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Publication numberUS3364929 A
Publication typeGrant
Publication date23 Jan 1968
Filing date21 Dec 1964
Priority date21 Dec 1964
Also published asDE1539104A1, DE1539104B2
Publication numberUS 3364929 A, US 3364929A, US-A-3364929, US3364929 A, US3364929A
InventorsWalter S Ide, William H Nickerson
Original AssigneeBurroughs Wellcome Co
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Method for administering muscle relaxant drug
US 3364929 A
Abstract  available in
Images(1)
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Claims  available in
Description  (OCR text may contain errors)

Jan. 23, 1968 w. 5.105 ETAL 3,364,929

- METHOD FOR ADMINISTERING MUSCLE RELXANT DRUG Filed Dec. 2l, 1964 ,zo ,22 3 lll 5? 45 f2( 58 56X z3 40 Z8 2Q 25 E 5M@ 6&5 N

Z5 75 HM' METER 0R A OSCILLOSCOPE ELE CTR \CQL. SUMUU TwlTcH fTETANus TwITH gb Nowoepommzme BLOCK MH @Us TunTcH g" .36. DEPoLQmzmG BLOCK INVBNTORS HHH l I l I I wlham H .NwKevmm Y BY TwlTcH TETANUSl TwmzH 90M@ (mm Y ATTQRNEY` United States Patent Office 3,364,929 Patented Jan. 23, 1968 3,364,929 METHOD FOR ADMINISTERING MUSCLE RELAXANT DRUG Walter S. Ide, Eastchester, and William H. Nickerson,

Tuckahoe, N.Y., assignors to Burroughs Wellcome &

Co. (U.S.A.) Inc., Tucltahoe, N Y., a corporation of New York Filed Dec. 21, 1954, Ser. No. 419,949 4 Claims. (Cl. 128-172.1)

ABSTRACT OF THE DISCLOSURE A method for administering a muscle relaxant antagonist drug to counteract muscle relaxant drugs which produce both non-depolarizing and depolarizing blocks in patients, comprising the steps of rst applying an electrical stimulus to the ulnar nerve and/ or the nerve motor point muscle junction of a patient at a twitching frequency rate, secondly applying electrical stimulus at a tetanus frequency rate to the same part of the patient, and thirdly reapplying the electrical stimulus at the frequency rate, differentiating between responsiveness of the patient to said stimuli to determine the types of neuromuscular block, and introducing an antagonist into the system of the patient only if the response of the patient is such that a non-depolarizing block exists.

Athe completion of surgery, it is sometimes required that the patient who has been administered a muscle relaxant drug be stimulated by the administration of an antagonist drug to counteract the elfects of the muscle relaxant drug. Commonly used antagonist drugs are physostigmine, eserine and edrophonium.

In some instances instead of the antagonist stimulating the patient a continuation of the relaxation of the patient for prolonged periods has occurred. The prolonged period of relaxation has tended to be greater than that which would ordinarily occur without the administration of the antagonist, It is believed that this continuation of relaxation is related to the type of neuromuscular block existing in the patient.

In View of the foregoing, a new and improved apparatus for determining the correct time to administer muscle `antagonist drugs was required. Additionally, a new and improved method was required in order to administer antagonists to produce a stimulation of the patient instead of prolonging the relaxation of the patient. Accordingly, it is an object of this invention to provide a new and improved apparatus for providing electrical stimuli4 to differentiate between depolarizing and nondepolarizing neuromuscular blocks due to the action of certain muscle relaxant drugs.-

Another object of this `invention is to provide a new and improved method of administering antagonist drugs. It is a further object of this invention to provide a new and improved method of determining when to introduce muscle relaxant drugs and the administration of such drugs.

It is'an additional object of this invention to provide a new and improved and simplified monitoring apparatus for stimulating the patient and to determine the type of neuromuscular block exhibited by the patient.

Other objects of the invention will in part be obvious and will in part appear hereinafter.

The invention accordingly comprises the several steps and the relation of one or more of such steps with respect to each of the others, and the apparatus embodying features of construction, combinations of elements and arrangements of parts which are adapted to eect such steps, all as exemplified in the following detailed disclosure, and the scope of the invention will be indicated in the claims.

For a fuller understanding of the nature and objects of the invention, reference should be had to the following detailed description taken in conjunction with the accompanying drawings, in which FIG. 1 illustrates schematically a transistorized, neuromuscular block monitoring device;

FIG. 2 is an isometric representation of a splint for mounting on a patient to detect response of a patient to electrical stimuli;

FIG. 3a is a graph illustrating the sequential electrical stimuli applied to the patient in accordance with this invention;

FIG. 3b is a graph showing the resultant response of a patient to the electrical stimuli as a result of a non-depolarizing block affecting the nerves of the patient; and

FIG 3c is a graph illustrating a depolarizing block of a patient in response to electrical stimuli.

Referring now to FIGS. l and 2, a monitor oscillator or pulse generator is shown at 20 for generating an electrical stimuli in accordance with this invention. The pulse generator Z0 includes a relaxation oscillator circuit having an NPN transistor 21 with an emitter electrode 22, a base electrode 23 and a collector electrode 24 and a PNP transistor 25 with an emitter electrode 26, a base electrode 27 and a collector electrode 28. The collector 24 of transistor 21 is coupled to the base 27 of transistor 25. Connected between the base electrode 23 of transistor 21 and collector electrode of transistor 25 is a capacitor 30. Coupled intermediate the base 23 of transistor 21 and capacitor 30 is a variable resistance network for varying the frequency of the oscillator. The resistance network includes a switch 31 and two resistors 33 and 34, Switch 31 can be connected to either of resistors 33 and 34 to control the frequency of the oscillator. A source of direct current energy 34, such as a battery, is coupled at its positive terminal to emitter 26 of transistor 25 and to the other end of resistors 33 and 34. A switch 36 is provided in the line to place the DC energy source 35 in the circuit, One end of the switch is coupled to the emitter 22 and the other end of the switch is coupled to the battery 35. A voltage step-up transformer is generally shown at 37. Transformer has its primary winding 38 between the collector 28 of transistor 25 and emitter 22 of transistor 21.

