens  40  located between the proximal end portion  14   a  and the distal tip portion  14   b , the inner lateral surface  15   b  extending at the first taper angle β from the proximal end portion to the camera lens location  40  and extend parallel to the first plane P from the camera lens location  40  to the distal tip portion  14   b . The outer surface  15   b  can extend parallel to the bisecting plane P from the proximal end portion  14   a  to the camera lens location  40  and define a second taper angle of about two to six degrees (2-6°) with respect to the bisecting plane P from the camera location  40  to the distal tip portion  14   b.    
     At the distal tip portion  14   b , the first internal passageway  26  is in fluid communication with the inlet  20 . The inlet  20  has a width extending from the outer flange portion  17   a  to the inlet flange portion  17   b  with the inlet  20  crossing the bisecting plane P. The inlet preferably defines one of an oblong or elliptical geometry, as seen in  FIG. 1C ; and additionally or alternatively, the inlet  20  has a cross-sectional area greater than the cross-sectional area of the first internal passageway  26 . 
     Moreover, with reference to  FIG. 2D  the distal tip portion  14   b  defines a transition passageway  20   a  defining the fluid communication between the inlet  20  and the first internal passageway  26 . The transition passageway  20   a  defines a reduction in at least one of height and width of less than 10% from the inlet  20  to the first internal passageway  26 . The transition passageway  20   a  can be angled with respect the first internal passageway  26  at an orientation angle α with respect to a tangential plane T extending perpendicular to the bisecting plane P ( FIG. 2B ) and tangential to the arcuate anterior surface  16   b  of the blade  14 . In one orientation, the transition passageway  20   a  is angled with respect to the first internal passageway and the tangential plane T at a preferred downward orientation angle α′ ranging from zero degrees to thirty degrees (0-(30) degrees). In one embodiment, the distal tip portion  14   b  defines an angle Θ of 24-28 degrees relative to the plane T′, which is parallel to the tangential plane T. In another preferred aspect of the distal tip portion  14   b , the inlet  20  is preferably disposed at a preferred elevation E 1  from the tangential plane T of 48-52 mm. Additionally, the fluid port  22  is disposed at a preferred elevation E 2  of 12-18 mm from the tangential plane T. 
     The second internal passageway  28  may be located anteriorly of the first internal passageway  26 . With reference to  FIGS. 2B and 2C , the outer wall  34   b  of the second internal passageway  28  may be located laterally between the outer wall  34  of the first internal passageway  26  and the bisecting plane P. The second internal passageway  36   b  can extend across the bisecting plane P with at least 90% disposed in the outer flange portion  17   a . Alternatively, the inner wall  36   b  of the second passageway  28  is aligned with the bisecting plane P or further in the alternative be located between the outer wall  34   b  of the second passageway  28  and the bisecting plane P. By positioning the internal passageways  26 ,  28  in a manner relative to the lateral surfaces  15   a ,  15   b  of the blade, a wall thickness can be maintained to provide a desired structural thickness and/or strength along the length of the blade  14 . 
     The second internal fluid passageway  28  is in fluid communication with the fluid port  22 , which is located adjacent the operative end of a visual aid component  40 , such as camera lens or LED positioned along the blade  14 . The blade further may include other fluid ports defining a tissue release hole for removing tissue coming into contact with the blade  14 . One tissue release hole  22   a  may be formed along the anterior surface  16   b  of the blade  14 , as seen for example in  FIG. 1A . The tissue release hole  22   a  may be located proximally 0.25-0.5 inches of the operative location  40  of the visual aid component and defining an angle of orientation ranging from zero to forty-five degrees (0°-45°) relative to the tangential plane T. Another tissue release hole  22   b  may be formed proximate the inlet  20  of the distal tip end  14   b  on the anterior surface  16   b  of the blade  14 . The tissue release hole may be disposed within 0.5 inches of the inlet  20 . The second tissue release hole  22   b  may define an angle of orientation ranging from zero to forty-five degrees (0°-45°) with respect to the tangential plane T. 
     The first and second internal passageways  26 ,  28  may be located to facilitate formation of a blade geometry including the outer and inner flange portions  17   a ,  17   b  and viewing window W as previously described. Moreover, the locations of the first and second internal passageways  26 ,  28  facilitate formation of the device  10 . 
     Internal Passageways and Fluid Flow 
     Each of the first and second internal (blade) passageways  26 ,  28  of the blade  14  are placed in fluid communication with a suction source  19  by the first and second internal passageways  24   a ,  24   b  of the handle  12 , which may be circular in cross-section. In other examples, the passageways  24   a ,  24   b  can be non-circular such as for example, oblong, elliptical, oval or rectangular. Each of the first and second internal (handle) passageways  24   a ,  24   b  of the handle  12  are preferably respectively formed integrally with the first and second (blade) internal passageways  26 ,  28  of the blade  14 . The first and second internal (handle) passageways  24   a ,  24   b  extend preferably parallel to one another from first end of  12   a  the handle  12  in the direction of the second end  12   b . The first and second internal passageways  24   a ,  24   b  each preferably define a centerline and the centerlines are preferably spaced apart and aligned with one another in a plane extending preferably parallel to the bisecting plane P, as seen for example in  FIG. 2E . The parallel passageways can be alternately oriented provided they provide the fluid communication between the suction source  19  and the passageways  26 ,  28  of the blade  14 . 
