Patent Publication Number: US-2012031400-A1

Title: Cricoid manipulating apparatus for anesthesia assistance and tracheal intubation

Description:
CROSS-REFERENCE TO RELATED APPLICATION(S) 
     This United States Non-Provisional patent application relies for priority on U.S. Provisional Patent Application Ser. No. 61/370,124, filed on Aug. 3, 2010, the contents of which are incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention concerns an apparatus that may be employed in an operating room setting, among other environments. Specifically, the present invention concerns an apparatus that assists with the administration of anesthesia to a patient by providing cricoid manipulation. The apparatus assists with the application of anesthesia by helping an anesthesiologist to intubate a patient on an operating table, for example. 
     DESCRIPTION OF THE RELATED ART 
     In an operating room, prior to an operation where anesthesia is administered to a patient, it is necessary to intubate the patient. 
     Intubation involves inserting an endotracheal tube (“ETT”) in the patient&#39;s throat. 
     As should be apparent to those skilled in the art, including anesthesiologists, to insert the ETT, it is often necessary to manipulate the tissues in the patient&#39;s throat so that the ETT may be inserted without difficulty. For example, the practitioner will usually apply external pressure on the anterior portion of the patient&#39;s neck to push the tracheal opening in the throat (i.e., the glottis) into a more posterior position. This places the throat into a better position for viewing though the mouth by the anesthesiologist using a laryngoscope. 
     Because the laryngoscope is held by the anesthesiologist&#39;s left hand, and placement of the ETT is performed by the right hand, it is often necessary to have a second person (i.e., a nurse) assist the anesthesiologist to apply external pressure on the neck. 
     It is also desirable for an assistant (i.e., a nurse) to be available for other tasks like holding the right side of the patient&#39;s mouth open, handing the anesthesiologist a suction tip or handing the anesthesiologist the ETT. 
     As may be apparent to those skilled in the art, when a nurse is asked to assist the anesthesiologist, the nurse is not available for other tasks in the operating room. 
     In addition, even after an anesthesiologist has manipulated the patient&#39;s throat to present an appropriate alignment for insertion of the ETT, it is seldom successful for the anesthesiologist to ask the nurse to take over by maintaining pressure on the patient&#39;s throat. Simply, a second person infrequently applies exactly the pressure that maintains the neck tissues in the optimal orientation. As may be appreciated by those skilled in the art, slight variations of pressure on a patient&#39;s throat can alter the alignment of the tissues to effectively prevent insertion of an ETT. 
     Cricoid manipulation is only one aspect of manipulation that may be employed by the anesthesiologist to assure proper throat alignment for proper administration of anesthesia during an operation. 
     For example, it is sometimes necessary to apply pressure to the person&#39;s forehead to maintain the head at a particular angular orientation. This may be required, for example, to assure adequate ventilation of the patient. 
     In addition, it may be necessary in some cases to apply an upward pressure on the back of the patient&#39;s neck to establish an air passageway that is suitable for a particular operation. 
     Further still, it may be necessary for the anesthesiologist to require that at least one of the cheeks of the patient be pulled laterally to facilitate access to the patient&#39;s air passageway. 
     In addition, it may be necessary to apply pressure to the patient&#39;s tongue to keep the tongue from interfering with the intubation procedure or the administration of anesthesia. 
     As should be apparent from the foregoing, positioning a patient properly before an operation often requires cooperation between two persons. 
     There are a number of devices that have been created to address various aspects associated with the administration of anesthesia and the intubation of patients. Some of those devices are discussed below. 
     U.S. Patent Application Publication No. 2010/0089410 (hereinafter the &#39;410 Application) describes an apparatus and a method for airway patency and head immobilization. The &#39;410 Application describes a device that performs a jaw thrust and a chin tilt to open and maintain on opened passageway during emergency or surgical care. (The &#39;410 Application at paragraph [0008].) With reference to FIG. 8, for example, the apparatus includes head support assemblies 140 and mandible rest assemblies 108. (The &#39;410 Application at paragraph [0032].) The head rest assemblies 140 are adjustable until the head rests 150 contact the person&#39;s head. (The &#39;410 Application at paragraph [0032].) A chin strap 122 is placed over the person&#39;s chin and cooperates with the mandible assemblies 108 to assist the health care provider with an advantageous jaw thrust maneuver. (The &#39;410 Application at paragraph [0032].) 
     U.S. Patent Application Publication No. 2007/0181122 (hereinafter the &#39;122 Application) describes an intubation positioning apparatus, breathing facilitator, and non-invasive assist ventilation device. The device is intended for use with patients who are lying down, are in a supine position, or are prone on an operating table. (The &#39;122 Application at paragraph [0002].) The device includes a number of balloons 1-7 that may be inflated to elevate different parts of the human body, thereby altering the positional arrangement of various parts of the human body. (The &#39;122 Application at paragraph [0015].) 
     U.S. Pat. No. 7,621,009 (hereinafter the &#39;009 patent) describes a surgical coordinator for an anesthesiologist and methods of use. The device includes a flexible pad 21 with one or more holders 31 for holding fluid tubing lines leading to and from the patient during and after surgery. (The &#39;009 patent at col. 7, lines 17-21.) 
     U.S. Pat. No. 7,096,869 (hereinafter the &#39;869 patent) describes a device and method for maintaining a patient&#39;s airway. The device 10 described in the &#39;869 patent includes a neck support 11, an extendible swing arm 12, a cross-arm 13, and a chin support 14. (The &#39;869 patent at col. 2, lines 45-51.) As illustrated in FIG. 9, the device 10 lifts the patient&#39;s chin and tilts the patient&#39;s head. (The &#39;869 patent at col. 1, lines 46-49.) 
     U.S. Pat. No. 6,969,366 (hereinafter the &#39;366 patent) describes a hands-free chin lift and airway support device 10. The device 10 includes a chin rest 12, a base 16, and a shaft 14 connecting the chin rest 12 to the base 16. (The &#39;366 patent at col. 4, lines 39-41.) The shaft 14 is a cylindrical solid that is malleable to accommodate the person&#39;s anatomy. (The &#39;366 patent at col. 4, lines 56-58.) As illustrated in FIGS. 3 a  and 3 b , the base 16 is placed on the patient&#39;s manubrium 38 and is affixed to the patient via an adhesive 26. (The &#39;366 patent at col. 5, lines 2-7.) The device 10 holds the patient&#39;s head in the sniffing position. (The &#39;366 patent at col. 5, lines 22-27.) 