A resistor 40 coupled in series with capacitor 30 and a capacitor 41 connected across winding 38 are preferably included to decrease extraneous voltages in the circuit. The secondary winding 39 of transformer 37 is coupled across a resistor 4S and a gas tube 46. The'resistor 45 and gas tube 46 are in parallel with a variable resistor 47. The gas tube 46 indicates when the device 20 is providing a signal of a predetermined voltage level. Coupled across variable resistor 47 is a first electrode 50 and a second electrode 51 connected through a resistor 49. The electrodes may be surface-type electrodes which are suitable for applying an electrical stimuli to the arm 52 of a patient. But, preferably, needle-type electrodes are utilized which may be of the standard 25 gage metal needle type.

The electrodes are placed on the arm or the legs of a patient in a well -known manner such that the ulnar nerve and/or the nerve motor point muscle function is stimulated by the signal provided from the oscillator 20. The oscillator operates as follows: upon closure of switch 36 and the connection of switch 31 to one of resistors 33 and 34, the circuit 20 will begin to oscillate. Assume, for example, that switch 31 is coupled to resistor 34. The value of resistor 34 is selected such that the relaxation oscillator 2t)v will oscillate at a frequency somewhat above zero impulses per second rbut below 30 impulses per second. This is commonly termed as the frequency which will produce twitching of a digital member of a limb of a patient, as for example, a finger or a toe. This will henceforth be defined as the twitching frequency. The exact impulse frequency range to produce twitching will vary with the patient, and therefore af requency of 20 impulses per second is preferred. With switch 31 coupled to the resistor 34, a voltage will be applied to transistor base 23 in such a direction as to cause transistor 21 to turn on. The turning on of transistor 21 causes transistor to turn on. This causes a current to ow within the primary 3S of the transformer 37. Transistors 21 and 25 will continue to conduct as long as the transformer 37 is unsaturated. After a period of time, transformer 37 becomes saturated and a voltage across secondary 39 rapidly reverses according to Lcnzes law. This causes a potential to be applied to base 23 of transistor 21 of such a polarity as to turn off transistor 21. This, in turn, turns off transistor 25. Capacitor which charged in the reverse direction to cut olf transistor 23 due to the saturation of inductor 37 then gradually discharges until the potential at the base electrode 23 of transistor 21 once again becomes of the proper polarity to turn on transistor 21 to restart the cycle.

The resultant output wave form of the oscillator is shown across electrodes 50 and 51. It is to be noted that the topmost portion of the turn on cycle is slightly clipped due to the presence of gas tube 46. This gas tube ckering indicates to the observer that the impulse generating device 20 is operating. Assume now that the switch 31 is coupled to resistor 33. Resistor 33 is selected such that the impulse frequency rate will be in the order of between -120 impulses per second. In the preferred embodiment, 50 impulses per second was chosen. This range of frequencies is generally referred to as the tetanus frequency rate. The tetanus frequency reaction is observed by noticing the involuntary closing of a linger or a toe of a patient. The exact values for the frequency rate for both tetanus and twitching is generally a function of the patient and it is, therefore, to be understood that the ranges described are only illustrative and are not limiting.

Although it is to be understood that many modifications may be made to the above circuit, the following circuit values may be utilized to provide an impulse generating device suitable for generating both tetanus and twitching frequency impulses.

Transistor 21 2N335.

Transistor 25 2Nl66.

Capacitor 30 2O microfarads.

Resistor 33 5.1K ohms.

Resistor 34 330K ohms.

Battery 35 3 volts. Transformer 37 Voltage step-up of approximately 30. Resistor 40 100 ohms.

Capacitor 41 l5 microfarads.

Gas tube 46 NESlH.

The device 20 is capable of providing approximately a 90 R.M.S. output signal across electrodes 50 and 51 when used with a 3-volt battery as the energy source for the circuit. This circuit is particularly usable during the administration of an anesthesia and during operations because it is explosion-proof due to the low value of currents and voltages utilized. To detect the response to the electrical stimuli provided across the electrodes 50 and 51, a digital member such as a finger 53 of arm 52 may be observed. This may be accomplished without the use of any auxiliary detecting and monitoring devices shown in FIG. l. By applying a twitching frequency signal to the electrodes 50 and 51, the twitching signal will produce a periodic contraction of the finger 53. The application of a tetanus signal will draw the finger closed. Thus, the twitching and tetanus signals may be observed by watching the motion of the finger or the toes of a patient.

The use of this information will be described at a later time in this specification in accordance with the method of this invention.

Although the reaction of the patient to the application of tetanus and Ytwitching muscle electrical stimuli mayl be obsterved without the use of electrical equipment, it is preferred that some type of electrical monitoring device be utilized to better assist in the recognition of the patients response.

By the use'of a splint, generally shown at 55, which is suitable for mounting on thumb 53, a device for indicating and displaying the response of the patient may be provided. The splint 55 comprises resilient lat portions 55 and 57 having a bend 58 therebetween. Positioned at one end of resilient member 57 is ring 61 suitable for surrounding the tip portion of patients thumb 53.

Attached to the other member 56 of splint 55 are clamps 62 and 63. These clamps are shaped like rings, but have cut out portions for permitting the clamps to extend over the upper portion of patients thumb 53 above the joint. To record the bending of the splint 55, a suitable strain gage 70 is mounted thereon in a position to record the pressure produced by the thumb against the splint. A strain gage, such as the type SR-4 available from Baldwin-Lima Hamilton Corp., Waltham, Massachusetts, may be used. Other types of strain or stress transducers such as strain sensitive diodes and transistors may also be utilized as well as piezo electric devices. Strain gage 70 is connected to a suitable circuit comprising resistor 72 and battery 73 for providing a current through the strain gage. The variations of the current flow through the strain gage due to a change in resistance of the strain gage because of flexing of thumb 53, can then be monitored on a meter such as a voltage meter or an oscilloscope 75. Further, other display devices may be utilized, for example, electrical type brush recorders.

