Patent Publication Number: US-4321917-A

Title: Surgical drape support and oxygen supply device

Description:
RELATED APPLICATIONS 
     The present application is a continuation-in-part of the inventor&#39;s copending application Ser. No. 40,087, filed May 17, 1979 and now abandoned. The disclosure of that application is hereby incorporated by reference as though fully set forth herein. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention relates to a device for supporting a surgical drape above a patient and enabling the supplying of a respirable atmosphere to a patient during a surgical operation. The atmosphere may be either an oxygen enriched air or pure oxygen. The device is used in conjunction with a surgical operating table having a patient supporting mattress thereon and with a drape or cover sheet in order to retain the supplied atmosphere for patient respiration. The drape support device described herein is of particular usefulness with respect to ophthalmological operations in which a surgical field must be maintained through an opening in a drape for operations upon the eye. 
     Intraocular operations upon the human eye are mostly conducted under a local anesthetic and hence the patient is awake and must be kept comfortable during the operation. Movement to a new patient position must be provided for under the direction of the operating ophthalmologist. It is desirable to let the patient seek the most comfortable attitude and to then arrange the cover drape so that the patient&#39;s breathing can be natural and unencumbered. At the same time, another major requirement is that the operating microscope field must be well presented for access by the ophthamologist. Yet another requirement is that the field be presented in a manner so that operating tools can be moved in and out without obstruction. The operating field must be maintained directly centered on the eye since a small field aperature in the drape is used to prevent the patient from looking up at the surgeon with the other eye and to maintain sanitary field conditions. Also the drape support device must be rigid once fixed in position so that accidental movement during an operation is rendered impossible. Operating room personnel often rest their hands and place various instruments on the drape. These requirements mean that the various devices and surgical implements are close spaced to the operating field which is small and delicate to properly maintain. 
     These critical and desirable conditions are regarded as important for intraocular surgical procedures such as cataracts extractions with or without lens implants, glaucoma treatment, corneal transplants (keratoplasties), retinal detachment treatment and exploratory orbitotomies for tumor and bone chip location. Patient comfort is less of concern for those extraocular procedures where general anesthetics are used such as for eyelid plastic surgery, strabismus (eye muscle surgery) procedures, refractive radial keratotomies procedures, and retinal surgery. 
     One aspect of the criticality of the spacing is that the cover sheet which is used to maintain a respirable atmosphere over the patient&#39;s nose and mouth must not be lifted or moved off of the underlying drape support device. Movement of the cover sheet is necessary in many of the devices in the prior art because the adjustment screws on those devices are located at various positions which underly the drape or cover sheet. Another general problem in the prior art is that the adjustments necessary to obtain different positions of the atmosphere supply device and the overlying cover sheet are distributed at different locations rather than being located in a single position outside of the cover sheet. Such devices require a special search for the proper set screw which then disturbs the delicate surgical procedure. 
     Another problem in surgical operations in which close control must be maintained over the operating field is that the underlying support device for the cover sheet should be capable of being dipped downwardly toward the patient in an arcuate motion which will folow the turn of a patient&#39;s head as the patient tries to maintain an acceptable level of comforture during the eye operation which can frequently be one hour to one and one half hours in duration. 
     Maintaining patient comfort can best be provided in head and neck operations by holding the cover drape a substantial distance of 5 cm to 10 cm above the patient&#39;s nose and mouth and by supplying a distributed flow of oxygen which gives a sensation of air flow across the face. This helps to alleviate apprehension arising from a mild suffocation sensation which can lead to a dyspneic (shortness of breath) condition in some patients. The oxygen flow provided reassures the patient and permits better surgery results. 
     U.S. Pat. No. 2,180,480 to M. G. Richardson illustrates some of the above problems. The set screws which allow adjustment of the anesthetics screen support frame immediately underlie the cover screen and hence it is necessary to lift the drape off of the support in order to adjust the same to various positions. Also in this device, there is no provision for the inflow of oxygen. 
     U.S. Pat. No. 3,347,544 to Uffenorde discloses a head rest for eye surgery having a nonadjustable anesthetic screen support attached thereto. The fixed position of this type of device has been found to be unacceptable. U.S. Pat. No. 3,482,571 to Behrendt shows a similar head rest with an oxygen tube support means. 
