This application claims the benefit of priority under 35 U.S.C. §119 of German Patent Application DE 10 2007 023 246.4 filed May 18, 2007, the entire contents of which are incorporated herein by reference.
The present invention pertains to a device for respirating a patient with gaseous anesthetic. The present invention pertains, furthermore, to a process for operating a device for respirating a patient with gaseous anesthetic, as well as to a system for respirating a patient with gaseous anesthetic.
The waking up of a patient after anesthesia requires that the patient's respiratory center be stimulated. This stimulation is carried out, as a rule, by intentionally raising the carbon dioxide (CO2) level in the breathing gas. However, such an increase is, in principle, in conflict with the reduced oxygen (O2) supply of the patient, which is associated herewith, and also with the necessary wash-out of the volatile anesthetic or anesthetics at the end of the anesthesia.
The waking-up process from an anesthesia is usually controlled such that after the anesthetic agent is turned off or its concentration is reduced, respiration is switched over to manual respiration. It is achieved by a slight hypoventilation that the CO2 concentration in the breathing gas rises and the respiratory center is stimulated hereby. One difficulty in this procedure is that the hypoventilation slows down the likewise necessary wash-out of the volatile anesthetic, so that the waking-up process cannot be carried out in a time-optimal manner.
Furthermore, there are different, relevant wash-out times and such wash-out times are to be taken into account, especially in case of using more than one anesthetic, depending on the type, combination and duration of administration of the drugs used. It is hardly possible so far to predict the time to wake up precisely in the case of complex dosing schemes.
The object of the present invention is therefore to provide a device and a process for shortening the phase of waking up of a patient from anesthesia. Another object of the present invention is to offer clues for the depth of anesthesia and/or the foreseeable time to wake up the patient at the end of the anesthesia.
The object according to the present invention is accomplished by the combination of the features of the device according to the present invention for respirating a patient with gaseous anesthetic. The device has at least one hypoventilation means for bringing about hypoventilation of the patient and at least one means for checking the spontaneous breathing of the patient once hypoventilation has been brought about. This is achieved by means of the at least one hypoventilation means of bringing about hypoventilation that the CO2 concentration in the lungs of the patient rises and the respiratory center is stimulated hereby. The present invention covers any means of bringing about an increase in the CO2 concentration, i.e., hypoventilation, which is known to the person skilled in the art. Such an increase in the CO2 concentration may be brought about, for example, by reducing the respiration rate. However, an increase in the CO2 content in the breathing gas may also be brought about by deactivating a CO2 absorber possibly provided in the respiration system.
After thus bringing about hypoventilation of the patient, the spontaneous breathing of the patient is checked by means of at least one checking means for checking the spontaneous breathing to determine whether the patient is already sufficiently prepared for waking up. Criteria for such a state close to waking up can be set variably and individually depending on the particular patient and have one or more of the following conditions a) through f). Thus, the criterion of sufficient spontaneous breathing and/or of a sufficiently low end-expiratory gaseous anesthetic concentration can be met if:
a) the end-tidal CO2 value has returned to a normal value;
b) uniform breaths are recorded;
c) the spontaneous minute volume is more than 60% of the last mandatory respiration setting;
d) the end-tidal anesthetic concentration has dropped to less than 30% of the mean value measured during the anesthesia;
e) the oxygen saturation in the blood is more than 97%; and/or
f) the bispectral index in the electroencephalogram is greater than 60, should such a measured value be determined in the particular case.
It is noted that the criterion may comprise one or more of the above-mentioned individual criteria a) through f). Furthermore, it is noted that the values given above for the spontaneous minute volume, the oxygen saturation, the anesthetic concentration and the like can be made dependent on other values or on values of another level.
If the criterion of a sufficient spontaneous breathing and/or of a sufficiently low end-expiratory anesthetic gas concentration is met, a fresh gas flow can be set at, e.g., 6 L/minute or higher, and the respiration can pass over into a spontaneous breathing mode. Furthermore, an instruction can be sent to the user or the attending physician that the wake-up process has ended.
By means of the device according to the present invention and its means for bringing about hypoventilation and for checking spontaneous breathing during hypoventilation, the checking can be carried out as often as desired and repeated at time intervals that can be set as short as desired until a transition into the spontaneous breathing mode has taken place.
The present invention is advantageously characterized in that the physician or user in charge of the device according to the present invention now has the possibility of predicting the transition to spontaneous breathing with a hitherto unknown accuracy and therefore unknown safety for the patient. The present invention leads, furthermore, to a shortening of the wake-up phase and hence to a termination of anesthesia that causes less discomfort for the patient. Furthermore, the present invention advantageously relieves the staff and leads, moreover, to a shortening of the entire surgical process, for which the anesthesia was carried out, and hence to a shorter occupation of the operating room, as well as to an overall reduction of the duration of anesthesia and to an anesthesia that is therefore felt by the patient to be more pleasant. Due to the fact that the point in time at which the transition to spontaneous breathing takes place can be determined more accurately according to the present invention, it is, furthermore, possible to prematurely withdraw the anesthetics used, and anesthetics can therefore also be saved according to the present invention. Not only does such a saving of drugs for maintaining the anesthesia make anesthesia less expensive, but, as has been shown by experience, also causes less discomfort for the patient, which implies further advantages of the present invention.