     The geometries and profiles of the internal passageways  24 ,  26 ,  28  provide for desired flow characteristics upon application of the negative pressure. The preferred first internal passageways  24   a ,  26  of the handle and blade  12 ,  14  defines a preferred internal volume that ranges from a minimum of 4100 mm 3  to 11000 mm. 3  The first internal passageway  26  of the blade  14  may define an internal volume ranging from 600 mm 3  to 7200 mm 3  and may range from 1450 mm 3  to 4450 mm 3  with a preferred ratio of LL 1  to average equivalent diameter (equal circular diameter) of equivalent diameter of 4.75:1 to 18.5:1 or 10:1. 
     The first internal passageways  24   a ,  26  in the handle and the blade experience a pressure drop from the inlet  20  at the distal tip portion  14   b  from the outlet of the handle being of less than 4%, preferably ranging from 3-3.25% over the length of the passageway and is more preferably about 1.5% over the length of the blade when a negative pressure is applied at the outlet  18 . Moreover, where the second internal passageways  24   b ,  28  in the handle and blade defines an internal volume ranging from a minimum 3900 mm 3  to 6400 mm 3  with the second internal passageway  28  in the blade ranging from 450 mm 3  to 2600 mm 3  or 700 mm 3  to 1100 mm 3  and a ratio of length LL 2  to average equivalent diameter of preferably ranging from 4.75:1 to 17.25:1 or 14:1. 
     The second internal passageways  24   b ,  28  of the handle and blade  14  further preferably define a pressure drop from the fluid port  22  to the outlet  18  of less than 7% and more preferably about 6.25%-6.1%, more preferably less than 5% with a loss of about 4.5% through the blade section. For blade lengths L 2  ranging between 170-240 mm, the total passageway length through the handle and blade may range from 205-215 mm. 
     Manufacturing 
     The device  10  may be constructed from a polycarbonate or thermoplastic material in an injection molding process. Alternatively, the device can be made from a 3-D printing process. The device can be made by fabricating two elements which respectively include complementary internal and external surfaces of the device, such that when the elements are joined together by any one of plastic welding, mechanical joining or chemical bonding, the elements form the device  10  including the handle  12 , blade  14  and their internal passageways. Because it is anticipated that a polycarbonate device  10  will come into contact with bodily fluids, it is anticipated that the device  10  is a single use, preferably disposable device in some examples. 
     In one aspect of forming the device  10 , two elements  10   a ,  10   b  are joined together along a split line SL by an appropriate joining process. Each of the complimentary elements  10   a ,  10   b , include a portion of the handle  12  and a portion of the blade  14  such for each element  10   a ,  10   b  the handle  12  and blade  14  portions are integral with one another. In another aspect of the process of forming the device  10 , each element  10   a ,  10   b  include one-half of the handle such that the split line SL is formed along the plane P bisecting the handle  12  as seen in  FIG. 3A . 
     In another aspect of joining the elements  10   a ,  10   b , the elements can be formed such that the complementary portions of the blade  14  are joined along a split line that is aligned with or parallel to the plane P bisecting the handle as seen for example in  FIG. 3B . By locating the all of the second internal passageway  28  medially of the outer wall  32   a  of the first internal passageway, a single split line SL between the two elements  10   a ,  10   b  can be used to form the blade  14  and enclose the first and second internal passageways  26 ,  28 . 
     In another example aspect, the split line SL can extend out of the bisecting plane P. For example, as shown in  FIG. 3C , the second internal passageway  28  is laterally located between the outer and inner walls  34   a ,  36   a  of the first internal passageway  26  and the two elements  10   a ,  10   b  are joined along the split line SL having a portion that extends perpendicular to the bisecting plane P. Accordingly, an embodiment of the device  10  is formed with the handle being formed symmetric about the split line SL and the blade being formed asymmetric about the split line SL.  FIGS. 3D and 3E  show a blade  14  that is formed symmetrically about the plane P. The blade  14  show the first and second internal passageways  26 ,  28  symmetrically disposed about the plane P. Because of the location of the first and second internal passageways  26 ,  28 , the device  10  includes two split line SL 1 , SL 2  with a central element  10   a  joined to two lateral elements  10   b ,  10   c  enclosing the passageways  26 ,  28 . 
     Fluid Control/Suction Assemblies 
     Shown schematically in  FIGS. 4A-4F  are various embodiments of a fluid control assembly  25  for use in the device  10 . The control assembly  25  has at first operative configuration to allow application of the negative pressure or suction and flow of fluid through the first internal passageways  24   a ,  26  and to prevent flow through the second internal passageways  24   b ,  28 . The control assembly  25  has at least a second operative configuration to allow application of the negative pressure and flow through the second internal passageways  24   b ,  28  and to prevent flow through the first internal passageways  24   a ,  26 . The control assembly  25  can include a third configuration or home position in which fluid is not permitted to flow through either the first or second internal passageways. 