     U.S. Pat. No. 6,935,340 (hereinafter the &#39;340 patent) describes a device that assists with endotracheal intubation. The endotracheal assistance device 100 is a pillow, cushion, support, or device that has at least two independently adjustable chambers 102, 104. (The &#39;340 patent at col. 3, lines 6-13.) The first chamber 102 supports the patient&#39;s shoulder region and the second chamber 104 supports the person&#39;s head. (The &#39;340 patent at col. 3, lines 14-20.) The first and second chambers 102, 104 cooperate with a pressure applicator 106 to position the person&#39;s head. (The &#39;340 patent at col. 3, lines 32-45.) 
     U.S. Pat. No. 6,422,873 (hereinafter the &#39;873 patent) describes a device for use in the application of cricoid pressure and/or for training for such application. The background in the &#39;873 patent describes that studies have found that 47-61% of medical staff apply inadequate cricoid force during an intubation procedure before administration of anesthesia. (The &#39;873 patent at col. 1, lines 56-59.) The device includes a gauge 3 that indicates the amount of pressure (i.e., force) applied to the cricoid cartilage. (The &#39;873 patent at col. 3, lines 57-66.) U.S. Pat. No. 6,171,314 (hereinafter the &#39;314 patent) describes a device to maintain open air passageways for people requiring anesthesia during a surgical procedure. (The &#39;314 patent at the Abstract.) The chin support 28 includes a central support 30 and to side supports 32, 34 that extend between the patient&#39;s chin and chest. (The &#39;314 patent at col. 4, lines 38-48.) 
     U.S. Pat. No. 5,483,974 (hereinafter the &#39;974 patent) describes a device to apply, hold, and measure the cricoid pressure applied during endotracheal intubation. The &#39;974 patent describes how important it is to apply cricoid pressure to avoid aspiration of gastric contents during specific procedures. (The&#39;974 patent at col. 1, lines 45-48.) The device includes a housing  10  disposed on the cricoid cartilage 56. (The &#39;974 patent at col. 4, lines 40-44.) An inflatable bladder 40 applies pressure to the cricoid cartilage 56. (The &#39;974 patent at col. 4, lines 59-61.) 
     As should be apparent from the foregoing, there is considerable need for medical practitioners (i.e., doctors, nurses, emergency medical technicians, etc.) to have available to them a wide variety of devices to assist with the administration of anesthesia and the intubation of patients. 
     These needs remain unaddressed by the prior art. 
     SUMMARY OF THE INVENTION 
     The present invention resolves one or more of the needs identified with respect to the related art and the prior art. 
     One embodiment of the present invention contemplates a medical assistance apparatus that includes a support adjacent to a patient, a flexible shaft with a first end and a second end, with the first end being connected to the support, a housing connected to the second end of the flexible shaft, a shaft movably disposed with respect to the housing, an adjustment device associated with the housing, permitting adjustment of the shaft with respect to the housing, and a cricoid manipulating head connected to the shaft. In this embodiment, the cricoid manipulating head is adjusted with respect to the housing along when the shaft is adjusted with respect to the housing. 
     It is also contemplated that the support for the medical device may be a rail connected to a patient table. 
     In one contemplated embodiment, the support is a rod that may be substantially vertically oriented adjacent to a table. 
     The flexible shaft may include at least one of a flexible material, a plurality of articulated segments, or a combination of a flexible material and at least one articulated segment. 
     It is contemplated that the medical device may have a ball joint connecting the flexible shaft to the housing, thereby permitting multi-axial movement of the housing with respect to the flexible shaft. 
     It is also contemplated that the adjustment device may have a plurality of tooth-engaging grooves disposed on the shaft, a gear rotationally disposed adjacent to and engaging the plurality of tooth-engaging grooves, a gear shaft on which the gear is disposed, the gear shaft being disposed rotationally with respect to the housing, and a head disposed on the gear shaft, permitting manipulation of the shaft and the gear, thereby causing movement of the shaft and the cricoid manipulating head with respect to the housing. 
     With respect to one embodiment of the present invention, the adjustment device may include threads on the shaft, a threaded opening in the housing into which the shaft is threadedly disposed, and a joint disposed at one end of the shaft, connecting the shaft to the cricoid manipulating head. In this embodiment, the joint permits the cricoid manipulating head to rotate with respect to the shaft, independently of any rotation of the shaft within the housing. 
     A further embodiment of the medical device contemplates that the adjustment device will have a plurality of grooves disposed on the shaft, a first adjustment lever and a second adjustment lever pivotally connected to the housing and disposed adjacent to substantially opposite sides of the shaft, rounded ends on each of the first and second adjustment levers, and a plurality of teeth disposed on the rounded ends of the first and second adjustment levers, the teeth engaging with the grooves on the shaft. Here, actuation of the first and second adjustment levers causes the shaft to move in relation to the housing. 
     The cricoid manipulating head may have a body with a hemi-cylindrical shape. 
     Alternatively, the cricoid manipulating head may have a body defined by a central region, a right side lobe, and a left side lobe, wherein the body compliments a natural shape of a person&#39;s neck. 
     In still another embodiment, the cricoid manipulator head may have a body defined by a central section with four flexible fingers extending therefrom. 
     The present invention also contemplates a medical suite with a medical assistance apparatus as discussed above and at least manipulator selected from a manipulator group. The manipulator group may include one or more of the following: (1) a cheek manipulator with a flexible shaft with a first end and a second end, the first end being connected to the support, an L-shaped body movably connected to second end of the flexible shaft, the L-shaped body having a first leg and a second leg, wherein the first leg is movably disposed with respect to the flexible shaft and the second leg is provided to engage a patient&#39;s cheek, and an adjustment device associated with the flexible shaft, permitting adjustment of the first leg of the L-shaped body with respect to the flexible shaft, (2) a tongue manipulator with a flexible shaft with a first end and a second end, with the first end being connected to the support, a clamp attached to the second end of the flexible shaft, the clamp having first and second clamping members that oppose one another, and a tongue depressor disposable between the first and second clamping members of the clamp, (3) a tool rack with a flexible shaft with a first end and a second end, with the first end being connected to the support, and a tool rack head disposed on the second end of the flexible shaft, wherein the tool rack head has a body with a plurality of flexible fingers attached thereto, the fingers being disposed adjacent to one another so that items may be inserted therebetween, the fingers including at least a flexible surface thereon so that items inserted therebetween are retained therebetween at least partially due to the flexible surface on the plurality of fingers, and (4) a neck manipulator having a flexible shaft with a first end and a second end, with the first end being connected to the support, and a neck manipulator head fixedly disposed on the second end of the flexible shaft. 
     One variation of the medical suite contemplates at least two or three manipulators are selected from the manipulator group defined above. 