Referring now to FIGS. 3a, 3b and 3c for a description of the method according to this invention, assume that the patient has been injected with a syringe carry,

ing muscle relaxant drugs such as succinylcholine, or dimethyl tubocurare. Further assume that an anesthesiologist deems it necessary to introduce a muscle antagonistic drug to counteract the effects of the muscle relaxant drug. To determine the proper time to inject the muscle relaxant antagonist is, for example, by the use of a syringe 80 as shown in FIG. l, the neuromuscular block monitoring device 20, is turned on and set to provide electrical stimuli at a twitching frequency. The electrical stimuli is applied at the ulnar nerve at the wrist, elbow or at a motor junction point. It is preferable to use needle electrodes which may be inserted into the arm of the patient, rather than surface electrodes which tend to cause slight damage tothe skin due to irritation of the electrodes after long periods of time as, for example, four hours. FIG. 3a shows the application of the electrical stimuli at a twitching frequency of about twenty impulses per second, although variations may exist due to the particular patient. The response of the patient is shown in FIGS. 3b and 3c and may be observed on the oscilloscope 75. The spikes in FIGS. 3b and 3c indicate that the patient has reacted to the stimuli such as to produce a twitching of the digital member. This can also be observe-d by watching the digital member itself. lAfter a period of time as, for example, 20 seconds monitor oscillating device 20 is then set to provide electrical stimuli at a tetanus frequency. In the preferred embodiment, the monitor is set to provide 50 impulses per seconduwh'ich is shown in FIG. 3a. The application of electrical im'- pulses at tetanus frequency produces a clamping response of the patients hand or toes such that the hand or toes tend to close during the application of the tetanus stimuli. This may be observed by noticing the square wave representation in FIGS. 3b and 3c or, again, by watching the digital member.

In the preferred method, the tetanus is held for approximately two to three seconds although many variations may be possible depending on the response of the patient. To determine the nature of the neuromuscular block, the monitor is switched to provide electrical stimuli at the twitching frequency once again. FIG. 3b shows the response of the patients digit-al members to the re-application of the twitch frequency when there exists a non-depolarizing neuromuscular block within the patient. This figure further shows what is generally termed post-tetanic facilitation and which is represented by a sudden increase in the amplitude of the switch response. This has been determined to vbe the response by the patient to a twitch frequency after ythe application of a tetanus frequency electrical stimuli when there exists a nondepolarizing block within the patient. In FIG. 3c there is shown the response of the patient to the twitch electrical frequency stimuli when there exists a depolarizing neuromuscular block within the patient. In this figure it may be seen that there is no post-tetanic facilitation which is indicative of a depolarizing neuromuscular block.

In accordance with this invention, it has been determined that a muscle antagonist drug should be introduced into the patient only when there exists a nondepolarizing block such as shown by the post-tetanic facilitation of FIG. 3b. The introduction of an antagonist drug when there is a depolarizing block such as shown in FIG. 3c potentiates the depolarizing block rather than counteracting the muscle relaxant drug. If the drug is administered when there is a depolarizing block, the patient generally requires a longer period of time to overcome the relaxant drug then would normally -be required if the neuromuscular block were permitted `to switch from a depolarizing to the non-depolarizing neuromuscular block by itself. This will generally occur after a predetermined time interval h-as elapsed to permit the muscle relaxant 4drum to lose at least some of its potency. It should be understood that a sensor strapped to an arm or leg of the patient could also be utilized although a sensor strapped to a digit-al member is preferred.

It will thus be seen that the objects set forth above, among those made 4apparent from the preceding description, are eiiciently attained and, since certain changes may be made in the above article without departing from the scope of the invention, it is intended that all matter contained in the above description or shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.

It is also to be understood that the following claims are intended to cover all of the generic and specific features of the invention hereindescribed, and all statements of the scope of the invention which, as a matter of language, might be said to fall therebetween.

What we claim is:

1. A method for administering a muscle relaxant antagonist drug to counteract muscle relaxant drugs which produce both non-depolarizing and depolarizing blocks in patients, comprising the steps of first applying an electrical stimulus to the ulnar nerve and/ or the nerve motor point muscle junction of a patient at a switching frequency rate, secondly applying electrical stimulus lat a tetanus frequency rate to the same part of the patient, point muscle junction of a patient at a twitching frequency rate, differentiating between responsiveness of the patient to said stimuli to determine the types of neuromuscular block, and introducing an antagonist into the system of the patient only if the response of the patient is such that a non-depolarizing block exists.

2. A method for the intravenous administration of antagonistic drugs to counteract the effects of drugs producing muscle relaxation, comprising the steps of sequentially applying a low amperage electrical stimuli of two different frequencies to a muscle motor point and/or the ulnar nerve of a patient to produce -a muscle stimulus, and administering the antagonistic drugs only when the response of the patient to the electrical stimuli is such that a non-depolarizing neuromuscular block exists within the patient.

3. A method for Vthe intravenous administration of antagonistic drugs to counteract the effects of muscle relaxant drugs producing 'both depolarizing and nondepolarizing neuromuscular blocks in patients, comprising the steps of sequentially applying an electrical stimulus at both twitching and tetanus frequencies to a muscle motor point and/ or the ulnar nerve of a patient to produce a muscle stimulus, Vand administering antagonistic drugs only when the response of the patient to the electrical stimuli is such that a non-depolarizing neuromuscular block exists.

4. A method for administering muscle relaxation antagonistic drugs to counteract the effects of muscle relaxant drugs which produce both non-depolarizing and depolarizing neuromuscular blocks in patients, comprising the steps of first applying an electrical stimulus at a twitching frequency to the ulnar nerve and/ or the muscle motor point of a, patient, then applying an electrical stimulus at a tetanus frequency to the ulnar nerve and/or the muscle motor point of a patient and then reapplying an electrical stimulus at a twitching frequency to the ulnar nerve and/or the muscle motor point of a patient, and administering antagonistic drugs only when the response of the patient is such that a depol-arizing neuromuscular `block will not be potentiated.

References Cited UNITED STATES PATENTS 2,493,155 1/1950 McMillan 128-172.1 2,808,826 10/1957 Reiner et al 12S-2.1 2,830,578 4/1958 De Groff 12S- 24.5 2,840,069 6/ 1958 Squire et al. 12S-2 3,200,814 8/1965 Taylor et al. 12S-2 3,207,151 9/ 1965 Takagi 12S-2.1 3,258,007 6/1966 Karpovich et a1. 12S-2 3,292,620 12/ 1966 Mahler 12S-172.1 2,979,055 4/ 1961 De Beer et al 12S-214 RICHARD A. GAUDET, Primary Examiner. SIMON BRODER, Examiner,

Disclaimer 3,364,929. Walter S. lele, Eastchesber, and William H. Nickerson, Tuckahoe, N.Y. METHOD FOR ADMIN ISTERING MUSCLE RELAXANT DRUG. Patent dated J an. 23, 1968. Disclaimer filed Apr. 20, 197 8, by the assignee, Burroughs Wellcome 00. Hereby enters this disclaimer to all claims of said patent.

