Sonant respiration indicator
United States Patent 2376971

This invention relates to indicators for the respiration of patients who are under the influence of general anaesthetics, and has particular reference to such indicators applicable to patients breathing through the nose. The problem to which this invention is addressed is well illustrated...

Kleit, Morris W.
Application Number:
Publication Date:
Filing Date:
Kleit, Morris W.
Primary Class:
Other Classes:
116/137R, 128/207.13, 137/543.17, 137/551, 600/529, 600/538
International Classes:
A61M16/06; A61M16/01
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This invention relates to indicators for the respiration of patients who are under the influence of general anaesthetics, and has particular reference to such indicators applicable to patients breathing through the nose.

The problem to which this invention is addressed is well illustrated by the technique of dentists in the administration of nitrous oxide. The latter is inhaled by the patient through the nose, while his mouth is open so that the dentist may perform whatever dental work may be necessary.

It is well known that patients react differently, sometimes in the most unexpected ways, to the gas. Frequently the patient's pulse and respiration becomes rather weak, and sometimes stop altogether; hence the patient may be regarded as in continuous danger. There is usually no history of the patient's action under the influence of gas, and if there were, the patient's reaction may be different. While the dentist is busy working in the mouth and using both hands in manipulating various instruments, he is unable to take the patient's pulse. Nor have the majority of dentists assistants or nurses to observe the patient. Yet a delay of a minute in changing the ratio of oxygen to nitrous oxide, or in completely shutting off the anaesthetic may result in a serious condition or even death of the patient.

One object of the invention, therefore, is to provide an improved device, including a sonant respiration indicator which shall give the operator a continuous indication of the condition of the patient without requiring visual reading or use of one or both hands.

Another object of the invention is the provision of an indicator which shall produce a sound, and which, without any manipulation by the dentist, shall instantly indicate the strength or weakness of the patient's respiration or the total cessation of breathing.

Another object of the invention is to furnish improved means such that the indicator shall sound only upon exhalation and be cut off on inhalation to prevent aspiration of air which would affect the carefully adjusted gas to oxygen ratio in degrees which may vary as the strength of the respiration diminishes.

Another object of the invention is to provide an improved device whereby the sonant indicator does not prevent the making of various adjustments, for instance at the exhalation nose piece, so that the device may be readily set to the needs of the individual patient.

In general, the invention has the further object of providing a sonant respiration indicator so arranged and constructed in an improved manner as to be responsive to the relatively slight exhalation pressure of an unconscious patient whose mouth is held open, the indicator being simple, compact, durable, highly reliable in use, and. light in weight.

Other objects and advantages of the invention will become apparent as the specification proceeds.

With the aforesaid objects in view, the invention consists in the novel combinations and arrangements of parts hereinafter described in their preferred embodiments, pointed out in the subjoined claims, and illustrated on the annexed drawing, wherein like parts are designated by the same reference characters throughout the several views.

In the drawing: Figure 1 is a diagrammatic view, with parts in elevation and other parts in perspective, showing a device embodying the invention, as applied to a patient of whom a fragmentary view is given in dotted lines.

Fig. 2 is an enlarged view of a device according to the invention with parts in section and parts in elevation.

Fig. 3 is an enlarged top plan view of the sounding member in detached position.

Fig. 4 is a view in elevation thereof.

Fig. 5 is a central sectional view, with parts in elevation showing the combined valve means and sounding member of the nose piece, according to the invention.

The advantages of the invention as here outlined are best realized when all of its features and instrumentalities are combined in one and the same structure, but, useful devices may be produced embodying less than the whole.

It will be obvious to those skilled in the art to which, this invention appertains, that the same may be incorporated in several different constructions. The accompanying drawing, therefore, is submitted merely as showing the preferred exemplification of the invention.

Referring in detail to the drawing, 10 denotes a device embodying the invention and illustrating a typical use thereof. The same may include any desired source I I of a suitable anaesthetic, comprising a tank of nitrous oxide 12 and a tank of oxygen 13. The outlets of these tanks may be controlled as by pressure reducing and regulating devices 14, each of which includes a valve 15.