     The present invention also contemplates a medical assistance device with a support adjacent to a patient, a flexible shaft with a first end and a second end, with the first end being connected to the support, an L-shaped body movably connected to second end of the flexible shaft, the L-shaped body having a first leg and a second leg, wherein the first leg is movably disposed with respect to the flexible shaft and the second leg is provided to engage a patient&#39;s cheek, and an adjustment device associated with the flexible shaft, permitting adjustment of the first leg of the L-shaped body with respect to the flexible shaft. 
     In still another contemplated embodiment, the medical device of the present invention includes a support adjacent to a patient, a flexible shaft with a first end and a second end, with the first end being connected to the support, a clamp attached to the second end of the flexible shaft, the clamp having first and second clamping members that oppose one another, and a tongue depressor disposable between the first and second clamping members of the clamp. 
     It is contemplated that the medical device of the present invention may include a support adjacent to a patient, a flexible shaft with a first end and a second end, with the first end being connected to the support, and a tool rack head disposed on the second end of the flexible shaft, wherein the tool rack head has a body with a plurality of flexible fingers attached thereto, the fingers being disposed adjacent to one another so that items may be inserted therebetween, the fingers having at least a flexible surface thereon so that items inserted therebetween are retained therebetween at least partially due to the flexible surface on the plurality of fingers. 
     The medical assistance device according to the present invention also may include a support adjacent to a patient, a flexible shaft with a first end and a second end, with the first end being connected to the support, and a neck manipulator head fixedly disposed on the second end of the flexible shaft, wherein pressure may be applied by the neck manipulator head to a posterior surface of a patient&#39;s neck. 
     In any of its embodiments, the medical assistance device also may be provided with a distal locking mechanism that permits a releasable locking of the flexible shaft to maintain the flexible shaft in a selected, predetermined orientation. The distal locking mechanism is contemplated to permit the practitioner to place the flexible shaft into a rigid condition with a one-handed operation, thereby facilitating manipulation of the flexible shaft. 
     Still further aspects of the present invention will become apparent from the discussion that follows and from the drawings appended hereto. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention will now be described in connection with several drawings, appended hereto, in which: 
         FIG. 1  is an elevational, end view of an operating table, illustrating various aspects of the present invention; 
         FIG. 2  is a side view illustration of a patient on an operating table, with the cricoid manipulating device of the present invention being illustrated in relation to the patient&#39;s neck; 
         FIG. 3  is a front view of a first embodiment contemplated for the cricoid manipulator of the present invention; 
         FIG. 4  is a side view of the cricoid manipulating device illustrated in  FIG. 3 ; 
         FIG. 5  is a front view of a second embodiment of a cricoid manipulator contemplated for use with the present invention; 
         FIG. 6  is a bottom view of the cricoid manipulator illustrated in  FIG. 5 ; 
         FIG. 7  is a side view illustration of the cricoid manipulator of the present invention, showing a first embodiment of an adjusting device associated therewith; 
         FIG. 8  is a side view illustration of the cricoid manipulator of the present invention, showing a second embodiment of an adjusting device associated therewith; 
         FIG. 9  is a cross-sectional, side view illustration of the cricoid manipulator of the present invention, showing a third embodiment of an adjusting device associated therewith; 
         FIG. 10  is a top view illustration of a cheek manipulator according to the present invention, shown in association with the mouth of a patient; 
         FIG. 11  is a side view illustration of the cheek manipulator according to the present invention, which is illustrated in  FIG. 10 ; 
         FIG. 12  is a front view of a tongue manipulator according to the present invention; 
         FIG. 13  is a top view of the tongue manipulator illustrated in  FIG. 12 ; 
         FIG. 14  is a side view illustration of a patient&#39;s head, showing an application of pressure to the patient&#39;s forehead and chin via the cricoid manipulator of the present invention; 
         FIG. 15  is an elevational, end view of an operating table, illustrating various aspects of the present invention, including the use of the cricoid manipulator as a support for anesthesia gases; 
         FIG. 16  is a side view of a tool rack according to the present invention; 
         FIG. 17  is an end view of the tool rack depicted in  FIG. 16 ; 
         FIG. 18  is a side view of one contemplated embodiment of the flexible shaft portion of the present invention; and 
         FIG. 19  is a side view of another contemplated embodiment of the flexible shaft of the portion of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENT(S) OF THE INVENTION 
     The present invention will now be described in connection with one or more specific, contemplated embodiments. While specific embodiments are discussed, the present invention is intended to encompass equivalents and variations, as would be understood by those skilled in the art. In other words, the invention is not intended to be limited solely to the select embodiments described and/or depicted. 
       FIG. 1  is an end view representation of a patient table, such as an operating table  10  that incorporates many of the features of the present invention. As illustrated, the operating table  10  includes a pedestal  12  that supports an operating surface  14 . A patient support  16  is disposed on the operating surface  14 . 
     On either side of the operating surface  14 , equipment rails  18  are provided. The equipment rails  18  typically extend the entire length of the operating surface  14 . Of course, as should be apparent to those skilled in the art, other configurations also are known and are contemplated to fall within the scope of the present invention. 
     In the illustrated embodiment of the operating table  10 , the equipment rails  18  are illustrated as T-shaped rails that extend laterally adjacent to the operating surface  14 . As should be apparent, other types of equipment rails  18  (i.e., other than T-shaped rails) may be used without departing from the scope of the present invention. It is noted that equipment rails  18 , regardless of their specific cross-section or design, typically permit devices to be attached thereto along the length of the operating table  10 . This permits equipment to be connected to the operating table  10  at any discrete location along its length. 
     In the embodiment illustrated in  FIG. 1 , a single equipment rack  20  is attached to the equipment rail  18  on the right-hand side of the drawing. The equipment rack  20  in this embodiment includes a rod  22  that connects to a clamp  24 . The clamp  24  is intended to slide onto the equipment rail  18  from one end. So that the equipment rack  20  cannot be moved from the selected location on the equipment rail  18 , the clamp  14  is provided with a fastener  26 . 
     In the illustrated embodiment, the rod  22  may be a cylindrical metal rod. As should be apparent to those skilled in the art, the rod  22  need not be cylindrical. Moreover, the rod  22  need not be made from metal. Other configurations and materials may be employed without departing from the scope of the present disclosure. 
     In  FIG. 1 , the fastener  26  is a crew-type fastener. In other words, as the user twists a handle  28 , a threaded rod  30  associated therewith is tightened against the equipment rail  18 , which secures the clamp  24  in the location selected by the user. 
     As should be apparent, the simple construction for the clamp  24  is not intended to be limiting of the instant disclosure. The clamp  24  may be of any type and be made from any material suitable for the operating theater. 