[Oficial Gazette June 13, 1.978.]

Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US2493155 *9 Jan 19473 Jan 1950Mine Safety Appliances CoApparatus for treating skin diseases
US2808826 *19 Jan 19568 Oct 1957Teca CorpElectro-diagnostic apparatus and a circuit therefor
US2830578 *31 Jan 195715 Apr 1958Mark E DegroffElectro-sonic apparatus
US2840069 *22 Sep 195524 Jun 1958Nat Res DevPenetrating instruments such as hypodermic needles and their use in an imbibition pressure meter
US2979055 *18 Jun 195411 Apr 1961Burroughs Wellcome CoMethod for the administration of muscle relaxant drugs
US3200814 *12 Mar 196317 Aug 1965Richard F ChandlerApparatus for measuring reflexes, tremors and the like
US3207151 *17 Sep 196221 Sep 1965Tateisi Denki KabushikikaishaInstrument for locating particular cutaneous points caused by viscerovascular reflex
US3258007 *19 Jul 196328 Jun 1966Peter V KarpovichRotary electrogoniometer for measuring degree of rotation of the forearm
US3292620 *30 Jul 196320 Dec 1966Instro Dynamics CorpElectric desensitizer
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US3468302 *20 May 196623 Sep 1969Godfrey BrookeSkin resistance reaction time testing apparatus
US3513834 *21 Nov 196726 May 1970Hitachi LtdAnesthetic depth measuring system
US3570473 *28 Feb 196616 Mar 1971Cargille Scient IncManually controllable medical aid oscillator instrument
US3618601 *16 Oct 19699 Nov 1971Richardson Thatcher WIontophoresis unit
US3898983 *3 Oct 197312 Aug 1975James O ElamDevice and method for detecting the degree of muscle relaxation of a medical patient
US3908669 *17 Dec 197330 Sep 1975American Acupuncture Medical IApparatus for use by physicians in acupuncture research
US4291705 *10 Sep 197929 Sep 1981The Regents Of The University Of CaliforniaNeuromuscular block monitor
US4387723 *9 Dec 198014 Jun 1983Wisconsin Alumni Research FoundationMethod and apparatus for determining the level of neuromuscular block in a patient
US4399821 *19 Feb 198123 Aug 1983Bowers David LFree moving animal physiological monitoring and identification system and method
US4411268 *10 Feb 198225 Oct 1983Medtronic, Inc.Muscle stimulator
US4558704 *15 Dec 198317 Dec 1985Wright State UniversityHand control system
US4595018 *6 Jun 198417 Jun 1986Instrumentarium Corp.Method of further developing the measuring of a neuro-muscular junction
US4644959 *1 Nov 198424 Feb 1987Sergiu CalmanoviciMethod of functional assessment of cancer humoral factors
US4748987 *25 Sep 19857 Jun 1988The University Of MichiganAcoustic myography
US4795433 *31 Mar 19883 Jan 1989Survival Technology, Inc.Automatic injector for emergency treatment
US4807643 *16 Aug 198228 Feb 1989University Of Iowa Research FoundationDigital electroneurometer
US4817628 *18 Oct 19854 Apr 1989David L. ZealearSystem and method for evaluating neurological function controlling muscular movements
US4832682 *20 May 198523 May 1989Survival Technology, Inc.Injection method and apparatus with electrical blood absorbing stimulation
US4962766 *19 Jul 198916 Oct 1990Herzon Garrett DNerve locator and stimulator
US4986280 *20 Jul 198822 Jan 1991Arthur D. Little, Inc.Hand position/measurement control system
US5020542 *16 Apr 19904 Jun 1991Charles RossmannMethod of measuring skin sensitivity to electrical stimulation
US5085226 *30 May 19904 Feb 1992Trustees Of Boston UniversityForce monitoring apparatus for back muscles
US5284153 *14 Apr 19928 Feb 1994Brigham And Women's HospitalMethod for locating a nerve and for protecting nerves from injury during surgery
US5284154 *23 Oct 19928 Feb 1994Brigham And Women's HospitalApparatus for locating a nerve and for protecting nerves from injury during surgery
US5775331 *7 Jun 19957 Jul 1998Uromed CorporationApparatus and method for locating a nerve
US6226552 *16 Apr 19991 May 2001Stryker InstrumentsNeuromuscular electrical stimulation for preventing deep vein thrombosis
US63123926 Apr 20006 Nov 2001Garrett D. HerzonBipolar handheld nerve locator and evaluator
US64668178 Jun 200015 Oct 2002Nuvasive, Inc.Nerve proximity and status detection system and method
US65001288 Jun 200131 Dec 2002Nuvasive, Inc.Nerve movement and status detection system and method
US65640784 Jun 199913 May 2003Nuvasive, Inc.Nerve surveillance cannula systems
US7058438 *1 Apr 20036 Jun 2006Grace Lawrence JMethod and apparatus for self-diagnostic evaluation of nerve sensory latency
US70798837 May 200318 Jul 2006Nuvaslve, Inc.Nerve surveillance cannulae systems
US717767716 Oct 200213 Feb 2007Nuvasive, Inc.Nerve proximity and status detection system and method
US720794925 May 200524 Apr 2007Nuvasive, Inc.Surgical access system and related methods
US747023624 Nov 200030 Dec 2008Nuvasive, Inc.Electromyography system
US752295325 Mar 200421 Apr 2009Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US758205826 Jun 20031 Sep 2009Nuvasive, Inc.Surgical access system and related methods
US764388431 Jan 20055 Jan 2010Warsaw Orthopedic, Inc.Electrically insulated surgical needle assembly
US765730818 Feb 20052 Feb 2010Nuvasive, Inc.System and methods for performing dynamic pedicle integrity assessments
US765819625 Apr 20079 Feb 2010Ethicon Endo-Surgery, Inc.System and method for determining implanted device orientation
US766454430 Apr 200416 Feb 2010Nuvasive, Inc.System and methods for performing percutaneous pedicle integrity assessments
US769105716 Jan 20046 Apr 2010Nuvasive, Inc.Surgical access system and related methods
US769356231 Oct 20076 Apr 2010Nuvasive, Inc.Nerve surveillance cannulae systems