From these devices 14 may extend sections of hose, such as tubes 16 which lead to a common 65 fitting or mixing chamber 17, whence extends a 2 ;! , " .<.. . - ' single flexible tube 18. The latter may lead into a branch fitting 19, from which extend flexible tubes 20 that connect into a nose piece device 21.

Also connected to the tube 18 is an inflatable bag 22 of limp material which is used as a pressure indicator, the pressure being adjusted by a valve 23 of the chamber 17. It will be perceived that the proportions of nitrous oxide and oxygen may be adjusted at valves 15, and that these gases are continuously~ ixed together onrtheir wayvto 'the nose piece with4the pressure of :the mixture .controlled and indicated. In general, when once the proportions and pressure of the mixture have; been adjusted they need not be changed, except . as may be required by a change ilitlhe- conditi6rr of the patient indicated by the respiration,,.,as.* hereinafter described. It will be appreciated that the structure thus far described& icontventi6nal and merely illustrative.

The sonant respiration indicator 21 may in- 20 clude.ai-nose--piece 2-·imae' of:'any fixible mate-rial' suehcas' rubber, arid b'e ig- suitably 'shaped>as- dasired-"' t'embtacee-the nose -:or'at ;Ieastthle' nostri 'portion. Pief&rably the-nose piece ,24-is. f6ritred'with'-a conrtinmuus'miargiiai 'iiturnedili.p 25 of soft rubber to aid in forming a gas-tight seal :i ith.lth efa ce'of thlepatient: The-lower'end of -'tle :nse'.ptece"has"sufflciefit dbptlto-receive. the nose and to contact the face immediatelybelow'then ose,-as irdicated'bý'th)e'patient shown in: dotted' lires. Otpposit&" outlet ports- 28' are provided' at- which' the' tiubls ,120 are connected' tob the -ose piece to' 'asslstifthoild.ing the' latterirn p'sition the'tubes'2ijbiein g trained" around' the si'des ofothtelhead'tb;th e back of the head'or; ne ,' at -wh~i- tle' fitting" I is -iocattr- C'6r nected to the nose piece 24 is a device 276e mrbodying the invention., The san macbmp-ri'e bodyig tn e invenic-ton.xg v same may 'comp. rise. a- combined'control and soinantlindicator. 'Fr examii; it mar yieid" a 'rem.b'r-.2W, connect6d ins &gas -tight' imanIer tht! nose'piec byer desi6d' :means'-sch'em6tiialii--sh own'at 29.' Themember 28 may be of cylindrical or other-reqi- d form b '-a. tlbe 'hav in.g 'a lar" ilert' 30' 's It asorad singe- ofce ntiaresal ouetb pe alatL 'iwlich if thea exhaltioe-b every-weas n:thcasof small as to be capable of acting as a-coilfitgo ofing ihaation, 0.625 iasestin dianieteris satfct r. of anaesthetictas ath-er sarM~edgf iesmas - 50tio nestitute hats knopenin -i'pneumatics aa i to nesorifib. Abcordingly ihasean ight : coefflcien ' fricftheexalAtion-and a w coery-wa-citin of discharge, heresbytherangte orificeflow is resnduced. Thisons truction iof the'exh-orifa l 31 als enbles ;imembes of an. unconscious person. In ge her aln opening of 'aDout:' 025 iichesi diameter.. i satisfac Titsopeninfe g-asrathe' 3hmyarp ed:ed ,esb. "ss toning the end wall 3U2ii which tiheaorificeais aformed. stutewat i s kino li it pressure tis as tMire ai.e orifine. Abcordiniigly ithas.,na iigh'oeffehins' of.: friction and albw,doeffcient:of "discharge wherebythe rate of flow is rediced. Trinscbinstriitiobn so. that .thtendency . orany flow .throughthe. orifice-o th 31alsm. enables tre hema ember 2tito serve.as.. a. soundingfdxevice. .slThet action oftheorifte-s 3 may. be-enteanced ib~.-inwar dlty ing the end wall 32 in which .the-orifibe.is formed.: If the.supplyof notrous oxide-andoxygen m- 65' turen isessuffriet onla nigitb pessuiin ,,the..tubesdleading-to the- nose: pi$ece,.this pressure. dropping, almost to, zero d uring.inhalation,.n so.-that.:thetendency: for. anyiflow throughthe, orifice':to the.-atmosphere.; n. may~ be, practically,. nil. DIyring-exhalation; the slight:pressurden the.tubes ,ma'ybe counteracted in- part byrthe' exhalal:tion pressure, so,.:that; onlysa negligiblewquatityW of gas may.,'escape:lintothe atmosphere.r i:In faet' some:;of the exhalation may'return:;toa the:bag22g 2,376,97 1;: . ; so that any gas which has not been absorbed by the patient may again be used.