     As shown in  FIG. 1 , there are a number of devices that are connected to the rod  22 . The top-most device is referred to as the cricoid manipulator  32 . The second device is a tool rack  34 . The third device is a cheek manipulator  36 . The fourth device is a neck manipulator  38 . 
     The cricoid manipulator  32  includes a cricoid manipulator head  40 , a flexible shaft  42 , and a clamp  44  with an adjustment screw  46 . The tool rack  34  includes a tool rack head  48 , a flexible shaft  50 , and a clamp  52  with and adjustment screw  54 . Similarly, the cheek manipulator  36  includes a cheek manipulator head  56 , a flexible shaft  58 , and a clamp  60  with an adjustment screw  62 . Finally, the neck manipulator  38  includes a neck manipulator head  64 , a flexible shaft  66 , and a clamp  68  and adjustment screw  70 . 
     The details of the cricoid manipulator  32 , the tool rack  34 , the cheek manipulator  36 , and the neck manipulator  38  are discussed in the paragraphs that follow. 
       FIG. 2  illustrates a first embodiment of the cricoid manipulator  32  in relation to a patient  72  lying on the patient support  16  of the operating table  10 . In the illustration, the patient&#39;s head  74  and neck  76  are shown. The patient&#39;s head  74  is positioned on a pillow  78  for illustrative purposes. 
     As should be appreciated by those skilled in the art, the cricoid cartilage is a ring of cartilage that surrounds the trachea. During intubation with an ETT, an anesthesiologist is required to apply pressure to the cricoid cartilage so that the tissues in the patient&#39;s throat are properly aligned for insertion of the ETT. The precise pressure applied to the cricoid cartilage differs for each patient. 
     It is noted that, while the present invention is contemplated for use by an anesthesiologist in an operating room, the present invention is not limited solely to this use. In addition, while aspects of the present invention are discussed in connection with intubation of a patient with an ETT, the present invention is not intended to be limited solely to this use. 
     As should be apparent, there are many medical practitioners who may benefit from aspects of the present invention in many different environments, too numerous to list here. The precise use or environment where the present invention is employed, therefore, is not considered to be critical to the present invention or to be limiting of the present invention in any manner. 
     In the paragraphs that follow, the term practitioner is employed to refer generally to any person that may rely on the present invention for any purpose. A practitioner may include, but is not limited to, a doctor, nurse, doctor&#39;s assistant, anesthesiologist, emergency medical technician, etc. 
     Returning to  FIG. 2 , once the appropriate pressure is applied to the cricoid cartilage, the anesthesiologist usually inserts the ETT with his or her free hand while maintaining the throat tissue in the appropriate orientation. This presents a challenge to the practitioner who may need both hands to guide the ETT into position. As such, many practitioners enlist assistance from another person to maintain pressure on the cricoid cartilage. This also presents a challenge since the assistant cannot visualize the throat tissue and, therefore, cannot typically apply appropriate pressure to the patient&#39;s neck in exactly the manner desired by the practitioner. 
     The cricoid manipulator  32  provides the “extra hand” that the practitioner requires for insertion of the ETT. 
     As illustrated in  FIG. 2 , in its simplest deployment, the cricoid manipulator  32  includes a housing  80  that is connected to the flexible shaft  42  via a ball joint  82 . The ball joint  82  permits the housing  80  to be disposed in any number of angular orientations with respect to a vertical axis  84 , which also is illustrated in  FIG. 2 . 
     With respect to the flexible shaft  42 , it is contemplated that the flexible shaft will be made from one or more materials. It is contemplated that the shaft will be made from a material that allows the practitioner to bend the shaft  42  into any shape or configuration that may be useful in treating a patient  72 . The flexible shaft  42  may be a continuous shaft construction. Alternatively, the shaft  42  may be constructed from a plurality of discrete segments that are connected to one another. In still another construction, the flexible shaft  42  may combine both continuous segments and discrete segments that move with respect to one another. The exact configuration for the flexible shaft  42  is not critical to the construction or operation of the present invention. 
     While not required for operation of the cricoid manipulator  32 , multi-axial movement of the housing  80  is preferred because it allows the practitioner to apply pressure to the cricoid cartilage both in an anterior/posterior direction, illustrated by the arrows  86 ,  88 , in a lateral direction (arrows  90 ,  92 ), and also in head to toe directions (arrows  94 ,  96 ). While the primary force that is applied is in the posterior direction  88 , it is often necessary to apply pressure slightly to the patient&#39;s left (arrow  90 ) or right (arrow  92 ) to along the throat tissue as required for insertion of the ETT. It may also be necessary to apply pressure in a direction toward the patient&#39;s head (arrow  94 ) or toward the patient&#39;s toes (arrow  96 ). Any other combination of vectors also may need to be employed. 
     As noted above, the ball joint  82  permits multi-axial movement of the housing  80  in arcuate directions, such as those indicated by arrows  98 ,  100  in  FIG. 2 . In the illustrated embodiment, the ball joint  82  includes a spherical body  102  embedded in the housing  80  so that the housing  80  rotates about the spherical body  102 . The spherical body  102 , in turn, is fixedly connected to the flexible shaft  42 . 
     In the embodiment illustrated in  FIG. 2 , the spherical body  102  may be made from stainless steel. As should be appreciated by those skilled in the art, however, the spherical body  102  may be made from any suitable material including aluminum, metal, plastic, or composites, among others. The housing  80  is anticipated to be constructed from a plastic material, but also may be made from any suitable material such as steel, stainless steel, aluminum, or composites, among others. 
     It is anticipated that the spherical body  102  will reside in a socket in the housing  80  in a tightly-fitted manner so that the angular orientation of the housing is maintained even after the practitioner releases the housing  80 . Alternatively, the ball joint  82  may be loosely fitted but provided with a fastener or clamp (or other type of fixing device) that holds the housing  80  in a fixed orientation after being released by the practitioner. Since the exact construction for the ball joint  82  is not critical to operation of the cricoid manipulator  32 , further details concerning this aspect of its construction are not provided. 
     The cricoid manipulator head  40  is disposed at one end of a shaft  104  that is movably inserted into the housing  80 . In the illustrated embodiment, the shaft  104  is disposed within the housing so that the shaft  104  maintains its axial orientation with respect to the housing  80 . In other words, the shaft  104  and the housing  80  are coaxially arranged with respect to one another. This construction is considered to be sufficient for operation of the cricoid manipulator  32  primarily because the ball joint  32  provides multi-axial movement of the cricoid manipulator head  40 . 
     It is noted that the cricoid manipulator head  40  need not be connected fixedly to the shaft  104 . To the contrary, any other type of connection may be employed. For example, the cricoid manipulator head  40  may be connected to a ball joint at the end of the shaft  104 . Alternatively still, the cricoid manipulator head  40  may be pivotally disposed on the shaft  104 . The exact connection between the cricoid manipulator head  40  and the shaft  104  is not critical to the operation of the cricoid manipulator  32 . 