US77752157 Mar 200617 Aug 2010Ethicon Endo-Surgery, Inc.System and method for determining implanted device positioning and obtaining pressure data
US77759667 Mar 200617 Aug 2010Ethicon Endo-Surgery, Inc.Non-invasive pressure measurement in a fluid adjustable restrictive device
US778525331 Jan 200631 Aug 2010Nuvasive, Inc.Surgical access system and related methods
US781980127 Feb 200426 Oct 2010Nuvasive, Inc.Surgical access system and related methods
US78443427 Feb 200830 Nov 2010Ethicon Endo-Surgery, Inc.Powering implantable restriction systems using light
US78921737 Dec 200922 Feb 2011Nuvasive, Inc.Surgical access system and related methods
US790584018 Oct 200415 Mar 2011Nuvasive, Inc.Surgical access system and related methods
US792092224 Feb 20105 Apr 2011Nuvasive, Inc.System and methods for determining nerve proximity, direction, and pathology during surgery
US792727029 Jan 200719 Apr 2011Ethicon Endo-Surgery, Inc.External mechanical pressure sensor for gastric band pressure measurements
US793505122 Apr 20093 May 2011Nuvasive, Inc.Surgical access system and related methods
US796219131 Oct 200714 Jun 2011Nuvasive, Inc.Nerve surveillance cannulae systems
US796392721 Apr 200421 Jun 2011Nuvasive, Inc.Electromyography system
US80007821 Dec 200916 Aug 2011Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US800553514 Apr 200923 Aug 2011Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US80167447 Mar 200613 Sep 2011Ethicon Endo-Surgery, Inc.External pressure-based gastric band adjustment system and method
US80167456 Apr 200613 Sep 2011Ethicon Endo-Surgery, Inc.Monitoring of a food intake restriction device
US801676723 Apr 200713 Sep 2011Nuvasive, Inc.Surgical access system and related methods
US802771620 Apr 200927 Sep 2011Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US803406526 Feb 200811 Oct 2011Ethicon Endo-Surgery, Inc.Controlling pressure in adjustable restriction devices
US80507691 May 20091 Nov 2011Nuvasive, Inc.System and methods for determining nerve proximity, direction, and pathology during surgery
US805749212 Feb 200815 Nov 2011Ethicon Endo-Surgery, Inc.Automatically adjusting band system with MEMS pump
US806662912 Feb 200729 Nov 2011Ethicon Endo-Surgery, Inc.Apparatus for adjustment and sensing of gastric band pressure
US80689129 Jan 200429 Nov 2011Nuvasive, Inc.System and methods for determining nerve proximity, direction, and pathology during surgery
US809043629 Oct 20093 Jan 2012Nuvasive, Inc.Tissue discrimination and applications in medical procedures
US80924557 Feb 200510 Jan 2012Warsaw Orthopedic, Inc.Device and method for operating a tool relative to bone tissue and detecting neural elements
US810087014 Dec 200724 Jan 2012Ethicon Endo-Surgery, Inc.Adjustable height gastric restriction devices and methods
US811401930 Dec 200914 Feb 2012Nuvasive, Inc.Surgical access system and related methods
US81143458 Feb 200814 Feb 2012Ethicon Endo-Surgery, Inc.System and method of sterilizing an implantable medical device
US813317330 Dec 200913 Mar 2012Nuvasive, Inc.Surgical access system and related methods
US81372848 Oct 200320 Mar 2012Nuvasive, Inc.Surgical access system and related methods
US814245227 Dec 200727 Mar 2012Ethicon Endo-Surgery, Inc.Controlling pressure in adjustable restriction devices
US814742115 Jul 20053 Apr 2012Nuvasive, Inc.System and methods for determining nerve direction to a surgical instrument
US815271028 Feb 200810 Apr 2012Ethicon Endo-Surgery, Inc.Physiological parameter analysis for an implantable restriction device and a data logger
US816565314 Jun 201124 Apr 2012Nuvasive, Inc.Surgical access and nerve surveillance
US817275017 Mar 20108 May 2012Nuvasive, Inc.Surgical access system and related methods
US818242330 Dec 200922 May 2012Nuvasive, Inc.Surgical access system and related methods
US81871626 Mar 200829 May 2012Ethicon Endo-Surgery, Inc.Reorientation port
US818716310 Dec 200729 May 2012Ethicon Endo-Surgery, Inc.Methods for implanting a gastric restriction device
US818717930 Dec 200929 May 2012Nuvasive, Inc.Surgical access system and related methods
US819235028 Jan 20085 Jun 2012Ethicon Endo-Surgery, Inc.Methods and devices for measuring impedance in a gastric restriction system
US819235610 Dec 20095 Jun 2012Nuvasive, Inc.Surgical access system and related methods
US819235730 Dec 20095 Jun 2012Nuvasive, Inc.Surgical access system and related methods
US820631222 Sep 200626 Jun 2012Nuvasive, Inc.Multi-channel stimulation threshold detection algorithm for use in neurophysiology monitoring
US82214397 Feb 200817 Jul 2012Ethicon Endo-Surgery, Inc.Powering implantable restriction systems using kinetic motion
US82339956 Mar 200831 Jul 2012Ethicon Endo-Surgery, Inc.System and method of aligning an implantable antenna
US824434323 Aug 201114 Aug 2012Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US82550442 Feb 201028 Aug 2012Nuvasive, Inc.System and methods for performing dynamic pedicle integrity assessments
US8255045 *3 Apr 200828 Aug 2012Nuvasive, Inc.Neurophysiologic monitoring system
US826574416 Aug 201111 Sep 2012Nuvasive, Inc.Systems and methods for performing surgical procedures and assessments
US828759716 Apr 201016 Oct 2012Nuvasive, Inc.Method and apparatus for performing spine surgery
US830349818 Feb 20116 Nov 2012Nuvasive, Inc.Surgical access system and related methods
US830351511 Dec 20096 Nov 2012Nuvasive, Inc.Surgical access system and related methods
US831343011 Jan 200720 Nov 2012Nuvasive, Inc.Surgical access system and related methods