Thus, in an especially preferred embodiment, the device according to the present invention has a carbon dioxide absorber or CO2 absorber and at least one switchable bypass position for the CO2 absorber. By switching the carbon dioxide absorber into its bypass position, hypoventilation of the patient is brought about, as it was defined and discussed above.
The use of a CO2 absorber together with a bypass position advantageously permits the CO2 in the breathing gas of the patient to be increased even in case of respirators that have a CO2 absorber for lowering the CO2 level in the rebreathed breathing gas during a middle section of anesthesia as a permanently integrated CO2 absorber.
Another preferred embodiment according to the present invention has at least one detector for the above-mentioned bypass position. This detector advantageously ensures that the device, which may have a complicated alarm system for avoiding excessively high and excessively low concentrations of the anesthetics but also of the CO2 content in the breathing gas, will not generate an unintended alarm at least when the device intentionally provokes an increase in the CO2 level in the breathing gas to bring about hypoventilation of the patient.
In another preferred embodiment, the device according to the present invention has a combination cartridge for the carbon dioxide absorber or CO2 absorber and for a gaseous anesthetic absorber. Both CO2 absorption during the ongoing anesthesia during rebreathing by the patient and, in a bypass position of the CO2 absorber by switching over the combination cartridge to the anesthesia absorber, wash-out of the anesthetics can take place especially advantageously by means of this combination cartridge in a compact manner in a device for respirating a patient with gaseous anesthetic. Consequently, while the CO2 absorber is in the bypass position, in which it is not connected into the respiration circuit, wash-out of the anesthetic or anesthetics used thus takes place by means of the gaseous anesthetic absorber connected into the respiration circuit instead of the CO2 absorber. Thus, the same space available for installation can be used both to receive the CO2 absorber and to receive the activated carbon filter without these mutually interfering with one another functionally. A device according to the present invention thus designed is therefore of a welcome compact nature.
The combination cartridge may be equipped such that the CO2 absorber and the activated carbon filter or absorber for the anesthetics are connected simultaneously into the breathing gas flow. However, at least the CO2 absorber or the gaseous anesthetic absorber has a reduced activity only in such a case. Thus, wash-out of the anesthetics and an increase in the CO2 concentration can take place simultaneously.
It is clear to the person skilled in the art that the invention is also directed towards the combination cartridge and its use alone, i.e., regardless of other features, the combination cartridge alone is an aspect of the invention.
The combination cartridge may have a manual changeover switch between the CO2 absorber and the anesthetic absorber. However, it is also covered by the present invention in the design in which it can be changed over automatically. Another preferred embodiment according to the present invention has a detector for the position of the switch of the combination cartridge. It is indicated to the device by means of this detector whether the combination cartridge is in the position in which the gaseous anesthetic absorber is connected into the breathing gas circuit or in a position in which the CO2 absorber is connected into the breathing gas circuit, or whether the combination cartridge is in an intermediate position. As was already discussed above, alarm reports can be prevented by means of this detector, because the information on the current position of the combination cartridge is available in the device of this embodiment according to the present invention. The cause of certain values or monitoring results, which would otherwise lead to an alarm, is thus known.
In yet another preferred embodiment according to the present invention, the device has a preparatory process means for carrying out a preparatory process. Waking up of the patient from an anesthesia is prepared by this preparatory process means, and the composition of the anesthetics administered can be optimized by the preparatory process means such that early waking up is possible and/or a sufficient wash-out of every anesthetic used (or at least of one of the anesthetics) takes place within the narrowest possible time window. Such a preparatory process means can make possible the controlled supply of at least one first anesthetic and of a second anesthetic in such a way that the quantity of these anesthetics can be set. Furthermore, the preparatory process means may have a data processing unit with a display means belonging to the data processing unit, which is set up to perform a pharmacokinetic model calculation and an action module for storing the course of at least one anesthesia action parameter as a function of the concentrations of the anesthetic or anesthetics.
The preparatory process means may contain, furthermore, a display module for displaying an action diagram, in which the concentration of the anesthetics as well as the sequence of the concentration data of the past course of anesthesia are displayed. Such a means is described in the German Patent DE 10 2004 050 717 B3 (corresponding to U.S. patent application Ser. No. 11/250,026). Reference is expressly made hereby to the overall disclosure of German Patent DE 10 2004 050 717 B3 (corresponding to U.S. patent application Ser. No. 11/250,026, which is hereby incorporated by reference). The subject of the patent specification mentioned above may be provided and used in connection with the device according to the present invention in any desired embodiment. The wash-out of the anesthetics can be optimized by means of this embodiment according to the present invention already before the start of the wake-up operation to the shortest possible wake-up time by increasing the relative or absolute concentration of the short-acting anesthetics and lowering the relative or absolute concentrations of the long-acting anesthetics.
In another preferred embodiment, a device according to the present invention for respirating a patient may be designed such that the wake-up process is started by only pressing a button and the anesthetic dispensing systems stop the dispensing, the bypass function is turned on manually or automatically and the wake-up algorithm is started.
