Method and system for endotracheal/esophageal stimulation prior to and during a medical procedure

Abstract

A method of performing a medical procedure, such as surgery, is provided. A nerve is stimulated in order to adjust the beating of the heart to a first condition, such as a stopped or slowed condition. The medical procedure is performed on the heart or another organ. The stimulation of the nerve is stopped in order to adjust the beating of the heart to a second condition, such as a beating condition. The heart itself may also be stimulated to a beating condition, such as by pacing. The stimulation of the nerve may be continued in order to allow the medical procedure to be continued. Systems and devices for performing the medical procedure are also provided.

We claim:  
     
         1 . A method of performing a medical procedure, comprising: 
 esophageal stimulation of a vagal nerve to adjust the beating of a heart to a first condition;    performing the medical procedure on an organ;    reducing esophageal stimulation of the vagal nerve;    epicardial stimulation of the heart to adjust the beating of a heart to a second condition;    reducing epicardial stimulation of the heart;    esophageal stimulation of the nerve a subsequent time in order to re-adjust the beating of the heart to the first condition; and    continuing the medical procedure.    
     
     
         2 . The method of  claim 1  wherein the esophageal stimulation is stopped to achieve the second condition.  
     
     
         3 . The method of  claim 1  wherein the epicardial stimulation is stopped to re-adjust the beating of the heart to the first condition.  
     
     
         4 . The method of  claim 1  wherein the first condition is a stopped condition.  
     
     
         5 . The method of  claim 1  wherein the first condition is a slowed condition.  
     
     
         6 . The method of  claim 1  wherein the second condition is a beating condition.  
     
     
         7 . The method of  claim 1  further comprising: 
 delivering at least one drug during the medical procedure.  
 
     
     
         8 . The method of  claim 7  wherein the drug is selected from the group consisting of: 
 a beta-blocker, a cholinergic agent, a cholinesterase inhibitor, a calcium channel blocker, a sodium channel blocker, a potassium channel agent, adenosine, an adenosine receptor agonist, an adenosine deaminase inhibitor, dipyridamole, a monoamine oxidase inhibitor, digoxin, digitalis, lignocaine, a bradykinin agent, a serotoninergic agonist, an antiarrythmic agent, a cardiac glycoside, a local anesthetic, atropine, a calcium solution, an agent that promotes heart rate, an agent that promotes heart contractions, dopamine, a catecholamine, an inotrope glucagon, a hormone, forskolin, epinephrine, norepinephrine, thyroid hormone, a phosphodiesterase inhibitor, prostacyclin, prostaglandin, methylxanthine, a P 2 -purinoceptor agent, an ischemia agent, and a delta opioid agonist.  
 
     
     
         9 . The method of  claim 8  wherein the drug is naturally occurring  
     
     
         10 . The method of  claim 8  wherein the drug is chemically synthesized.  
     
     
         11 . The method of  claim 1  wherein the medical procedure is selected from the group consisting of: 
 surgical procedures, non-surgical procedures, endoscopic procedures, fluoroscopic procedures, stent delivery procedures, aortic aneurysm repairs, cranial aneurysm repairs, delivery of drugs, delivery of biological agents, cardiac surgery with cardiopulmonary bypass circuits, cardiac surgery without cardiopulmonary bypass circuits, brain surgery, cardiograms, heart valve repair, heart valve replacement, MAZE procedures, transmyocardial revascularization, CABG procedures, beating heart surgery, vascular surgery, neurosurgery, electrophysiology procedures, diagnostic ablation of arrhythmias, therapeutic ablation of arrhythmias, endovascular procedures, treatment of injuries to the liver, treatment of the spleen, treatment of the heart, treatment of the lungs, treatment of major blood vessels, non-invasive procedures, invasive procedures, and port-access procedures.  
 
     
     
         12 . A device for performing a medical procedure comprising: 
 a processor;    an esophageal nerve stimulation electrode operatively connected to the processor and arranged on an esophageal tube; and    a cardiac stimulation electrode operatively connected to the processor, wherein the processor processes output from the nerve stimulation electrode and adjusts output from the cardiac stimulation electrode based on output from the nerve stimulation electrode.    
     
     
         13 . The device of  claim 12  further comprising: 
 drug delivery means for delivering at least one drug during the medical procedure.  
 
     
     
         14 . The device of  claim 13  wherein the drug delivery means is selected from the group consisting of: 
 a spray, a cream, an ointment, a medicament, a pill, a patch, a catheter, a cannula, a needle and syringe, a pump, and an iontophoretic drug delivery device.  
 
     
     
         15 . The device of  claim 12  wherein the cardiac stimulation electrode is selected from the group consisting of: 
 clip electrodes, needle electrodes, probe electrodes, pacing electrodes, epicardial electrodes, endocardial electrodes, patch electrodes, intravascular electrodes, balloon-type electrodes, basket-type electrodes, tape-type electrodes, umbrella-type electrodes, suction-type electrodes, endoesophageal electrodes, transcutaneous electrodes, intracutaneous electrodes, screw-type electrodes, barb-type electrodes, bipolar electrodes, monopolar electrodes, metal electrodes, wire electrodes and cuff electrodes.  
 
     
     
         16 . The device of  claim 12  further comprising: 
 a respiratory controller for controlling respiration.  
 