US832885128 Jul 200611 Dec 2012Nuvasive, Inc.Total disc replacement system and related methods
US833738928 Jan 200825 Dec 2012Ethicon Endo-Surgery, Inc.Methods and devices for diagnosing performance of a gastric restriction system
US834304612 Mar 20121 Jan 2013Nuvasive, Inc.Surgical access system and related methods
US835578020 Nov 200915 Jan 2013Nuvasive, Inc.Surgical access system and related methods
US837707927 Dec 200719 Feb 2013Ethicon Endo-Surgery, Inc.Constant force mechanisms for regulating restriction devices
US838852731 Dec 20095 Mar 2013Nuvasive, Inc.Surgical access system and related method
US840384114 Dec 200926 Mar 2013Nuvasive, Inc.Surgical access system and related methods
US842543010 Dec 200923 Apr 2013Warsaw Orthopedic, Inc.Electrically insulated surgical needle assembly
US84398324 Jan 201114 May 2013Nuvasive, Inc.Surgical access system and related methods
US850063417 Jan 20136 Aug 2013Nuvasive, Inc.Surgical access system and related methods
US850065326 Jun 20126 Aug 2013Nuvasive, Inc.Neurophysiology monitoring system configured for rapid stimulation threshold acquisition
US85122351 Jun 201220 Aug 2013Nuvasive, Inc.Surgical access system and related methods
US85237688 May 20123 Sep 2013Nuvasive, Inc.Surgical access system and related methods
US85485797 Aug 20121 Oct 2013Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US85509945 Nov 20128 Oct 2013Nuvasive, Inc.Surgical access system and related methods
US855680815 Jan 201315 Oct 2013Nuvasive, Inc.Surgical access system and related methods
US85625211 Feb 201322 Oct 2013Nuvasive, Inc.Surgical access system and related methods
US856253921 Aug 200722 Oct 2013Nuvasive, Inc.Electromyography system
US856831727 Sep 200629 Oct 2013Nuvasive, Inc.System and methods for nerve monitoring
US85683312 Feb 200629 Oct 2013Nuvasive, Inc.System and methods for monitoring during anterior surgery
US859139528 Jan 200826 Nov 2013Ethicon Endo-Surgery, Inc.Gastric restriction device data handling devices and methods
US85914323 Jan 201126 Nov 2013Nuvasive, Inc.Surgical access system and related methods
US859153212 Feb 200826 Nov 2013Ethicon Endo-Sugery, Inc.Automatically adjusting band system
US86029824 Apr 201310 Dec 2013Nuvasive, Inc.Surgical access system and related methods
US862846930 Jul 201314 Jan 2014Nuvasive, Inc.Surgical access system and related methods
US86349048 Nov 201121 Jan 2014Nuvasive, Inc.System and methods for determining nerve proximity, direction, and pathology during surgery
US86521403 Jan 201218 Feb 2014Warsaw Orthopedic, Inc.Device and method for operating a tool relative to bone tissue and detecting neural elements
US86631004 Sep 20134 Mar 2014Nuvasive, Inc.Surgical access system and related methods
US86728408 May 201218 Mar 2014Nuvasive, Inc.Surgical access system and related methods
US86790061 Feb 201325 Mar 2014Nuvasive, Inc.Surgical access system and related methods
US86965591 Feb 201315 Apr 2014Nuvasive, Inc.Surgical access system and related methods
US87088991 Feb 201329 Apr 2014Nuvasive, Inc.Surgical access system and related methods
US873812311 Feb 201327 May 2014Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US874078320 Jul 20063 Jun 2014Nuvasive, Inc.System and methods for performing neurophysiologic assessments with pressure monitoring
US87473074 Sep 201310 Jun 2014Nuvasive, Inc.Surgical access system and related methods
US875327031 Jul 201317 Jun 2014Nuvasive, Inc.Surgical access system and related methods
US875327113 Jan 201417 Jun 2014Nuvasive, Inc.Surgical access system and related methods
US876464911 Oct 20131 Jul 2014Nuvasive, Inc.Surgical access system and related methods
US87684508 Feb 20131 Jul 2014Nuvasive, Inc.System and methods for performing surgical procedures and assessments
US87904062 Apr 201229 Jul 2014William D. SmithSystems and methods for performing spine surgery
US88121167 May 201219 Aug 2014Nuvasive, Inc.System and methods for determining nerve proximity, direction, and pathology during surgery
US88213969 Jun 20142 Sep 2014Nuvasive, Inc.Surgical access system and related methods
US882790020 Nov 20129 Sep 2014Nuvasive, Inc.Surgical access system and related methods
US887074228 Feb 200828 Oct 2014Ethicon Endo-Surgery, Inc.GUI for an implantable restriction device and a data logger
US887096011 Dec 201228 Oct 2014Nuvasive, Inc.Total disc replacement system and related methods
US891584618 Apr 201323 Dec 2014Nuvasive, Inc.Surgical access system and related methods
US892050016 Oct 201230 Dec 2014Nuvasive, Inc.Methods and apparatus for performing spine surgery
US89428019 Jun 201427 Jan 2015Nuvasive, Inc.Surgical access system and related methods
US89450041 Aug 20143 Feb 2015Nuvasive, Inc.Surgical access system and related methods
US89562833 Mar 201417 Feb 2015Nuvasive, Inc.Surgical access system and related methods
US897735215 May 201410 Mar 2015Nuvasive, Inc.Systems and methods for performing surgical procedures and assessments
US901477616 Jul 201321 Apr 2015Nuvasive, Inc.Surgical access and nerve surveillance
US903725014 Feb 201319 May 2015Nuvasive, Inc.System and methods for determining nerve proximity, direction and pathology during surgery
US913194723 Jan 200915 Sep 2015Nuvasive, Inc.Neurophysiological apparatus and procedures
US916814928 Oct 201427 Oct 2015NaVasive, Inc.Total disc replacement system and related methods
US919248219 Dec 201424 Nov 2015Nuvasive, Inc.Methods and apparatus for performing spine surgery
US919876531 Oct 20121 Dec 2015Nuvasive, Inc.Expandable spinal fusion implants and related methods