Another preferred embodiment has a combination cartridge. The combination cartridge may comprise a container with two separate components. The container may be designed such that the CO2 absorbent and the activated carbon can be refilled in a first embodiment. This embodiment is therefore a reusable combination cartridge. In another embodiment, the combination cartridge may be filled up with a defined quantity of CO2 absorbent and/or activated carbon as a representative of a gaseous anesthetic absorber. This cartridge must be replaced after depletion. Provisions are made in a preferred embodiment of the combination cartridge for providing suitable membranes as filters for the CO2 absorption and/or gaseous anesthetic absorption.
An alternative embodiment is provided with an intravenously administered anesthetic, e.g., propofol. Activation of the activated carbon filter or of the gaseous anesthetic absorber is not necessary in this embodiment, but a gaseous anesthetic absorber, which is used as a bypass of the CO2 absorber, may be present here as well. The presence of a gaseous anesthetic absorber during an anesthesia, which is carried out without the use of a volatile anesthetic, is not harmful. The wake-up criterion is modified in this embodiment such that the expiratory anesthetic concentration is not checked, but a time to wake up calculated from a three-compartment model for this intravenous agent is used (time to wake up), as this appears from DE 10 2004 050 717 B3.
Therefore, the respirating device may have, in each embodiment according to the present invention, a variant for operation with both a volatile anesthetic and propofol as an example of a non-volatile anesthetic. The basic embodiment of the device according to the present invention and its fundamental function are, however, identical to those described above.
The device according to the present invention may have, moreover, in another preferred embodiment, an electronically controlled evaporator for the anesthetic with an electronic mixer or a manual steamer with an electronic mixer or a purely manual dispensing system. When manually controlled components are used, the control signals of the wake-up algorithm are replaced by user instruction reports. These may optionally be acknowledged.
The device according to the present invention for respirating a patient may have a fan of a piston-and-cylinder unit or a system with turbine drive with or without circulation flow. Moreover, a conventional or a closed circulation system may be provided. Furthermore, the device may have a means for the manual or automated dispensing of the anesthetics.
The device according to the present invention may be designed for use with commercially available breathing tube accessories. The device is, furthermore, suitable for being operated with volatile anesthetic dispensing and/or intravenous anesthesia.
The object according to the present invention is also accomplished, furthermore, by the combination of the process as well as by the system. Since all the above-described advantages also apply in full measure to the process, reference is expressly being made here to the above discussion to avoid repetitions. Furthermore, it is pointed out that all the above-described embodiments can also be interpreted as variants of the processes. The description of these embodiments is therefore also disclosed, insofar as the person skilled in the art can identify them in the above discussion.
The present invention will be explained in more detail below on the basis of the drawings attached. The various features of novelty which characterize the invention are pointed out with particularity in the claims annexed to and forming a part of this disclosure. For a better understanding of the invention, its operating advantages and specific objects attained by its uses, reference is made to the accompanying drawings and descriptive matter in which the preferred embodiments of the invention are illustrated.
In the drawings:
Referring to the drawings in particular,
A combined fresh gas feed consisting of gas 15 and anesthetic 17 is designated by reference number 11. Gas is dispensed in the means 13.
Furthermore,
It can be recognized from
The filter 3 may be designed as a hygiene filter to avoid contamination of the device 1 by the respiration of a previous patient.
The wake-up process, which is shown in
If, by contrast, the algorithm has passed over to step S19, a checking is performed to determine whether the pressure support PS is above 2 mbar. If yes, the algorithm (state “J”) proceeds to step S21, in which the pressure support PS is lowered by 2 mbar. However, if it is determined in step S19 that the pressure support is not greater than 2 mbar (state “N”), the algorithm passes over to step 22, in which the user is asked whether he or she would like to end the algorithm or the wake-up process. If the user answers this question with a “Yes” (state “J”), the bypass is switched back in step S23, the fresh gas flow for the spontaneous breathing is set to a high value in step S24, and the algorithm comes to an end in step S25. If, by contrast, a “No” answer (state “N”) is given in step S22, the algorithm passes again over to step S20.
It is noted that the processes shown in
A tongue designated by reference number 41 is used to turn the mobile cover 33 to switch over the cartridge 31 between its operating positions along the arrow designated by 43 in
The cartridge 31 has an inner tube 45, through which the breathing gas flows through the cartridge 31. Furthermore, the cartridge 31 has two partitions 47 for guiding the gas and storing the filter materials (i.e., the absorbent for CO2 as well as for the anesthetics) separately.
Thus, the present invention proposes, for the first time ever, a device for shortening the wake-up phase of an anesthetized patient. Furthermore, a process for operating a device according to the present invention as well as a process for respirating a patient with gaseous anesthetic are proposed according to the present invention.
While specific embodiments of the invention have been shown and described in detail to illustrate the application of the principles of the invention, it will be understood that the invention may be embodied otherwise without departing from such principles.
Number | Date | Country | Kind |
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10 2007 023 246.4 | May 2007 | DE | national |