     In another operative configuration of the control assembly  25 , fluid is permitted to flow through both the first or second internal passageways  24   a ,  24   b ,  26 ,  28  of the handle and blade. Moreover, the operation of the fluid control assembly  25  can provide for fixed fluid flow rates through the internal passageways or alternatively provide for adjustable fluid flow rates. Additionally, the fluid control assemblies can be configured for variable or differential flow rates through both the first or second internal passageways  24   a ,  24   b ,  26 ,  28  of the device  10 . 
     Schematically shown in  FIGS. 4A-4B  is a first embodiment of a control assembly  25  embodied as a gate valve. The first and second internal passageways  24   a ,  24   b  extend parallel to one another in the direction of the first axis A-A with the passageways  24   a ,  24   b  coming together to form the outlet  18  in connection with the vacuum source  19 . The control assembly  25  includes a plate  100  for selectively sliding in a proximal-distal direction of the second axis B-B perpendicularly through the first and second passageways  24   a ,  24   b . The plate  100  includes two spaced apart through holes  104   a ,  104   b . By sliding the plate  100  in the proximal-distal direction, the through holes  104   a ,  104   b  can be alternately and respectively aligned with the passageways  24   a ,  24   b  for select application of the negative pressure and suction to the first or second internal passageways  24   a ,  24   b ,  26 ,  28  of the handle and blade for fluid flow therethrough. 
     Coupled to opposite ends of the plate  100  are manual push-buttons  102   a ,  102   b  for respective depression by, for example, the index finger and thumb of the left hand of the user for one-hand use. For various embodiments shown herein, the push-buttons  102   a ,  102   b  can be alternatively configured as pull-rings  102   a ′.  FIG. 4A  shows the fluid control assembly for fluid flow through the first internal passageways  24   a ,  26  and  FIG. 4B  shows the fluid control assembly for fluid flow through the second internal passageways  24   b ,  28 . 
     Schematically shown in  FIG. 4C  is an alternate fluid control assembly  25   a  embodied as an alternate gate valve arrangement for the passageway arrangement previously described. The assembly is viewed from the proximal end. The control assembly  25   b  includes a first plate  100   a  inserted through the first passageway  24   a  for sliding perpendicularly in the lateral direction of the third axis C-C. A second plate  100   b  is inserted through the second passageway  24   b  for sliding perpendicularly in the lateral direction of the third axis C-C. Each of the plates  100   a ,  100   b  include a through hole  104   a ,  104   b  for respective alignment with the respective passageway  24   a ,  24   b  and selective application of the suction source  19 . The plates  100   a ,  100   b  can be independently operated from one another by depressing the opposed push-buttons  102   a ,  102   b ,  102   c ,  102   d .  FIG. 4C  shows the fluid control assembly  25   a  for selected fluid flow through the first internal passageways  24   a ,  26  and the second internal passageways  24   b ,  28  closed off from the vacuum source  19 . 
     Schematically shown in  FIG. 4D  is an alternate fluid control assembly  25   b  embodied as a rotatable disc valve  100  for controlling through portions of the internal passageways  24   a ,  24   b  disposed parallel to the second axis B-B. The disc valve  100  includes at least two through holes  104   a ,  104   b  for selective alignment with the internal passageways  24   a ,  24   b . The disc  100  includes a control arm  102  for selectively aligning the through holes  104   a ,  104   b  with the passageways  24   a ,  24   b  by rotating the disc about an axis parallel to the second axis B-B. Particularly shown in  FIG. 4D  is the fluid control assembly  25   b  for selected fluid flow through the first internal passageways  24   a ,  26  with the second internal passageways  24   b ,  28  closed off from the vacuum source  19 . 
     Schematically shown in  FIGS. 4E-4F  is an alternate fluid control assembly  25   c  embodied as a rotatable disc valve  100  for controlling through portions of the internal passageways  24   a ,  24   b  disposed parallel to the first axis A-A. The disc valve  100  includes at least two through holes  104   a ,  104   b  for selective alignment with the internal passageways  24   a ,  24   b . The disc  100  includes the a control arm  102  for selectively aligning the through holes  104   a ,  104   b  with the passageways  24   a ,  24   b  by rotating the disc  100  about an axis parallel to the first axis A-A. Particularly shown in  FIGS. 4E-4F  is the fluid control assembly  25   b  for selected fluid flow through the first internal passageways  24   a ,  26  with the second internal passageways  24   b ,  28  closed off from the vacuum source  19 . 
     For the described fluid control assemblies  25 , the desired flow or operational configuration can be realized by proper selection and adjustment in any one of the number of through holes  104 , the spacing between the through holes  104 , the size of the through holes or the adjustability in aligning the through holes  104  over the passageways  24   a ,  24   b  within the handle  12 . The embodiments of the fluid control assemblies  25  shown and described in  FIGS. 4A-4F  may be mechanical arrangements for operation by one hand. Alternate examples of the fluid control assemblies can include electrically operated valve assemblies controlled and operated by controls disposed about the handle  12  for preferred single handed operation. 
       FIGS. 6A-6C  illustrate another embodiment of a laryngoscope according to the present invention that show the control assemblies.  FIG. 6A  illustrates a side view of the laryngoscope device  10  that illustrates an embodiment of a control assembly  25 . The control assembly  25  is also illustrated in  FIG. 6C .  FIG. 6B  illustrates a front view of this embodiment of the laryngoscope device  10  including the handle  12 , blade  14 , and fluid ports including intake  20 . 