US920487116 Jan 20158 Dec 2015Nuvasive, Inc.Surgical access system and related methods
US926549316 Jan 201523 Feb 2016Nuvasive, Inc.Surgical access system and related methods
US929539628 Aug 201229 Mar 2016Nuvasive, Inc.Neurophysiologic monitoring system
US930174327 May 20145 Apr 2016Nuvasive, Inc.Surgical access system and related methods
US931415229 Oct 201319 Apr 2016Nuvasive, Inc.Surgical access system and related methods
US935184531 Mar 201131 May 2016Nuvasive, Inc.Method and apparatus for performing spine surgery
US939295319 Sep 201119 Jul 2016Nuvasive, Inc.Neurophysiologic monitoring
US945678315 Apr 20154 Oct 2016Nuvasive, Inc.System and methods for determining nerve proximity, direction and pathology during surgery
US94684053 Feb 201418 Oct 2016Nuvasive, Inc.Surgical access system and related methods
US95725624 Dec 201521 Feb 2017Nuvasive, Inc.Surgical access system and related methods
US961007115 Jan 20154 Apr 2017Nuvasive, Inc.Surgical access system and related methods
US961017127 Oct 20154 Apr 2017Nuvasive, Inc.Total disc replacement system and related methods
US962273211 Oct 200518 Apr 2017Nuvasive, Inc.Surgical access system and related methods
US965574420 Oct 201523 May 2017Nuvasive, Inc.Expandable spinal fusion implants and related methods
US968188023 Oct 201320 Jun 2017Warsaw Orthopedic, Inc.Device and method for operating a tool relative to bone tissue and detecting neural elements
US974385313 Feb 201529 Aug 2017Nuvasive, Inc.Electromyography system
US975049028 Apr 20145 Sep 2017Nuvasive, Inc.Surgical access system and related methods
US975706714 Mar 201312 Sep 2017Nuvasive, Inc.Systems and methods for performing neurophysiologic monitoring during spine surgery
US975707211 Feb 201412 Sep 2017Nuvasive, Inc.Waveform marker placement algorithm for use in neurophysiologic monitoring
US975724620 Oct 201512 Sep 2017Nuvasive, Inc.Methods and apparatus for performing spine surgery
US978882213 Jan 201617 Oct 2017Nuvasive, Inc.Surgical access system and related methods
US97953711 Mar 201624 Oct 2017Nuvasive, Inc.Surgical access system and related methods
US981440214 Feb 201414 Nov 2017Acacia Designs BvElectrode systems for use with medical monitoring systems
US20030045808 *16 Oct 20026 Mar 2003Nuvasive, Inc.Nerve proximity and status detection system and method
US20030105503 *31 Dec 20025 Jun 2003Nuvasive, Inc.Relative nerve movement and status detection system and method
US20030195405 *7 May 200316 Oct 2003Nuvasive, Inc.Nerve surveillance cannulae systems
US20040024299 *1 Apr 20035 Feb 2004Grace Lawrence J.Method and apparatus for self-diagnostic evaluation of nerve sensory latency
US20040199084 *21 Apr 20047 Oct 2004Nuvasive, Inc.Electromyography system
US20040225228 *10 May 200411 Nov 2004Ferree Bret A.Neurophysiological apparatus and procedures
US20050075578 *25 Mar 20047 Apr 2005James GharibSystem and methods for performing surgical procedures and assessments
US20050149035 *18 Oct 20047 Jul 2005Nuvasive, Inc.Surgical access system and related methods
US20050182454 *9 Jan 200418 Aug 2005Nuvasive, Inc.System and methods for determining nerve proximity, direction, and pathology during surgery
US20060025703 *18 Feb 20052 Feb 2006Nuvasive, Inc.System and methods for performing dynamic pedicle integrity assessments
US20060069315 *25 May 200530 Mar 2006Patrick MilesSurgical access system and related methods
US20060173374 *31 Jan 20053 Aug 2006Neubardt Seth LElectrically insulated surgical probing tool
US20060173521 *31 Jan 20053 Aug 2006Pond John D JrElectrically insulated surgical needle assembly
US20060178593 *7 Feb 200510 Aug 2006Neubardt Seth LDevice and method for operating a tool relative to bone tissue and detecting neural elements
US20060178594 *7 Feb 200510 Aug 2006Neubardt Seth LApparatus and method for locating defects in bone tissue
US20060200023 *4 Mar 20057 Sep 2006Sdgi Holdings, Inc.Instruments and methods for nerve monitoring in spinal surgical procedures
US20060211912 *7 Mar 200621 Sep 2006Dlugos Daniel FExternal pressure-based gastric band adjustment system and method
US20060224078 *23 May 20065 Oct 2006Nuvasive, Inc.Tissue discrimination and applications in medical procedures
US20070016097 *15 Jul 200518 Jan 2007Nuvasive, Inc.System and methods for determining nerve direction to a surgical instrument
US20070021682 *20 Jul 200625 Jan 2007Nuvasive Inc.System and methods for performing neurophysiologic assessments with pressure monitoring
US20070293782 *21 Aug 200720 Dec 2007Nu Vasive, Inc.Electromyography system
US20080015406 *29 Jan 200717 Jan 2008Dlugos Daniel FExternal Mechanical Pressure Sensor for Gastric Band Pressure Measurements
US20080058606 *8 Oct 20036 Mar 2008Nuvasive, Inc.Surgical access system and related methods
US20080058837 *30 Oct 20076 Mar 2008Active Implants CorporationMethod and apparatus for computerized surgery
US20080065144 *31 Oct 200713 Mar 2008Marino James FNerve surveillance cannulae systems
US20080065178 *31 Oct 200713 Mar 2008Nuvasive, Inc.Electromyography system
US20080071191 *31 Oct 200720 Mar 2008Nuvasive, Inc.Electromyography system
US20080097164 *16 Jan 200424 Apr 2008Nuvasive, Inc.Surgical access system and related methods
US20080167574 *22 Sep 200610 Jul 2008Allen FarquharMulti-Channel Stimulation Threshold Detection Algorithm For Use In Neurophysiology Monitoring
US20080249806 *28 Feb 20089 Oct 2008Ethicon Endo-Surgery, IncData Analysis for an Implantable Restriction Device and a Data Logger