It is a natural physiologic action for a person to be capable of breathing through the nose while his mouth is open. When gas is first administered, the mouth may be closed, but is opened before the patient lapses into unconsciousness.

As soon as the patient becomes unconscious, a wad of cotton is stuffed into the back of the mouth before thecdentistbegins.touworkbon teeth.

This cotton 'serves to prevent articles from accidentally falling into the patient's throat and . reduces any tendency to breathe through the mouth, if it does not wholly prevent it. If the 15'. cottobnshould'"sis into the throat it may cut ofi ,the, breathing: through the nose, but this would be instantly indicated by the sounding device.

Tth'eIbest:results :are obtained by embodying in the device, 27 a valve means for automatically cutting off the sounding device during inhalationm Thus' air:,is: avoided.. which- mighi be.nihaled^and affectithe delicate' balance: ofthecgas'and.oxygen mixture; especiatw.whenthe patient's breathing becomes-progressivelyweak'er.- In Fig.: 2: 5 is shown a device 27a.comprtsirrg :a:sounding member 28a:;which is: generally' like -that atr.28, adndany va;tvemrieansi33.,; ;Th'ledatter.mayinclude. as'cylindrical casing: 34, havingirithelower:.part.: thereof. a slidable' cylindrical, elementI 3i The': 30- elementS34, 35may.l: be threadedly interconnected; at! 36. The lower part- of element 35v:may be, thickened to; provide- a,, circular seat for:a.a disc,. valve:37, :which-lcommunicates:-with ;a clampingw nipple 38 orotherinlet., A:helicakexpansion coilh 35; spring398bears:on:the top wall of ielement.34,and: on the disc- valverto thold. tthe':latter down-omrits; seat. A-ipin 41 extends ,xially through the walli andthrourghr the top :walli,42,of the element ^S 3 , ..

34? being upwardly urged by cani expansion- coil. 40:spring-;:43 'extending. around the pimandibearing. any on:the wall 4and,otea collar44: of theL:in.whichl: collar rest& onth'e:wali 42.: For communication with -the:valve,:.the;walls.40,'and42,;nay:.eacthrespectively have:a a plurality of openings~ 415. 46: ie movementr-28 ofnstbe-;emvaablytsleeved.son ohe c maiyclosed by4 the sprnugf39wt ch is wea casing permt e the vave toha snug.-.frespo secured:5 te halatioiepere 2ssue; bi.y the- lvalmng i nipple 38:'g By'turningde the' casing elemen34,th. serve as 'a threads 3, icaunes. thessamtnge ton movet and 3car~ry: if therpin 41 otoward, the valire 3,eto.-lianut the open-s downovement.heofthperlapojectingend por:vtive;isnoher, in and cause intt to forcibly close thevalve3is3nor mally;closed :by: theispragcta 39t:wiie h ishe sou weakas to permit the valve to opaingrin;r3theelatter' be trt. 55, halation'. pressuire,, in' which case.. the '.valve'; is guidediby:the sided.walltof. thec asinge,.element.35.' I ill be noted.that, the soundmg orifice is The porting. 43.aissdtroi tere than- thsstantial.3dis, if tnhe. beratower: desi-resie 3pe-,mayl antuahy, p press 46 dowron .th'e':upperpyojecting.end prcrtionof.,the.60upi n and cause it to forcibly close the :vve,3: theturblence ausedart ,tbe prtsw4e.afects1the Due tor fictional contact n between e soun rgen eral eber 28aaaaimd the casingb34 the;latter mayibef' concav- turnedh by:turning th a ment mberi t28a, me-o It wilbe- noted.:thatth soundng orifice'is: much smaller. thanthe area.of theiports 4,ornof.: iayei tirevai ty i prossible b45, andthatly thersl -is sgute bstantia tance between the orifice 314 and: the pprts:.-46c', Such. sPacing, is, impprtant . beeausa'if- too close, the'tturbulene< cauised atlthe.ports-46-ffectshe. 70t;orifice3,1 so-that no soundiisPoduced.r In, ',general 'thatispacingshudlbe about onehsbaf of: an7 inch: Some' adjustment ,of the- veolmeof: sound,. is possible by -axially sliding'rthe,-member, 28aito.; a-desired.'position on thecasing: t3- Thersonant :75'iSindication istsosensitiivetas- toaryy;-in uewit~h the volume of respiration, thus giving the dentist a warning signal when it becomes very weak.