       FIG. 6C  illustrates a cross sectional view of the laryngoscope device  10  and particular shows the control assembly  25  and associated integration with the fluid channels  28  and  26 . The control assembly  25  includes a control arm  102  that may either or both rotate or translate in and out the plate  100  that covers the fluid channels  28  and  26 . 
     The through holes  104  illustrated demonstrate that by rotation of the control arm  102  the control plate  100  may rotate into position to allow fluid to flow through the channels  26  and  28 . In other embodiments, the through holes  104  will not be aligned with the fluid path axis oriented parallel to each other, so that only one through hole  104  will be lined up with a channel at a time allowing only suction through one channel at a time. 
     In other embodiments, suction from each channel may have separate connections to the suction source that may be toggled through an external valve. In other embodiments, the control handle  100  may retract to allow suction through channel  28  and then rotate to allow suction through channel  26 . In this example, the through hole  104  would be allowed distally from the channel  26  and then retraction of the control handle  102  would open up channel  28  and line up the through hole  104  in the same plane (but out of rotation). Then rotation of the control handle  28  would rotate the through hole  104  into alignment with the second channel  28  so that either, both, or none of the channels may be open at a time. 
       FIG. 7A  illustrates a cross sectional view of the laryngoscope device  10  and particular shows the control assembly  25  with a retention spring  700  and associated integration with the fluid channels  28  and  26 . The control assembly  25  includes a control arm  102  that may either or both rotate or translate in and out the plate  100  that covers the fluid channels  28  and  26 . In some examples, the spring  700  will retain the plate  100  in a closed state to prevent fluid flow through the channels  28  and  26  until the operator moves control arm  102  to push or pull against the spring  700  to open one or both of the channels  28  and  26 . In some examples, this will then only allow suction when the operator actively depresses the control arm  102 . 
       FIGS. 7B-7C  illustrate cross sectional views of the control assembly  25  including the plate  100  and control arm  102  and spring  700 . In this example, the through holes  104  are opened by pulling the control arm  102  so that the through holes  104  line up with the channels  26  and  28  to allow suction and fluid flow. 
       FIGS. 7D-7E  illustrate cross section views of the control assembly in a plane bisecting the device  10  along the control assembly  25 . As illustrated,  FIG. 7D  shows the control arm  102  in an extended state and  FIG. 7E  illustrates the control arm  102  (and associated control plate  100 ) in a state that it is completely depressed inside the device  10 . In some examples, extension (or retraction) of the control arm  102  will cause the through holes  104  to line up with the channels  26  and  28  and initiate suction. In other examples, depression of the control arm  102  (non-section state will be with control arm and control  100  plate extended) will cause the through holes  104  to line up with the channels  26  and  28  to initiate suction. 
     Examples of Medical Procedures 
     The device  10 , in some examples, is configured for one-handed operation and manipulation using the left hand with the blade  14  facing away from the operator. With reference to  FIG. 5 , the blade  14  lifts the epiglottis to expose the vocal cords indirectly. The outer flange portion  17   a  ( FIGS. 1D, 2B ) may be used for structural support to effectively push a patient&#39;s tongue from right to left in the mouth. The handle  12 , in the second end portion  12   b  of the handle  12 , includes a fluid control arrangement  25  for selection and controlled application of the negative pressure from the suction or vacuum source  19  to each of the first and second internal passageways  24   a  ( FIG. 2 ),  24   b  ( FIG. 2 ),  26  ( FIG. 6C ),  28  ( FIG. 6C ) of the handle and blade. The control arrangement  25  may be operable by the left hand; and more particularly, can be operated by a single finger, such as for example, the thumb or index finger. 
     Visualization Components 
     As previously noted, the device  10  may include or house visual-aid components, such as for example, lighting, video cameras, still picture cameras and/or associated components to facilitate either direct or indirect visualization of, for example, the glottis and/or vocal cords. In one example, the first end  12  of the handle  12  includes a third internal passageway  200 , as seen in  FIG. 2 , which extends toward the second end  12   a  of the handle. The third internal passageway  200  of the handle  12  is in communication with a preferably third internal passageway  210  formed in the blade  14  preferably in the outer flange portion  17   a , as seen in  FIG. 2B , to extend from the proximal end portion  14   a  of the blade  14  in the proximal-to-distal direction. Alternatively, the third internal passageway  200  of the handle  12  is placed in communication with another passageway of the blade  14 , such as for example, the second internal passageway  26 . 
     The third passageway  210  of the blade  14  may terminate between the proximal end portion  14   a  and the distal tip portion  14   b  to define the location of the operative end  40  of a visual-aid component housed in the third passageway  210  for facilitating viewing of the glottis and/or vocal cords with the device  10 . In one embodiment, a fiber optic wiring or harness can be disposed in the third passageway  210  of the blade  14  for locating a camera, LED or other light source at the preferred operative location. Moreover, the third internal passageway  210  terminates so as to locate the operative end  40  of the visual aid component adjacent the fluid port  22  for maintaining a clear field of view as previously described. 