US20080250340 *28 Feb 20089 Oct 2008Ethicon Endo-Surgery, Inc.GUI for an Implantable Restriction Device and a Data Logger
US20080250341 *28 Feb 20089 Oct 2008Ethicon Endo-Surgery, Inc.Gui With Trend Analysis for an Implantable Restriction Device and a Data Logger
US20090054804 *3 Apr 200826 Feb 2009Nuvasive Inc.Neurophysiologic monitoring system
US20090105604 *2 Feb 200623 Apr 2009Nuvasive, Inc.System and Methods for Monitoring During Anterior Surgery
US20090124860 *27 Feb 200414 May 2009Nuvasive, Inc.Surgical access system and related methods
US20090149874 *10 Dec 200711 Jun 2009Ethicon Endo-Surgery. Inc.Methods for implanting a gastric restriction device
US20090171375 *27 Dec 20072 Jul 2009Ethicon Endo-Surgery, Inc.Controlling pressure in adjustable restriction devices
US20090171379 *27 Dec 20072 Jul 2009Ethicon Endo-Surgery, Inc.Fluid logic for regulating restriction devices
US20090192403 *14 Apr 200930 Jul 2009Nuvasive, Inc.System And Methods For Performing Surgical Procedures and Assessments
US20090192534 *29 Jan 200830 Jul 2009Ethicon Endo-Surgery, Inc.Sensor trigger
US20090202387 *8 Feb 200813 Aug 2009Ethicon Endo-Surgery, Inc.System and method of sterilizing an implantable medical device
US20090204016 *20 Apr 200913 Aug 2009Nuvasive, Inc.System And Methods For Performing Surgical Procedures and Assessments
US20090204131 *12 Feb 200813 Aug 2009Ethicon Endo-Surgery, Inc.Automatically adjusting band system with mems pump
US20090204141 *7 Feb 200813 Aug 2009Ethicon Endo-Surgery, Inc.Powering implantable restriction systems using kinetic motion
US20090204179 *7 Feb 200813 Aug 2009Ethicon Endo-Surgery, Inc.Powering implantable restriction systems using temperature
US20090209879 *1 May 200920 Aug 2009Nuvasive, Inc.System and Methods for Determining Nerve Proximity, Direction, and Pathology During Surgery
US20090216255 *26 Feb 200827 Aug 2009Ethicon Endo-Surgery, Inc.Controlling pressure in adjustable restriction devices
US20090222065 *28 Feb 20083 Sep 2009Ethicon Endo-Surgery, Inc.Physiological Parameter Analysis for an Implantable Restriction Device and a Data Logger
US20090228028 *6 Mar 200810 Sep 2009Ethicon Endo-Surgery, Inc.Reorientation port
US20090228063 *6 Mar 200810 Sep 2009Ethicon Endo-Surgery, Inc.System and method of communicating with an implantable antenna
US20090228072 *6 Mar 200810 Sep 2009Ethicon Endo-Surgery, Inc.System and method of aligning an implantable antenna
US20090259108 *22 Apr 200915 Oct 2009Nuvasive, Inc.Surgical Access System and Related Methods
US20090299439 *2 Jun 20083 Dec 2009Warsaw Orthopedic, Inc.Method, system and tool for surgical procedures
US20100049081 *29 Oct 200925 Feb 2010Nuvasive, Inc.Tissue Discrimination and Applications in Medical Procedures
US20100069783 *20 Nov 200918 Mar 2010Nuvasive, Inc.Surgical access system and related methods
US20100076335 *1 Dec 200925 Mar 2010James GharibSystem and Methods for Performing Surgical Procedures and Assessments
US20100094093 *10 Dec 200915 Apr 2010Nuvasive, Inc.Surgical Access System and Related Methods
US20100105986 *30 Dec 200929 Apr 2010Nuvasive, Inc.Surgical Access System and Related Methods
US20100105987 *31 Dec 200929 Apr 2010Nuvasive, Inc.Surgical access system and related method
US20100113884 *30 Dec 20096 May 2010Patrick MilesSurgical Access System and Related Methods
US20100130827 *11 Dec 200927 May 2010Nuvasive, Inc.Surgical access system and related methods
US20100137690 *30 Dec 20093 Jun 2010Nuvasive, Inc.Surgical access system and related methods
US20100152604 *24 Feb 201017 Jun 2010Nuvasive, Inc.System and methods for determining nerve proximity, direction, and pathology during surgery
US20100160738 *14 Dec 200924 Jun 2010Nuvasive, Inc.Surgical access system and related methods
US20100174146 *30 Dec 20098 Jul 2010Patrick MilesSurgical access system and related methods
US20100249644 *2 Feb 201030 Sep 2010Patrick MilesSystem and Methods for Performing Dynamic Pedicle Integrity Assessements
US20100256517 *15 Jun 20107 Oct 2010Neubardt Seth LElectrically insulated surgical probing tool
US20100286784 *28 Jul 200611 Nov 2010Matthew CurranTotal disc replacement system and related methods
US20100317989 *16 Jun 201016 Dec 2010Nuvasive Inc.Systems and Methods for Performing Neurophysiologic Assesments With Pressure Monitoring
US20110098535 *3 Jan 201128 Apr 2011Nuvasive, Inc.Surgical access system and related methods
US20110144439 *18 Feb 201116 Jun 2011Nuvasive, Inc.Surgical access system and related methods
US20110196210 *4 Jan 201111 Aug 2011Nuvasive, Inc.Surgical access system and related methods
USRE44049 *6 Nov 20035 Mar 2013Garrett D. HerzonBipolar handheld nerve locator and evaluator
EP0025222A2 *4 Sep 198018 Mar 1981The Regents Of The University Of CaliforniaApparatus for monitoring neuromuscular transmission
EP0025222A3 *4 Sep 19806 May 1981The Regents Of The University Of CaliforniaApparatus for monitoring neuromuscular transmission and method of monitoring neuromuscular blockage
WO1986006965A1 *19 May 19864 Dec 1986Survival Technology, Inc.Injection method and apparatus with electrical blood absorbing stimulation
WO1999053996A1 *16 Apr 199928 Oct 1999Stryker InstrumentsNeuromuscular electrical stimulation for preventing deep vein thrombosis
Classifications
U.S. Classification600/554, 331/111, 607/48, 600/595, 607/74, 600/546
International ClassificationA61N1/34, A61N1/36, A61B5/11, A61B5/05
Cooperative ClassificationA61B5/05, A61N1/36021, A61B5/1106
European ClassificationA61N1/36E, A61N1/36E4, A61N1/36E2, A61N1/36, A61B5/05, A61B5/11H4