     The shaft  104  is axially moveable within the housing  80 . This permits the practitioner to make minor adjustments of the cricoid manipulator head  40  with respect to the housing  80 . Since the shaft  104  is moveable with respect to the housing  80 , it is anticipated that the shaft will include a fixing element that will hold the shaft  104  in a particular position, once selected. Various contemplated embodiments of such a fixing device are discussed below. 
     It is contemplated that the cricoid manipulator head  40  may be constructed in any of a number of different shapes and sizes. As should be apparent, the exact dimensions and shapes of the cricoid manipulator head  40  are not critical to operation of the cricoid manipulator  32 . It is noted that the cricoid manipulator head  40  is illustrated as a hemi-cylinder (or one half of a cylinder split along its axis). 
       FIG. 3  is a front view depicting one contemplated shape for the cricoid manipulator head  106  of the present invention. In this embodiment, the cricoid manipulator head  106  includes a body  108  with a central section  110  and right and left side lobes  112 ,  114 . The shape of the cricoid manipulator head  108  has been selected to compliment the natural shape of the patient&#39;s neck  76  at the location of the cricoid cartilage. Other shapes may be employed without departing from the scope of the present invention. 
     It is contemplated that the central section  110  and the right and left lobes  112 ,  114  of the cricoid manipulator head  106  will be made from a flexible material such as rubber or foam so that the cricoid manipulator head  106  molds, at least partially, to the exterior surface of the patient&#39;s neck  76 . Other materials, as should be apparent to those skilled in the art, also may be employed without departing from the scope of the present invention. 
       FIG. 4  is a side view of the cricoid manipulator head  106  illustrated in  FIG. 3 . As should be apparent from  FIGS. 3 and 4 , the housing  80  and the shaft  104  are the same as depicted and described in connection with  FIG. 2 . 
       FIG. 5  is a front view of a second embodiment of a cricoid manipulator head  116  according to the present invention. The cricoid manipulator head  116  includes a body  118  with a central section  120  and four fingers  122 ,  124 ,  126 ,  128  extending therefrom.  FIG. 6  provides a bottom view of the cricoid manipulator head  116 , showing in greater detail the four fingers  122 ,  124 ,  126 ,  128 . 
     As in the prior embodiment, the cricoid manipulator head  116  is intended to be made from a suitable, flexible material such as rubber or foam, among other possible materials. The fingers  122 ,  124 ,  126 ,  128  are anticipated to flex outwardly to accommodate the shape of the patient&#39;s neck  76 . 
       FIG. 7  is a side view of an embodiment of a cricoid manipulator  130  with an adjustment mechanism  132  (also referred to as a fixing device, herein), which is disposed within the housing  134 . The cricoid manipulator  130  includes the cricoid manipulator head  106  described in connection with  FIGS. 3 and 4 . The cricoid manipulator head  106  is connected to a shaft  136  that slides axially within the housing  134 . So that the housing  134  is adjustable in multiple axial directions, the housing  134  is connected by a ball joint  138  to the flexible shaft  42 . Like the ball joint  82 , the ball joint  138  includes a spherical ball  140  disposed within a socket within the housing  134 . 
     So that the practitioner may adjust the position of the cricoid manipulator head  106 , the shaft  136  is provided with a central track  142  containing a plurality of teeth-engaging grooves  144 . The grooves  144  extend from one end of the track  142  to the other. The grooves  144  mesh with teeth  146  on a gear  148  disposed on an adjustment shaft  150  within the housing  134 . As illustrated, the adjustment shaft  150  extends through the housing  134 . One end of the adjustment shaft  150  is provided with a key head  152  that may be manipulated by a practitioner. As should be apparent to those skilled in the art, by turning the key head  152 , the practitioner turns the gear  148 . The teeth  146  of the gear  148 , in turn, engage the plurality of grooves  144 . As a result, when the gear  148  is turned, the shaft  136  is moved relative to the housing  134 . 
     In this embodiment, it is contemplated that the shaft  136  will be disposed in the housing  134  in such a manner that upward pressure on the shaft  136  will not cause the shaft  136  to be pushed into the housing  134  after release of the key head  152 . Alternatively, it is contemplated that the adjustment mechanism may be provided with a locking device to hold the shaft  136  in a particular position relative to the housing  134 , once the appropriate position is selected. 
       FIG. 8  is a side view, cross-sectional illustration of another type of adjustment mechanism  154  contemplated for use with a cricoid manipulator head  156 . 
     In  FIG. 8 , the adjustment mechanism includes a threaded shaft  158  that engages a threaded opening in the housing  160 . The threaded shaft  158  may be manipulated by the practitioner to move shaft  158  in relation to the housing  160 . Specifically, the practitioner need but to rotate the shaft  158  with respect to the housing  160 . In this regard, it is anticipated that the individual threads on the threaded shaft  158  will be spaced apart from one another a sufficient distance to permit relatively quick adjustment upon rotation of the shaft  158 . In other words, a finely threaded shaft  158 , while useable, would lend itself to small variations in the displacement of the shaft  158 , which may not be the most practical. Closely-positioned threads would necessitate considerable rotation by the practitioner, which might frustrate the practitioner. 
     As in prior embodiments, the housing  160  connects to the flexible shaft  42  via a ball joint  162 . The ball joint  162  includes a spherical body  164  that is embedded in a socket in the housing  160 . The ball joint  162  permits multi-axial movement of the housing  160  with respect to the flexible shaft  42 . 
     So that the cricoid manipulating head  156  is able to maintain a stable orientation with respect to the patient&#39;s neck  76 , the shaft  158  is provided with a rotational joint  166  at one end. The rotational joint  166  includes a T-shaped structure  168  that is embedded within the cricoid manipulating head  156 . The T-shaped structure  168  is a flat, circular body that permits the cricoid manipulating head  156  to rotate therearound. As a result, when the shaft  158  is rotated, the cricoid manipulating head  156  may be kept in its initially-selected position so that it does not rotate together with the threaded shaft  158 . 
       FIG. 9  illustrates yet another contemplated embodiment for the cricoid manipulator  170  of the present invention. The cricoid manipulator  170  includes a cricoid manipulator head  172  connected to a shaft  174 . In this embodiment, the cricoid manipulator head  172  is fixedly attached to the shaft  174 . However, as in the embodiment illustrated in  FIG. 8 , the cricoid manipulator head  172  may be rotationally mounted onto the shaft  174 . 