     Referring again to the third internal passageway  200  of the handle  12  shown in  FIG. 2 , the passageway  200  preferably includes a first distal enlarged end  202  and a second proximal region  204 . The passageway  200  and portions thereof may be sized in depth and/or width to house the visual-aid components. For example, a first video camera can be housed in the first enlarged area  202  and at least a secondary camera can be housed in the second enlarged region  204 . The housing of multiple cameras facilitates the use of the device  10  to have multiple cameras of varying views. 
     Additionally housed in the third internal passageway  200  can be associated components, wiring or fiber optic cables including a microprocessor, power supply and/or wireless transmitter (Wi-Fi, Bluetooth® transmitter)  206  for powering and/or control of the visual aid components. Preferably housed and accessible about the handle  12  for single handed operation is a control button and/or switch  208 . The control button(s)  208  can be configured for operation by either the thumb or single finger operation of the left hand of the surgeon, physician or operator. In one example, the physician can power on, select, direct and focus a camera with the thumb of the left hand and additionally transmit the images to a wirelessly connected display device (not shown). 
     The laryngoscope device  10  provides a medical device having an insertion member for directly and/or indirectly viewing into a human cavity and a handle for manually locating the insertion member within the cavity. Moreover the insertion member can incorporate two fluid flow passageways with suction control incorporated in the handle of the device for removing fluids and/or tissue from around the viewing area of the device or the visual aid components of the device. Accordingly, while the suction and manual control can be embodied in the laryngoscope  10 , the described fluid flow passageways and control assemblies could be embodied in other medical devices for viewing 
     SELECTED EMBODIMENTS 
     Although the above description and the attached claims disclose a number of embodiments of the present invention, other alternative aspects of the invention are disclosed in the following further embodiments. 
     Embodiment 
     A laryngoscope device comprising: a handle extending axially along a first axis having a first end portion and a second end portion, the handle including a first internal passageway and at least a second internal passageway each extending from the first end portion to the second end portion; and an insertion member having a proximal end portion and a distal tip portion, the proximal end portion extending from the first end portion of the handle with the proximal end portion and the distal tip portion being spaced apart from one another in the direction of a second axis perpendicular to the first axis to define a first plane bisecting the handle portion, the insertion member including an inlet formed along the distal tip portion and at least one intermediate fluid port formed between the proximal end portion and the distal tip portion for intake of fluids, the insertion member including: a first internal passageway formed in the insertion member having a length extending from the proximal end portion to the distal tip portion for fluid communication with each of the first internal passageway of the handle and the inlet of the distal tip portion, the first internal passageway defining a non-circular passageway in a cross-section of the insertion member perpendicular to the second axis, the non-circular passageway having a floor and ceiling spaced apart from one another to define a height of the first internal passageway in the direction of the first axis, the height of the first internal passageway varying over the length of the first passageway, the first internal passageway having an inner wall and an outer wall spaced apart in a lateral direction of a third axis perpendicular to each of the first and second axes to define a width of the first internal passageway; and a second internal passageway formed in the insertion member anteriorly of the first internal passageway defining a length extending from the proximal end portion to the at least one intermediate fluid port for fluid communication with the second internal passageway of the handle and the at least one intermediate fluid port, the second internal passageway defining a non-circular passageway in a cross-section of the insertion member perpendicular to the second axis, the non-circular passageway having a floor and ceiling spaced apart from one another to define a height of the second internal passageway in the direction of the first axis, the height of the second internal passageway varying over the length of the second internal passageway, the second internal passageway having an inner wall and an outer wall spaced apart in the lateral direction to define a width of the second internal passageway, the outer wall of the second passageway being located laterally between the first plane and the outer wall of the first internal passageway; and a fluid control assembly incorporated in the handle for controlling fluid flow through each of the first and second internal passageways of each of the handle and the insertion member. 
     Embodiment 
     A laryngoscope device comprising: a handle extending axially along a first axis having a first end portion and a second end portion, the handle including a first handle passageway and at least a second handle passageway each extending from the first end portion to the second end portion; and a blade having a proximal end portion and a distal tip portion, the proximal end portion extending from the first end portion of the handle with the proximal end portion and the distal tip portion being spaced apart from one another in the direction of a second axis perpendicular to the first axis to define a first plane bisecting the handle portion, the blade including an inlet formed along the distal tip portion and at least one intermediate fluid port formed between the proximal end portion and the distal tip portion for intake of fluids, the blade including: a first blade passageway formed in the blade having a length extending from the proximal end portion to the distal tip portion in fluid communication with each of the first handle passageway of the handle and with the inlet of the distal tip portion, the first blade passageway defining a non-circular passageway in a cross-section of the blade perpendicular to the second axis, the first blade passageway having a floor and ceiling spaced apart from one another to define a height of the first blade passageway in the direction of the first axis, the height of the first blade passageway varying over the length of the first blade passageway, the first blade passageway having an inner wall and an outer wall spaced apart in a lateral direction of a third axis perpendicular to each of the first and second axes to define a width of the first blade passageway; and a second blade passageway formed in the blade anteriorly of the first blade passageway defining a length extending from the proximal end portion to the at least one intermediate fluid port for fluid communication with the second handle passageway and the at least one intermediate fluid port, the second blade passageway defining a non-circular passageway in a cross-section of the blade perpendicular to the second axis, the second blade passageway having a floor and ceiling spaced apart from one another to define a height of the second blade passageway in the direction of the first axis, the height of the second blade passageway varying over the length of the second blade passageway, the second blade passageway having an inner wall and an outer wall spaced apart in the lateral direction to define a width of the second blade passageway; and a fluid control assembly incorporated in the handle for controlling fluid flow through each of the first and second blade and handle passageways. 