     
     
         17 . The device of  claim 12  wherein stimulation from the nerve stimulation electrode occurs in an inverse relationship to stimulation from the cardiac stimulation electrode.  
     
     
         18 . The device of  claim 12  further comprising: 
 a drug pump for delivering at least one drug, the drug pump operatively connected to the processor wherein the processor adjusts the output of the drug.  
 
     
     
         19 . The device of  claim 12  further comprising: 
 a respiratory controller for controlling respiration, the respiratory controller operatively connected to the processor wherein the processor adjusts the output of the respiratory controller.  
 
     
     
         20 . A method of performing a medical procedure, comprising: 
 endotracheal stimulation of a vagal nerve to adjust the beating of a heart to a first condition;    performing the medical procedure on an organ;    reducing endotracheal stimulation of the vagal nerve;    esophageal stimulation of the heart to adjust the beating of a heart to a second condition;    reducing esophageal stimulation of the heart;    endotracheal stimulation of the nerve a subsequent time in order to re-adjust the beating of the heart to the first condition; and    continuing the medical procedure.    
     
     
         21 . The method of  claim 20  wherein the endotracheal stimulation is stopped to achieve the second condition.  
     
     
         22 . The method of  claim 20  wherein the esophageal stimulation is stopped to re-adjust the beating of the heart to the first condition.  
     
     
         23 . The method of  claim 20  wherein the first condition is a stopped condition.  
     
     
         24 . The method of  claim 20  wherein the first condition is a slowed condition.  
     
     
         25 . The method of  claim 20  wherein the second condition is a beating condition.  
     
     
         26 . The method of  claim 20  further comprising: 
 delivering at least one drug during the medical procedure.  
 
     
     
         27 . The method of  claim 26  wherein the drug is selected from the group consisting of: 
 a beta-blocker, a cholinergic agent, a cholinesterase inhibitor, a calcium channel blocker, a sodium channel blocker, a potassium channel agent, adenosine, an adenosine receptor agonist, an adenosine deaminase inhibitor, dipyridamole, a monoamine oxidase inhibitor, digoxin, digitalis, lignocaine, a bradykinin agent, a serotoninergic agonist, an antiarrythmic agent, a cardiac glycoside, a local anesthetic, atropine, a calcium solution, an agent that promotes heart rate, an agent that promotes heart contractions, dopamine, a catecholamine, an inotrope glucagon, a hormone, forskolin, epinephrine, norepinephrine, thyroid hormone, a phosphodiesterase inhibitor, prostacyclin, prostaglandin, methylxanthine, a P 2 -purinoceptor agent, an ischemia agent, and a delta opioid agonist.  
 
     
     
         28 . The method of  claim 27  wherein the drug is naturally occurring  
     
     
         29 . The method of  claim 27  wherein the drug is chemically synthesized.  
     
     
         30 . The method of  claim 20  wherein the medical procedure is selected from the group consisting of: 
 surgical procedures, non-surgical procedures, endoscopic procedures, fluoroscopic procedures, stent delivery procedures, aortic aneurysm repairs, cranial aneurysm repairs, delivery of drugs, delivery of biological agents, cardiac surgery with cardiopulmonary bypass circuits, cardiac surgery without cardiopulmonary bypass circuits, brain surgery, cardiograms, heart valve repair, heart valve replacement, MAZE procedures, transmyocardial revascularization, CABG procedures, beating heart surgery, vascular surgery, neurosurgery, electrophysiology procedures, diagnostic ablation of arrhythmias, therapeutic ablation of arrhythmias, endovascular procedures, treatment of injuries to the liver, treatment of the spleen, treatment of the heart, treatment of the lungs, treatment of major blood vessels, non-invasive procedures, invasive procedures, and port-access procedures.  
 
     
     
         31 . A device for performing a medical procedure comprising: 
 a processor;    an endotracheal nerve stimulation electrode operatively connected to the processor; and    an esophageal cardiac stimulation electrode operatively connected to the processor, wherein the processor processes output from the nerve stimulation electrode and adjusts output from the cardiac stimulation electrode based on output from the nerve stimulation electrode.    
     
     
         32 . The device of  claim 31  further comprising: 
 drug delivery means for delivering at least one drug during the medical procedure.  
 
     
     
         33 . The device of  claim 31  wherein the drug delivery means is selected from the group consisting of: 
 a spray, a cream, an ointment, a medicament, a pill, a patch, a catheter, a cannula, a needle and syringe, a pump, and an iontophoretic drug delivery device.  
 
     
     
         34 . The device of  claim 31  wherein the cardiac stimulation electrode is arranged on an esophageal tube.  
     
     
         35 . The device of  claim 31  wherein the nerve stimulation electrode is arranged on an endotracheal tube.  
     
     
         36 . The device of  claim 31  further comprising: 
 a respiratory controller for controlling respiration.  
 
     
     
         37 . The device of  claim 31  wherein stimulation from the nerve stimulation electrode occurs in an inverse relationship to stimulation from the cardiac stimulation electrode.  
     
     
         38 . The device of  claim 31  further comprising: 
 a drug pump for delivering at least one drug, the drug pump operatively connected to the processor wherein the processor adjusts the output of the drug.  
 
     
     
         39 . The device of  claim 31  further comprising: 
 a respiratory controller for controlling respiration, the respiratory controller operatively connected to the processor wherein the processor adjusts the output of the respiratory controller.