     U.S. Pat. No. 2,628,803 to Krewson shows an anesthetic screen support device for use during eye surgery in which the set screws are covered over by the screen material. Also, in this device it is not possible to follow the patients head movements since no single adjustment motion permits following of the turning of a patient&#39;s head. 
     U.S. Pat. No. 2,290,437 to Kilgore et al shows a support structure for use in eye operations. The upper thumb screw can only be adjusted by removing the overlying screen material. The gas supply tube is not supported for making an arcuate motion inward and outward toward and away from the patient and there is no provision for distribution of the gas flow over the patient&#39;s face. U.S. Pat. No. 3,530,515 to B. Y. Jacoby shows a patient guard for use during eye surgery which presents problems similar to the Kilgore device as does the device shown in German Pat. No. 2,614,202. 
     U.S. Pat. No. 2,963,247 to G. L. Collier et al. shows a form of an endotracheal tube holder which is not functional for eye operations or for supporting a drape. 
     U.S. Pat. No. 3,877,691 to Foster shows a flexible arm anesthetic shielding device which does not support a cover drape, supply oxygen nor provide the required rigidity of support for ophthalmological operations. 
     U.S. Pat. No. 3,859,993 to Bitner shows a largely nonadjustable oxygen supply and drape sheet for eye surgery in which the oxygen flows too far from the patient&#39;s face to alleviate a suffocation sensation. 
     Other medical and/or surgical devices having various types of positioning adjustments are disclosed in U.S. Pat. Nos. 3,026,079, 3,625,219 and 3,881,477. British Pat. No. 807,407 published Jan. 14, 1959 also shows an anesthetic gas supply tube and an adjustable support therefore. 
     SUMMARY OF THE INVENTION 
     A surgical drape support device is provided for use with a cover sheet and a conduit for supplying a respirable gas mixture to a patient disposed on a mattress overlying a surgical operating table. The device has a base member which is inserted between the mattress and the surgical table and a support rod which has a drape arm for disposition over a patient. This drape arm can also function as an oxygen distribution means by provision of an associated gas supply conduit. The base member and the support rod are interconnected by a unitary adjustment means which provides for at least 4 degrees of adjustment motion for the drape arm of the support rod. All adjustments for positioning of the drape arm can be made conveniently at the side of the operating table from a location which is removed from the operating field and the patient. All of the position adjustments can be made without removing the overlying drape or cover sheet which is used to retain the respirable atmosphere in the vicinity of the patient&#39;s nose and mouth. 
     One of the degrees of adjustment motion is over an arc about a longitudinal axis which is located parallel to and closely spaced from the edge of the operating table in order to allow movement of the drape arm toward and away from the patient on the operating table to provide for different side positions of the patient&#39;s head. 
     The unitary adjustment means is positioned on the drape support device near the edge of the operating table and is in the form of a block having adjustment means cooperating therewith which enable fixing of the relative position of the base member and the drape arm in various positions provided by the four degrees of adjustment motion. 
     It is, therefore, an object of the present invention to provide a drape support having a respirable atmosphere supply capability for use on surgical tables in which position adjustments can be achieved without removing the overlying cover sheet which is supported by said device. 
     Another object of the present invention is to provide a drape support and respirable atmosphere supply device wherein a drape arm is moveable in at least four degrees of adjustment motion which are all controlled from a unitary adjustment means which is positioned outside of the operating field and the cover sheet. 
     Another object of the present invention is to provide an improvement in a surgical drape support device of the above type in which a unitary adjustment means is interconnected between a base member and a support rod in order to provide at least four degrees of adjustment motion for a drape arm of the support rod. 
     The drape support device described and claimed herein is also useful in a wide range of surgical and other medical procedures. For example, in addition to eye surgery it is useful in ear, nose and throat; dermatological; plastic or facial reconstruction; and head and neck operations. More special employments are for the supply of oxygen to burned areas in skin grafting procedures to prevent anerobic infections of the gangrene type or as a supplementary oxygen tent with a transparent cover sheet. In abdominal and chest surgery the device can be used to protect against accidental closing off the anesthetic (endotracheal) tube. 