     Embodiment 
     The device of an embodiment above, wherein the fluid control assembly includes any one of a gate valve and a disc valve. 
     Embodiment 
     The device of an embodiment above, wherein the length of the second blade passageway ranges from 55-85% of the total blade length. 
     Embodiment 
     The device of an embodiment above, wherein the inner walls of the first and second blade passageways are aligned with one another in the direction of the first axis. 
     Embodiment 
     The device of an embodiment above, wherein the inner wall of the second blade passageway is located laterally between the outer wall and the inner wall of the first blade passageway. 
     Embodiment 
     The device of an embodiment above wherein the outer and inner walls of the either one of the first and second blade passageways have different heights. 
     Embodiment 
     The device of an embodiment above, wherein the channel height of the either one of the first and second blade passageways taper narrowly from the mating plane to the inner and/or outer walls. 
     Embodiment 
     The device of an embodiment above, wherein the height of any one of the first and second blade passageways taper narrowly in the proximal end portion to the distal tip portion. 
     Embodiment 
     The device an embodiment above, wherein the width of the first blade passageway is constant in the proximal end portion to the distal tip portion. 
     Embodiment 
     The device of an embodiment above, wherein the first blade passageway defines a width to height ratio ranging from 2.5:1 to 7.5:1 in the direction from the proximal end portion to the distal tip portion. 
     Embodiment 
     The device of an embodiment above, wherein the first blade passageway defines a height ranging from 2 mm to 6 mm. 
     Embodiment 
     The device of an embodiment above, wherein the width of the first blade passageway ranges from 9 mm to 15 mm. 
     Embodiment 
     The device of an embodiment above, wherein the height of the second blade passageway tapers narrowly in the proximal end portion to the distal tip portion. 
     Embodiment 
     The device of an embodiment above, wherein the second blade passageway defines a height ranging from 1 mm. to 8 mm. 
     Embodiment 
     The device of an embodiment above, wherein the width of the second blade passageway is about 2-8 mm. 
     Embodiment 
     The device of an embodiment above, wherein the ceiling and the floor of each of the first and second blade passageways define a radius of curvature, the radius of curvature of the floor being greater than the radius of curvature of the ceiling. 
     Embodiment 
     The device of an embodiment above, wherein the radii of curvatures of the ceiling and the floor are fixed over the lengths of at least one of the first and second blade passageways. 
     Embodiment 
     The device of an embodiment above, wherein the center of curvature of the ceiling and the center of curvature of the floor are offset from one another in the first plane. 
     Embodiment 
     The device of an embodiment above, wherein the centers of curvature of the second blade passageway are spaced apart from the centers of curvature of the first blade passageway in the direction of the second axis, such that the centers of curvature of the second blade passageway are closer to the handle than the centers of curvature of the first blade passageway. 
     Embodiment 
     The device of an embodiment above, wherein the floor of the first blade passageway defines a preferred radius of curvature of 105-130 mm and the ceiling of the first blade passageway defines a preferred radius of curvature of 100-120 mm; and wherein the floor of the second blade passageway defines a radius of curvature of 114-140 mm and the ceiling of the second blade passageway defines a radius of curvature of 106-135 mm. 
     Embodiment 
     The device of an embodiment above, wherein the second end portion includes an outlet in fluid communication with the first handle passageway, the first blade passageway defining a pressure drop from the inlet at the distal tip portion to the outlet of the handle being less than 15% when a negative pressure source is applied at the outlet, the first internal passageway defining a ratio of length to average equivalent diameter of 4.75:1 to 18.5:1. 
     Embodiment 
     The device an embodiment above, wherein the first blade passageway of the outer flange portion of the blade defines an internal volume ranging from a minimum 600 mm 2 . to 7200 mm 2 . 
     Embodiment 
     The device of an embodiment above, wherein the second end portion includes an outlet in fluid communication with the first handle passageway, the second blade passageway defining a pressure drop from the at least one fluid port to the outlet of the handle being less than 20% when a negative pressure source is applied at the outlet, the second blade passageway defining a ratio of length to average effective diameter of 4.75:1 to 17.25:1. 
     Embodiment 
     The device of an embodiment above, wherein the second blade passageway of the outer flange portion of the blade defines an internal volume ranging from a minimum 450 mm 2  to 2600 mm 2 . 
     Embodiment 
     The device of an embodiment above, wherein the inlet of the distal tip portion crosses the bisecting plane having one of an oblong or elliptical geometry. 