The invention thus relieves the dentist of the: loss of time in attempting to check the patient from time to time, and reduces the nervous strain due to the uncertainty of the patient's condition. from moment to moment, and is simple, practical, convenient and reliable in use.

It is interesting to note that my device is adapted to indicate the volume, frequency and depth of respiration, with the mouth open or closed, enabling the dental or medical anaesthetist to check the Condition of the patient whose mouth is initially closed and is opened after lapse into unconsciousness. The changes in volume, frequency and depth of respiration, indicated by the sounding device, are particularly instructive to the ear of the skilled anaesthetist with reference to the first, second, third and fourth stages of anaesthesia. The device produces a whistling sound by the exhalation pressure acting against the edge of the opening 31.

So sensitive is my device to those skilled in its use that the presence of an anatomical obstruction, such as a deviated septum, a tumor, or adenoids will be indicated, so that the action of the anaesthetist may be governed accordingly. Pressure on the nerves causing interference with respiration will be indicated or suggested. Accidental loosening of the nose piece, or shifting of a cotton wad in the back of the mouth to partially obstruct the respiratory tract, as where the dentist presses down on the tongue, will readily show up.

Where gas is used for analgesia to dull the pain of the conscious patient, the tendency to breathing through the mouth may be overcome by instructing the patient to listen to the sounding device to thus make sure that he is breathing through the nose.

I claim: 1. A sonant respiration indicator whereby a dentist can continuously check the condition of a patient who is under the influence of a gaseous anaesthetic, including a member arranged and constructed to embrace the nostril portion of a patient who is breathing through the nose, said member being adapted to communicate with a means for adjustably supplying oxygen and an anaesthetic gas to the member to be inhaled by the patient, said member having an exhalation outlet, and a sounding device external of the member and being connected thereto in communication with the exhalation outlet, the sounding device having an outlet so substantially small that the exhalation gases are capable of producing a sound whose volume varies with the breathing of the conscious and unconscious patient, said means being so adjusted as to be incapable of causing operation of the sounding device during inhalation.

2. A sonant respiration indicator whereby a dentist is given timely warning of the condition of a patient under the influence of nitrous oxide, including a nose piece having a casing adapted to snugly embrace only the nose of the patient, the casing having an inlet opening, a tube connected to the casing at said inlet for supplying gaseous anaesthetic thereto, said casing having an outlet opening and a sounding device connected to the casing at said outlet, a closure valve for the outlet openable in response to exhalation pressure the sounding device having a sound orifice substantially smaller in area than said tube and said openings, and being normally in continuous communication with said outlet subject to the control of the :valve, whereby a weak exhalation is capable of operating the sounding device.

3. A sonant respiration indicator for a dental patient breathing gaseous anaesthetic through the Snose including a nose piece having a casing, a sounding device connected to the casing, a tube connected.with the nose piece and providing with the latter a passage of 'relatively large area for communicating only exhalation pressure to the o' sounding device, the latter having a sonant orifice of substantially smaller area, the orifice having a thin sounding edge, and the casing having a relatively large volume with the sounding orifice being sufficiently spaced from the nose piece to 1 prevent turbulence of gases therein from preventing operation of the sounding orifice, whereby the sounding device is responsive to the weak exhalation of the unconscious patient.