     Specific preferred embodiments of the invention will be described below with reference to the appended drawing figures. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a perspective view of the drape support and respirable atmosphere supply device in accordance with the present invention; 
     FIG. 2 is a front plan view of the unitary adjustment means of the support device showing the knurled set screws removed therefrom; 
     FIG. 3 shows a schematic perspective view of the drape support device in use on an operating table with a patient; and 
     FIG. 4 shows the use of the support device for supporting an overlying cover sheet which provides an operating field viewable through an operating ophthalmological microscope. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring to FIGS. 1 and 2, a surgical drape support device 10 is shown with a base member 12 which is in the form of a generally rectangular metal frame having a rail 14 integrally formed by one side thereof. Rail 14 has a longitudinal axis 16 which is disposed along the longitudinal edge of an operating table as described below. This rail 14 also has a flat 18 along the outer surface thereof. 
     Rail 14 has a unitary adjustment block 20 slidably and rotatably supported thereon. Knurled set screw 22 is provided in adjustment block 20 in order to clamp against the outside surface of rail 14 to secure block 20 against the sliding and rotating motions. Set screw 22 abuts flat 18 on rail 14 when the adjustment block 20 is in the vertical position shown in FIG. 1. If desired, a secnd knurled set screw 24 can be provided in adjustment block 20 for allowing greater gripping force to be exerted upon the rail 14. 
     Adjustment block 20 has a vertical passage therein which accommodates a support rod 26 for vertical sliding adjustment and rotating adjustment. A knurled set screw 28 is provided on the side of unitary adjustment block 20 to fix the position of rod 26 with respect to the block 20. Support rod 26 has a drape arm 30 connected to its upper end and disposed generally perpendicularly thereto so as to form a horizontally disposable part thereof. This drape arm 30 can preferrably have a series of apertures 32 located therealong in the under surface in order to provide for the outflow of a respirable atmosphere gas from a conduit formed within the drape arm. The preferred embodiment is to form support rod 26 and drape arm 30 from a continuous metal tube. The opposite end of the support rod 26 can then have a receiving opening 34 which can be connected to a source of respirable gas which is provided in the operating theater. An oxygen flow of about 6 liters/minute is normally used. 
     The drape arm 30 of support rod 26 is then adjustable along four degrees of adjustment motion denoted as A-D in FIG. 1. Knurled set screws 22 and 24 provide securing means against sliding motion A with respect to rail 14 as well as against rotating motion about longitudinal axis 16 which then produces an arcuate motion D about this longitudinal axis 16 in order to obtain a movement of drape support arm 30 toward and away from a patient underlying the drape arm. If desired, the two set screws 22 and 24 can be replaced with a single set screw having a leverage means affixed to the outer end such as a large knob with finger scallops or an operator lever. 
     Two other degrees of adjustment motion for drape arm 30 are the vertical motion B and the rotating motion C. These two motions are controlled and secured against by means of knurled set screws 28. The arcuate adjustment motion D about the longitudinal axis 16 of rail 14 allows for various angular positions as shown in phantom lines away from the horizontal position for the drape arm 30. The material of construction for all of the parts of the supplied device 10 can be a metal such as stainless steel or other easily cleaned material such as rigid polymeric materials. Due to the requirement for rigidity during an operation, an all metal construction is preferred. 
     Base member 12 can be constructed of a tubular frame portion 36 which is secured to either end of a solid metal rail 14 after that rail is inserted through an opening 38 in the unitary adjustment block 20. The support rod 26 can then be placed into the unitary block 20 through the vertical opening 40 therein. The openings 38 and 40 can be seen in FIG. 2. These two openings are spaced from one another within unitary block 20 so that the rail 14 does not contact gas tube 26. If desired, the corners and edges of unitary block 20 can be beveled for safety. FIG. 2 also illustrates the optional element of an air exhaust tube 42 which is preferrably attached to the side of adjustment block 20. The exhaust tube 42 has an enlarged upper intake port 44 through which the heavier density carbon dioxide exhaled by the patient can flow. This exhaust tube can be circular or rectangular in cross-section and can be removably attached to block 20. 