     Embodiment 
     The device of an embodiment above, wherein the inlet has an cross-sectional area less than the cross-sectional area of the first blade passageway of the outer flange, the distal tip portion defining a transition passageway between the inlet and the first internal passageway, the transition passageway defining a reduction in at least one of height and width of less than 10% from the inlet to the first internal passageway, the transition passageway being angled with respect to a plane parallel to the plane defined by the second and third axes. 
     Embodiment 
     The device of an embodiment above, wherein the at least one fluid port in fluid communication with the second blade passageway is located adjacent an operative end of a visual aid component. 
     Embodiment 
     The device of an embodiment above, wherein the visual aid component is one of a camera, fiber optic cable or LED. 
     Embodiment 
     The device of an embodiment above, wherein the at least one fluid port includes a tissue release hole formed along an anterior surface of the blade, the tissue release hole being located proximally 0.25-0.5 inches of the visual aid component and defining an angle of orientation ranging from zero to forty-five degrees (0°-45°). 
     Embodiment 
     The device of an embodiment above, wherein the visual aid component is position such that a viewing path of the visual aid component is at an angle ranging from 90°-45° to a fluid flow path of the distal portion of the second blade passageway at the at least one fluid port. 
     Embodiment 
     The device of an embodiment above, wherein the blade has a dorsal surface and anterior surface spaced apart from one another in the direction of the first axis to define a height of the blade ranging from 2-20 mm., the blade height varying in the lateral direction to define at least one transition between an outer flange portion and an inner flange portion. 
     Embodiment 
     The device of an embodiment above, wherein the blade includes an outer lateral surface extending along outer flange and inner lateral surface extending along the inner flange, the outer and inner lateral surfaces being disposed about the plane to define a width of the blade, the outer lateral surface and the outer wall of the first internal passageway being spaced apart to define an outer wall thickness, the outer wall thickness defining a constant thickness from the proximal end portion to the distal tip portion. 
     Embodiment 
     The device of an embodiment above, wherein the blade includes an outer lateral surface extending along outer flange and inner lateral surface extending along the inner flange, the outer and inner lateral surfaces being disposed about the plane to define a width of the blade, the outer lateral surface and the outer wall of the first internal passageway being spaced apart to define an outer wall thickness, the outer wall thickness includes a first portion having a constant thickness and a second portion having a narrowing thickness in the direction from the proximal end portion to the distal tip portion. 
     Embodiment 
     The device of an embodiment above, wherein the inner lateral surface and the inner wall of the first internal passageway are spaced apart to define the thickness of the inner flange, the inner flange thickness defining a narrowing thickness from the proximal end portion to the distal tip portion. 
     Embodiment 
     The device of an embodiment above, wherein the outer lateral surface includes a portion extending parallel to the first plane bisecting the handle, the inner lateral surface defining a first taper angle with respect to the first plane. 
     Embodiment 
     The device of an embodiment above, wherein the width of the blade varies along the length of the blade, the width of the blade tapering narrowly in the direction from the proximal end portion to the distal tip portion. 
     Embodiment 
     The device of an embodiment above, wherein the inner lateral surface extending at the first taper angle of about three to five degrees (3-5°) from the proximal end portion, the outer surface extending parallel to the first plane from the proximal end and defining a second taper angle of about two to six degrees (2-6°) with respect to the first plane. 
     Embodiment 
     The device of an embodiment above, wherein the width of the blade portion at the distal tip portion is 12-24 mm. and the width of the blade at the proximal end portion is 20-37 mm. 
     Embodiment 
     The device of an embodiment above, wherein the height varies in the lateral section defines an L-shaped viewing window of the device. 
     Embodiment 
     The device of an embodiment above, wherein the height varies in the lateral section defines a plurality of transitions with the second blade passageway located laterally between the inner and outer walls of the first blade passageway. 
     Embodiment 
     The device of an embodiment above, wherein the height varies in the lateral direction such that blade is symmetrical about the bisecting plane. 
     The device of an embodiment above, wherein the height varies in the lateral direction such that blade is asymmetrical about the bisecting plane. 
     Embodiment 
     The device of an embodiment above, wherein the anterior surface of the blade has at least one radius of curvature to defines a tangential plane perpendicular to the first plane bisecting the handle, the distal tip portion being disposed at an elevation from the tangential plane of 8-12 mm. 
     Embodiment 
     The device of an embodiment above, wherein the inlet defines an angle of orientation of 24-28 degrees relative to the tangential plane. 
     Embodiment 
     The device of an embodiment above, wherein a portion of the first and second handle passageways each define a centerline, the centerlines being spaced apart and aligned with one another in a second plane parallel to the first plane. 
     Embodiment 
     The device of an embodiment above, wherein the first and second handle passageways are circular. 
     Embodiment 
     The device of an embodiment above, wherein the first and second handle passageways are non-circular. 
     Embodiment 
     A method of forming a laryngoscope device comprising forming a first elements and a second element, each element having a blade portion and a handle portion integral with the blade portion; and forming a handle and a blade of the device with the first and second elements along a split line, the handle being symmetrical about the split line and the blade being asymmetrical about the split line. 
     Embodiment 
     The method of an embodiment above, wherein the forming the blade includes forming a first blade passageway and a second blade passageway, the second blade passageway being medial of an outer wall of the first blade passageway, the second element enclosing each of the first and second blade passageways. 