4. A sonant respiration indicator:including a o nose piece having means for embracing the nose and having an inlet portion, a tube connected to the nose piece at the inlet portion, means for controlling the supply of a gaseous anaesthetic thereto to be inhaled by the wearer, the nose piece 2, having an outlet portion, a valve means carried by the nose piece that automatically closes the outlet to prevent flow of gases into the casing through the outlet upon inhalation and permits free flow of gases from the outlet upon exhalation, and a sounding device having a casing connected to said nose piece to communicate with the valve means, the sounding device having a thin edge orifice, the latter being sufficiently small to render the sounding device operative by an exhalation through the nose and the casing being of sufficient size with the orifice being at a sufficient distance from the valve means to prevent turbulence of gases caused by the latter from affecting the operation of the sounding device.

5. A sonant respiration indicator including means for supplying to a patient a mixture of oxygen and anaethetic gas, at an adjusted pressure, including means communicating solely with the nose while the mouth of the patient is open, valve means responsive to gaseous pressure for communicating with the nose to permit exhalation into the atmosphere at an adjusted pressure and to automatically cut off communication with the atmosphere during inhalation, and a sounding device communicating with the valve means for the discharge of the exhalation into the atmosphere, the sounding device being normally continuously operative upon each exhalation and being constructed to be so sufficiently sensitive to be responsive to relatively weak exhalations of the unconscious patient with the volume of sound varying to thus indicate the condition of the patient under the influence of said anaesthetic. 6. A sonant respiration indicator including a nose piece arranged and constructed to fit solely over the nose of the patient, said nose piece having a first port adapted to continuously communicate with a source of gaseous anaesthetic, and a second port communicating with the atmosphere, the nose piece having a chamber for the nostrils having direct, unrestricted continuous communication with the first port, and with the second port during exhalation, a valve means for the second port normally closing the same during inhalation and being responsive to exhalation pressure to open the second port, a sounding device communicating with said chamber through the second portion when the valve means is open, the sounding device having means sd constructed and arranged-thabtthe :exhataton .pressureof -air-.unl conscious-lperson 1s.-capbl egoftcausing op.eratior,; of:.the.soundeingrdevice means::ferrmounting, the soundingddvicesso::thatithe:'same-isdadap.tedtoa continuous ,coopration-; withlithee chamber;: anda 6 means:f or. so.controlling:ýhe:supply-ofanaesthetic gases- to:the,-chtamber'thatsthe same:?arersoo.rela-. tivelya completely. inhaled 'bythee patitient t:as toa avoid:pressure-:in the-chamber sufficient ;toopen:-. theivalvefmeansiduring.inhalation.., 7;: Aisonant'.respiration -indicator ,includinga a nose:piece havingý means:.for embracinrg:thesnose, and;having;an outlet po.rtionaitubeiconnectedto; the noser piece at the-;outlet ~portion,;,meansafon:r controlling. the, supply o of . a ,gaseous; anaethetic .- 15. thereto :to.-be. inhaled -by:rthe 'patient..the- nose;piece :having. an-: outlett portion,~ a~ valvee means. carried by the noseipiece;thatatomatically closes:. the outlet pprtion-upon inhalation; a-nd.-prmits-a free.lowof:gasesfromnthe.outlet portion upon ex~halation,,.and a,.sounding device havingea'icasing: connecteddtoothe nose-.iecetacommucicante&withe the valvemeans;, the.:soundingi device: havingu.a thin edgef orifice:. thel latter; beingý sufficiently small. tot render the sounding, device: opera-. tive:' by, an·, exhalation- throughi the': nose- andl theecasing beingof sufficient size-with:the orifice: being.at arsufficient distance from'the valve means; to prevent turbulence.of 7gases cauess-bythe latter, frontraiffectingitheoperatiort.of :the-:sounding devicep the(e control means .being; set. so that cthe. pressur.ef.of -he gaseousianaesthetic is:insufficient. t orp.rate:th'e:.soundingijdevice during inhalation;, thevalveimeans : includinga a: nmovabletcasing, a;. valve and,' a:. spring for the, latter, said valve-: meanas1havingmeans formingjaip.art ,ofthe casing. foria-djusting-theflowthrough the valvermeans-by: movenient'ofithe casings.thereof, and-theicasingoft, . thesoundingevdevice,:being connectedito.the casing. of-.the:vatve means for.-use;as a:filnger.:piece :for. ad~usting-the valve means2 MORRIS-W KLEIT.