     Referring now to FIG. 3, supply device 10 is shown having the base member 12 underlying a mattress 46 which is positioned with the exhaust tube 42 removed on an operating table (not shown). A patient P is supported on the operating table with a head rest 48. The drape arm 30 which also functions as a gas distribution means is positioned to overlie the patient and is secured in the positin shown by adjustment of knurled set screws 22, 24 and 28 on unitary adjustment block 20. The opposite end of the hollow support rod 26 has the receiving opening 34 connected to a gas hose 49 for the supply of a respirable gas. 
     When the drape arm and gas distribution portion 30 is aligned horizontally as shown in FIG. 3, the knurled set screws 22 and 24 abut the flat 18 on rail 14. However, when it is necessary to adjust this drape arm 30 to the angular position shown by phantom lines in FIG. 1, the knurled knobs 22 and 24 are tightened down upon the round portion of rail 14. Both of set screws 22 and 24 are then desirable to secure the gas distribution portion 30 in a fixed off-vertical position when this angular adjustment about arc D as shown in FIG. 1 is used. 
     FIG. 4 shows a schematically depicted operating ophthamological microscope 50 positioned over an operating field 52 which is formed by an opening in a drape or cover sheet 54 which is supported by drape arm 30. An angle of about 120° is present at the apex of the supported drape. It can be seen that the edge 56 of the cover sheet can be positioned with respect to the operating table so that the unitary adjustment block 20 is exposed for convenient adjustment by the operating ophthamist without the necessity of moving the cover sheet 54. These adjustments can be made at the beginning of the operation, which is preferable, and also during the often lengthy operations on the eye when patient comfort must be maintained. The four degrees of adjustment motion provided by adjustment means 20 allow patient movements to be accomodated for and still maintain a fully usable operating field 52. This is provided by the four degrees of adjustment motion of the drape arm with respect to the base member 12 and rail 18. An exhaust tube 42 is also shown attached to a flow tube 57 for carrying exhaled gas away from the space under cover sheet or drape 54. 
     Support device 10 can be used with all operating microscopes such as shown by microscope 50. These microscopes are highly specialized for different types of operations on the head, neck, eyes, ears and throat. An adjustable height floor stand 58 is provided with electrical connections 60 for powering one or more illuminators such as a coaxial illuminator 62 and an oblique illuminator 64 to produce a better viewable operating field 52. It is usual that two or more binocular microscopes 66 and 68 are provided for multiple surgeon use. Other attachments (not shown) can be film and TV cameras. Adjustment knobs 70-80 and brakable wheels 82-86 are typically provided. Slightly different constructions are used for throat, brain and plastic surgery. 
     The knurled set screw 28 is shown on the front face of the adjustment block 20 in FIGS. 1, 3 and 5. It is also possible to position this set screw 28 on the same surface as the outer set screws 22 and 24. Also, another variation is that only a single set screw engaging rail 14 is necessary if an additional tightening means is provided by means of a mechanical leverage device. That is, knurled set screw 24 is optional. 
     By FIGS. 3 and 4 the nonprotruding form of the unitary adjustment block 20 can be seen. No portion of the adjustment means or the entire device 10 extends more than several centimeters from the operating table. Hence no equipment inconvenience is set up by this device. Also it is highly significant that all adjustments can be made from a noninterferring position removed from the patient area of the table which is defined to be the space above the entire upper table surface. 
     The tubular base member 12 can also be constructed in the form of a platform such as described and claimed in the inventor&#39;s copending Application Ser. No. 40,087, filed May 17, 1979. In this common subject matter variation a rail 14 is fixed along the outside edge of a base plate member and the unitary adjustment block 20 is then mounted on the rail. 
     The surgical drape or cover sheet can be constructed of a tight woven cloth, usually cotton; a plastic sheet including one with an adhesive on one side; or a paper web. 
     If a solid support rod 26 and drape arm 30 are used a separate oxygen tube can be taped to one or both of these members to provide an oxygen flow. 
     The respirable gas supplied can be either oxygen enriched air or pure oxygen. 
     The invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The present embodiments are therefore to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims rather than by the foregoing description, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.