     Embodiment 
     A method of using a laryngoscope device on a patient comprises: withdrawing fluid through an inlet in fluid communication with a first passageway formed in an insertion member and through a fluid port in fluid communication with a second passageway formed in the insertion member, the inlet being located at a distal tip of the insertion member; and the fluid port being located between the distal tip and a proximal end portion of the insertion member; and alternating withdrawal between the inlet and the fluid port by a fluid control assembly located within a handle formed at the proximal end portion of the insertion member. The method of an embodiment above, wherein the withdrawing of the fluid at the fluid port is in a direction from an outer flange portion of the blade toward an inner flange portion of the blade. 
     Embodiment 
     The method of an embodiment above, further comprising adjusting the flow in each of the first and second passageways, the flow in the first being different than the flow in the second. 
     Embodiment 
     The method of an embodiment above, wherein alternating the withdrawal includes operating a gate valve to alternate fluid between a first and second passageways in the handle which are in fluid communication with the first and second passageways. 
     Embodiment 
     The method of an embodiment above, wherein alternating the withdrawal includes operating a gate valve in the proximal-distal direction of the blade. 
     Embodiment 
     The method of an embodiment above, wherein alternating the withdrawal includes operating a gate valve in a direction perpendicular to the blade. 
     Embodiment 
     The method of an embodiment above, wherein alternating the withdrawal includes operating a rotary disc valve, the disc rotating about an axis parallel the proximal-to-distal direction. 
     Embodiment 
     The method of an embodiment above, wherein alternating the withdrawal includes operating a rotary disc valve, the disc rotating about an axis perpendicular to the proximal-to-distal direction and parallel the axis of the handle. 
     Embodiment 
     The method of an embodiment above, wherein the insertion member is a blade. 
     Embodiment 
     The laryngoscope device of an embodiment above, wherein the insertion member is a blade. 
     Embodiment 
     The device of an embodiment above, wherein the inlet of the distal tip portion has the smallest cross sectional area of the second blade passageway. 
     CONCLUSION 
     The various methods and techniques described above provide a number of ways to carry out the invention. Of course, it is to be understood that not necessarily all objectives or advantages described can be achieved in accordance with any particular embodiment described herein. Thus, for example, those skilled in the art will recognize that the methods can be performed in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other objectives or advantages as taught or suggested herein. A variety of alternatives are mentioned herein. It is to be understood that some embodiments specifically include one, another, or several features, while others specifically exclude one, another, or several features, while still others mitigate a particular feature by inclusion of one, another, or several advantageous features. 
     Furthermore, the skilled artisan will recognize the applicability of various features from different embodiments. Similarly, the various elements, features and steps discussed above, as well as other known equivalents for each such element, feature or step, can be employed in various combinations by one of ordinary skill in this art to perform methods in accordance with the principles described herein. Among the various elements, features, and steps some will be specifically included and others specifically excluded in diverse embodiments. 
     Although the application has been disclosed in the context of certain embodiments and examples, it will be understood by those skilled in the art that the embodiments of the application extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses and modifications and equivalents thereof. 
     In some embodiments, the terms “a” and “an” and “the” and similar references used in the context of describing a particular embodiment of the application (especially in the context of certain of the following claims) can be construed to cover both the singular and the plural. The recitation of ranges of values herein is merely intended to serve as a shorthand method of referring individually to each separate value falling within the range. Unless otherwise indicated herein, each individual value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (for example, “such as”) provided with respect to certain embodiments herein is intended merely to better illuminate the application and does not pose a limitation on the scope of the application otherwise claimed. No language in the specification should be construed as indicating any non-claimed element essential to the practice of the application. 
     Certain embodiments of this application are described herein. Variations on those embodiments will become apparent to those of ordinary skill in the art upon reading the foregoing description. It is contemplated that skilled artisans can employ such variations as appropriate, and the application can be practiced otherwise than specifically described herein. Accordingly, many embodiments of this application include all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the application unless otherwise indicated herein or otherwise clearly contradicted by context. 
     Particular implementations of the subject matter have been described. Other implementations are within the scope of the following claims. In some cases, the actions recited in the claims can be performed in a different order and still achieve desirable results. In addition, the processes depicted in the accompanying figures do not necessarily require the particular order shown, or sequential order, to achieve desirable results. 
     All patents, patent applications, publications of patent applications, and other material, such as articles, books, specifications, publications, documents, things, and/or the like, referenced herein are hereby incorporated herein by this reference in their entirety for all purposes, excepting any prosecution file history associated with same, any of same that is inconsistent with or in conflict with the present document, or any of same that may have a limiting affect as to the broadest scope of the claims now or later associated with the present document. By way of example, should there be any inconsistency or conflict between the description, definition, and/or the use of a term associated with any of the incorporated material and that associated with the present document, the description, definition, and/or the use of the term in the present document shall prevail. 
     In closing, it is to be understood that the embodiments of the application disclosed herein are illustrative of the principles of the embodiments of the application. Other modifications that can be employed can be within the scope of the application. Thus, by way of example, but not of limitation, alternative configurations of the embodiments of the application can be utilized in accordance with the teachings herein. Accordingly, embodiments of the present application are not limited to that precisely as shown and described.