     The cricoid manipulator  170  includes a housing  176  that connects to the flexible shaft  42  via a ball joint  178 . As in prior embodiments, the ball joint  178  includes a spherical body  180  that is embedded or inserted into the housing  176 . The spherical body  180  permits the housing  176  to be positioned multi-axially. 
     An adjustment mechanism  182  in the housing  176  includes a first adjustment lever  184  and a second adjustment lever  186 . The first adjustment lever  184  is positioned on one side of the housing  176  and the second adjustment lever  186  is positioned on the opposite side. The first and second adjustment levers  184 ,  186  include rounded ends  188  with teeth  190  that engage grooves  192  on the shaft  174 . By pressing on the levers  184 ,  186 , the practitioner causes the teeth  190  to engage the grooves, thereby forcing the shaft  174  out from the end of the housing  176 . The levers  184 ,  186  may be spring actuated so that release of the levers  184 ,  186  causes the levers  184 ,  186  to remain engaged with the grooves  192  on the shaft  174 , thereby holding the shaft  174  in a fixed position with respect to the housing  176 . By completely depressing the levers  184 ,  186  against the housing  176 , the teeth  190  may be disengaged from the grooves  192  so that the shaft  174  retracts into the housing  176 . The shaft  174  may be spring-biased into a retracted state within the housing  176 . 
     As should be appreciated by those skilled in the art, there may be additional structures that may be employed in connection with the adjustment mechanism  182  to permit the practitioner to extend and/or retract the shaft  174  in the housing  176 . The exact details of the adjustment mechanism  182  is not critical to the present invention. As a result, further details are not provided herein. 
       FIG. 10  is a top view of a patient  72  on the patient support  16  of an operating table  10 . This illustration provides a top view of another aspect of the present invention, the cheek manipulator  36 . The cheek manipulator  36  is provided so that the practitioner may have assistance in holding at least one of the cheeks  194  of the patient  72  in an extended position to facilitate insertion of an ETT into the patient&#39;s throat. 
     The cheek manipulator  36  includes the cheek manipulating head  56  attached to the flexible shaft  58 . The flexible shaft  58  is intended to be of the same construction as the flexible shaft  42 . 
       FIG. 11  illustrates the cheek manipulator  36  of the present invention in greater detail. The cheek manipulating head  56  includes an L-shaped body  196  that is connected to the flexible shaft  58 . The L-shaped body  194  includes a first end  198  that is inserted into the patient&#39;s mouth  200 . A second end  202  of the L-shaped body  196  is positioned within the flexible shaft  58 . 
     So that the L-shaped body  196  may be adjusted in association with the flexible shaft  58 , an adjustment mechanism  204  is provided. The adjustment mechanism  204  includes a threaded key  206 . The threaded key  206  may be rotated by the practitioner to loosen and/or tighten its grip against the second end  202  of the L-shaped body  196 . This permits the L-shaped body  196  to be adjusted within the flexible shaft  58 . 
     It is contemplated that the L-shaped body  196  will be cylindrical in cross-section. As a result, not only may the second end  202  be adjusted in its lateral position with respect to the flexible shaft  58 , but it also may be rotated within the flexible shaft  58 . This provides the practitioner with greater adjustability. As should be apparent to those skilled in the art, a cylindrical cross-section is not required to practice the present invention. It is also noted that the L-shaped body  196  may be made from a material such as stainless steel. Alternatively, the L-shaped body  196  may be made from plastic of other suitable, disposable (or recyclable) material. The exact material is not critical to the present invention. 
     In one alternative embodiment, it is contemplated that the L-shaped body  196  may be held in a housing that is connected to the flexible shaft  58 . If a housing (not shown) is employed, the housing may be adjustable positionally with respect to the flexible shaft  58 . Other embodiments also are contemplated for the cheek manipulator  36 . 
       FIG. 12  is a front view of a tongue manipulator  208  according to the present invention. The tongue manipulator  208  includes a tongue manipulating head  210  that is connected to a flexible shaft  212 . The tongue manipulating head  210  includes a clamp  214  that holds a tongue depressor  216  therein. 
       FIG. 13  is a top view of the tongue manipulator  208  of the present invention. Details of the clamp  214  are more evident in this illustration than in  FIG. 12 . The clamp  214  includes a first clamping member  218  and a second clamping member  220 . The first and second clamping members  218 ,  220  are connected to one another via a joint  222  such that the members  218 ,  220  oppose one another in a scissor action. The first and second clamping members  218 ,  220  are contemplated to be biased, via a spring (not shown), so that they apply clamping pressure to the tongue depressor  216 . 
     As should be apparent to those skilled in the art, when utilized, the clamp  214  holds the tongue depressor  216  securely so that the tongue depressor may be inserted into the patient&#39;s mouth  200  and hold the patient&#39;s tongue in a position that assists the practitioner to insert an ETT into the patient&#39;s throat. 
     With respect to the tongue depressor  216 , it is contemplated that a traditional tongue depressor  216  will be used. A traditional tongue depressor  216  is a popsicle-stick-shaped, flat, wooden device that doctors traditionally use in an examining room. As should be apparent, other types and shapes of tongue depressors  216  may be employed with the tongue manipulator  208  without departing from the scope of the present invention. 
     As also may be appreciated by those skilled in the art, the tongue manipulator  208  may have any other type of construction that permits application of pressure to the patient&#39;s tongue. 
       FIG. 14  illustrates further aspects of the present invention, the neck manipulator  38 . The neck manipulator includes a neck manipulator head  64  that is connected to a flexible shaft  66 . The neck manipulator head  64  may be adjusted in any number of different orientations, as illustrated by the arrows  224 . The neck manipulator head  64  is provided so that the practitioner may apply pressure to the posterior portion of the patient&#39;s neck  76 . This may be desirable in instances where the practitioner needs to tilt the patient&#39;s head  74 , for example. 
       FIG. 14  also illustrates other aspects of the present invention. Specifically, multiple cricoid manipulators  32  may be used to assist with positioning the patient&#39;s head  74  for intubation. 
     In  FIG. 14 , a first cricoid manipulator  226  (which has the construction of the cricoid manipulator  32  described above) is positioned to support the patient&#39;s chin  228 . A second cricoid manipulator  230  is provided to apply pressure to the patient&#39;s forehead  232 . Together with the neck manipulator  38 , the two cricoid manipulators  226 ,  230  help to hold the patient&#39;s head  74  so that the practitioner may intubate the patient  72 . As may be apparent, each of the multiple cricoid manipulators  32  may be connected to the equipment rack  20  that is illustrated in  FIG. 1 . Alternatively, the cricoid manipulators  32  may be affixed directly to the equipment rail  18 . 
       FIG. 15  illustrates yet another aspect of the present invention. In this figure, an anesthesia administering device  234  is illustrated adjacent to the operating table  10 . The device  234  is connected to a tube  236  that provides the anesthetic gas to the patient. One or more of the flexible shafts, such as the flexible shaft  42 , may be used to support the tube  236 . In the example illustrated in  FIG. 15 , a clamp  238  secures the tube  236  to the flexible shaft  42 . In one contemplated embodiment, the clamp  238  may be a strap made from a hook and loop fastening material. One trademark for this type of material is Velcro®. Alternatively, the clamp  238  may be a traditional operating room clamp. Other types of clamps may be employed without departing from the scope of the present invention. 
       FIG. 16  is a front view of still another aspect of the present invention.  FIG. 16  illustrates the tool rack  34  with the tool rack head  48  attached to the flexible shaft  50 . 
     The tool head  48  includes an E-shaped body  240 . As such, there is a root segment  242  from which three fingers  244 ,  246 ,  248  extend. Tools  250  may be placed between and be gripped by the fingers  244 ,  246 ,  258 , as illustrated. The tools  250  may be tubes, surgical devices, or any other type of equipment that the practitioner may wish to have handy. One contemplated tool  250  could be a suction tip, for example. 
     So that the tools  250  are secured in the fingers  244 ,  246 ,  248 , it is contemplated that the fingers  244 ,  246 ,  248  are constructed with a flexible surface, such as a foam surface. In one contemplated construction, the fingers  244 ,  246 ,  248  may include rigid interior members that for a “skeleton” within the tool head  48 . The foam may be molded over the skeleton. As such, when the practitioner inserts a tool  250  between the fingers  244 ,  246 ,  248 , the foam deforms and holds the tool in place. 
     As should be appreciated by those skilled in the art, the tool head  48  may have any type of construction that would permit grasping of one or more tools  250 . In addition, while three fingers  244 ,  246 ,  248  are illustrated, the fool head  48  may include a greater or fewer number of fingers  244 ,  246 ,  248 . In addition, while the fingers  244 ,  246 ,  248  are illustrated as linear structures, they may take any suitable shape. 
     With renewed reference to  FIG. 1 , it is noted that the rod  22  may have any length suitable for the operating room. It is contemplated, however, that the rod  22  will extend about 2 feet (be about 60 cm) above the surface of the patient support  16 . In addition, any number of manipulators may be connected to the rod  22 . 
     It is noted that any of the adjusting mechanisms described herein may be utilized with any of the manipulators also described herein. 
     A discussion of various aspects of the present invention is now provided in the context of use from the viewpoint of an anesthesiologist in an operating room. 
     Prior to use, the flexible shaft  42  keeps the cricoid manipulator  32  out of the way of the patient&#39;s head  74 . With the cricoid manipulator  32  out of the way, the practitioner has room to insert a laryngoscope into the patient&#39;s throat. The laryngoscope (not illustrated) is inserted into the patient&#39;s mouth  200  with the anesthesiologist&#39;s left hand. 
     While viewing into the mouth  200 , the anesthesiologist bends the flexible shaft  42  down to the neck  76  with the right hand. The anesthesiologist applies downward force on the neck  76  with the cricoid manipulator head  40  in order to achieve an optimal view of the glottis. This may require manipulation of the articulated joint(s) (i.e., the ball joint  82 ) on the cricoid manipulator  32  to shift the glottis to either side. Once a good view of the glottis is achieved, the flexible shaft  42  is released. It is possible that the flexible shaft  42  may retract a bit when it is released and the view of the glottis may worsen. If so, the cricoid manipulator head  40  may be adjusted via the adjustment mechanism  132 , for example. The extension of the shaft  136  to press the cricoid manipulator head  108  on the flexible shaft  42  compensates for any retraction of the flexible shaft  42  when it is released. 
     With respect to the cheek manipulator  36 , it is anticipated that the L-shaped body  196  may be a fully bendable structure to accommodate a particular patient&#39;s physiology. 
     The cheek manipulator  36  may be used in the following manner. As before, the laryngoscope is inserted into the patient&#39;s mouth with the anesthesiologist&#39;s left hand. While viewing into the mouth, the anesthesiologist inserts the cheek manipulator  36  into the patient&#39;s mouth  200 . The cheek manipulator  36  holds the patient&#39;s cheek  194  to one side to afford a more clear view of the patient&#39;s throat. The tongue manipulator  208  may be used in conjunction with the cheek manipulator  36 , as needed. One inserted into the patient&#39;s mouth, it is anticipated that the cheek manipulator  36  will remain in place, because the elastic force of the cheek  194  on the cheek manipulator  36  will be minimal. 
     The tool rack  34  may be used by the anesthesiologist to hold various devices such as the endotracheal tube (“ETT”), a suction tip, a topical lidocaine injector, etc. The tool head  48  is anticipated to have soft fingers  244 ,  246 ,  248 . The tools  250  would be inserted, like a cigarette, between the fingers  244 ,  246 ,  248 . 
     The tool rack  34  might be used as follows. Before laryngoscopy, the flexible shaft  50  is bent to a convenient position so the anesthesiologist may easily grasp the tools  250  grasped by the tool head  48 . The various items like the ETT, the suction tip, topical local anesthetic injector, Magill Forceps, etc., are wedged between the fingers  244 ,  246 ,  248 . During larynoscopy, the anesthesiologist may grasp any of the tools  250  without diverting attention from the task at hand. Tools  250  may then be returned to the fingers  244 ,  246 ,  248  so that the tools  250  are accessible at a later point in the procedure and/or operation. 
     Reference is now made to  FIGS. 18 and 19 , which illustrate two contemplated embodiments for the flexible shaft  42 ,  50 ,  58 ,  66  of the present invention. The description of these contemplated embodiments of the flexible shaft  42 ,  50 ,  58 ,  66  is not intended to be limiting of the invention. 
     As illustrated in  FIG. 18 , a flexible shaft  252  includes a plurality of individual segments  254  that are threaded onto a cable  256 . The cable  256  extends between a first clamp  258  and a second clamp  260 . 
     In the embodiment illustrated in  FIG. 18 , the first clamp  258  includes an L-shaped body  262 . A first leg  264  extends along the axis of the cable  256 . The first leg  264  includes a tightening nut  266 . The tightening nut is threadedly disposed within the L-shaped body  262  so that turning of the nut  266  in one direction draws the cable  256  into the L-shaped body  262 . Turning the nut  266  in the opposite direction releases the cable  256  from the L-shaped body  262 . As should be apparent, when the cable  256  is drawn into the L-shaped body  262 , the cable  256  compresses the segments  254  together. As a result, via friction, the segments  254  become fixed in a predetermined orientation, permitting the flexible shaft  252  to retain the predetermined orientation. When the nut  266  is loosened, the cable  256  is extended with respect to the segments  254 , permitting the segments to move relative to one another. 
     The second leg  268  of the L-shaped body  262  has a clamp body  270  attached thereto. The clamp body  270  is essentially a U-shaped structure with a cylindrical opening  272  at one side and two opposed legs  274 ,  276  at the other. A nut  278  threadedly engages the opposed legs  274 ,  276 . As should be apparent, when the nut  278  is tightened, the legs  274 ,  276  are brought into close proximity (or into contact) with one another. As a result, the diameter of the opening  272  is reduced so that the L-shaped body  262  maybe fixedly held on a support or other structure. When the nut  278  is loosened, the clamp  270  may be removed from a supporting structure. 
     Each of the segments  254  includes a cylindrically-shaped end  280  and a spherically-shaped end  282 . The spherically-shaped end  282  of each of the segments  254  engages an indentation  284  within the end of the cylindrically-shaped end  280  of the adjacent segment  254 , as shown. With this configuration for each of the segments  254 , it is possible to manipulate the flexible arm  252  into virtually any configuration. Once the nut  266  is tightened, the segments  254  frictionally engage one another, thereby causing the flexible arm  252  to become rigid and retain the predetermined configuration. 
     In connection with this embodiment, it is contemplated that the spherically-shaped ends  282  and the indentations  284  may present roughened surfaces that improve frictional engagement therebetween. It is also contemplated that only one of the spherically-shaped ends  282  or the indentations  284  may be roughened to provide enhanced the frictional engagement between the components. Still other frictional enhancements may be employed including, but not limited to tacky materials, such as releasable adhesives and the like. 
     As should be apparent, the clamp  258  is intended to attach to a suitable structure, such as the support  22  discussed in connection with  FIG. 1 , for example. 
     The opposite end of the flexible arm  252  may include a clamp  260  that is configured to grasp a device, such as the cricoid manipulator head  40 , the tool rack head  48 , or the cheek manipulator head  56 , etc. 
     In the illustrated embodiment, the clamp  260  includes a body  286  that is connected to the terminal (or end) segment  288  of the flexible arm  252 . The body includes a movable segment  290  and a rotatable knob  292 . Rotation of the knob  292  causes the moveable segment  290  to move relative to the body  286 . This permits items to be held by the clamp  260 . 
       FIG. 19  provides an alternative embodiment to the embodiment illustrated in  FIG. 18 . 
     The embodiment illustrated in  FIG. 19  is presented, primarily because a practitioner typically would prefer to have a one-handed operation for the flexible shaft  252 . One reason for this is that the practitioner&#39;s other hand typically is occupied with activities concerning the patient. For example, the practitioner may be holding a laryngoscope with the left hand and wish to apply external neck pressure via the cricoid manipulator head  40  with the right hand. If so, one disadvantage with the embodiment discussed in connection with  FIG. 18  is the need for tightening of the nut  266 , which is positioned a distance away from the patient. The practitioner would have to release the manipulator head  40  to tighten the nut  266 , thus allowing the head  40  potentially to change position before being locked into place. 
     The flexible shaft  294  presents one contemplated embodiment for single-handed operation thereof. 
     The flexible shaft  294  that is illustrated in  FIG. 19  includes many of the same components that are discussed in connection with  FIG. 18 . The differences, which are apparent in the illustration, concern the terminal segment  296 . 
     The terminal segment  296  on the flexible shaft  294  includes a lever  298  that may be ratcheted into position to tighten the cable  256  and, thereby, secure the flexible shaft  294  in a predetermined orientation. The lever  298  is contemplated to be biased, by a spring, into a position where the end  300  is displaced a predetermined, axial distance from the terminal segment  296 . Application of pressure to the lever  298  causes the cable  256  to be drawn into the terminal segment  296 . It is contemplated that a single squeeze of the lever  298  will be sufficient to cause the flexible shaft  294  to become rigid so that it retains its desired orientation. 
     It is also contemplated that the lever  298  will be provided with a suitable release mechanism so that the flexible shaft  294  may be manipulated into any of a number of predetermined positions. 
     As illustrated, the terminal segment  296  includes a key  302 , which may be rotated to secure a device, such as the cricoid manipulator head  40  in a suitable orientation. 
     In this embodiment, it is contemplated that the practitioner will hand tighten the nut  266  until the flexible shaft  294  is in a nearly rigid condition, suitable for use. Once the cricoid manipulator head  40  is positioned to apply suitable pressure to the cricoid cartilage, the lever  298  will be depressed to that the flexible shaft assumes a static position in a rigid condition. 
     It is contemplated for this embodiment, that the nut  266  will provide a coarse adjustment of the rigidity of the flexible shaft  294  and that the lever  298  will provide a fine adjustment of the rigidity of the flexible shaft  294 . 
     As should be apparent to those skilled in the art, there are numerous ways in which the lever  298  may be designed to operate to provide the final adjustment of the rigidity for the flexible shaft  294 . As such, further details concerning the construction of the lever  298  are not provided. 
     As should be appreciated by those skilled in the art, the lever  298  and its associated components form a distal locking mechanism  304 . The distal locking mechanism  304  permits a releasable locking of the flexible shaft  294  to maintain the flexible shaft  294  in a selected, predetermined orientation. Specifically, the distal locking mechanism  304  permits the practitioner to place the flexible shaft  294  into a rigid condition with a one-handed operation, thereby facilitating manipulation of the flexible shaft  294 . 
     For purposes of the discussion of the present invention, the term “rigid” has been used. It is contemplated, however, that the flexible shaft  294  need not be placed into a perfectly rigid condition. To the contrary, at least a semi-rigid condition will suffice in many instances to accomplish the objective of applying a suitable force to the cricoid cartilage without the practitioner having to release cricoid pressure. Whether locked into a rigid or semi-rigid condition, it is contemplated that the flexible shaft  294  will present sufficient resistance to forces to maintain adequate pressure on the cricoid cartilage, if used for this purpose. 
     While the locking mechanism  304  is discussed in connection with the embodiment illustrated in  FIG. 19 , the distal locking mechanism  304  may be employed with any of the embodiments described herein, as should be apparent to those skilled in the art. 
     It is noted that the components of the flexible shaft  252  and the flexible shaft  294  are contemplated to be made from steel, such as stainless steel. However, other materials may be employed without departing from the scope of the present invention. 
     As discussed above, the present invention is not intended to be limited to the specific embodiments described herein. To the contrary, there are numerous equivalents and variations that may be appreciated by those skilled in the art upon understanding the details presented herein. The present invention is intended to encompass the equivalents and variations that would be appreciated by those skilled in the art.