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WORKSTATION
MODERATORS:
DR.B.SOWBHAGYA LAKSHMI,MD
PROFESSOR IN DEPT. OF ANAESTHESIOLOGY
DR.KRISHNA PRASAD,MD
ASSISTANT PROFESSOR
PRESENTED BY
DR.SIRISHA ANAPARTHI
PG IN ANAESTHESIOLOGY
The anaesthesia
machine is a device
which delivers a
precisely-known but
variable gas mixture,
including anaesthetizing
and life-sustaining
gases.
HISTORY
The original concept of Boyle's machine was
invented by the British anaesthetist H.E.G. Boyle
in 1917. Prior to this time, anaesthetists often
carried all their equipment with them, but the
development of heavy, bulky cylinder storage and
increasingly elaborate airway equipment meant
that this was no longer practical for most
circumstances. The anaesthetic machine is
usually mounted on anti-static wheels for
convenient transportation.
HISTORY :
1917 Boyle machine with a water sight
feed type of flowmeter is introduced by
Henry Edmund Gaskin Boyle.
1920 A vapourizing bottle is incorporated
to the machine.
1926 A 2nd vaporizing bottle and by-pass
controls are incorporated.
1930 A Plunger device is added to the
vaporizing bottle.
1933 A dry-bobbin type of flowmeter is
introduced.
1937 Rotameters displayed dry-bobbin
type of flowmeters
Anesthetic Machines
Anesthetic machines began appearing at the end of the 19th century
Early anesthetic machines were utilized in dental anesthesia for
administration of N2O and O2
Initial machines were either:
Continuous flow continuous flow throughout inspiration and
expiration (eg. Heidbrink, Foregger, Boyle)
Intermittent flow flow of gas during inspiration only (eg.
McKesson)
Machines evolved to incorporate reducing valves, flow meters,
vaporizers and circuits with carbon dioxide absorption
116a, 117
23
Waters Cannisters
(Waters to and fro) c. 1930
Ralph M Waters began experiments with CO2
absorption in 1915
Developed to and fro system through
which inspired and expired gases were
directed
Metal cylinder was packed with absorbent
alkaline granules resulting in economy of
gas use along with heat and moisture
conservation
109 a-c
119
Heidbrink Apparatus
(mixing head only) c. 1930
Modification of Dentist Jay
Heidbrinks original apparatus
introduced in 1912 for administration
of N2O and O2 primarily for dental
anaesthesia
Proportioning device and valves
reduced cylinder pressure of tank
gases to working pressures
143
118
OUTLINE
The Machine
Gas Supply Systems:
Hospital pipeline
Cylinder
High Pressure System (exposed to cylinder pressure)
Intermediate Pressure System (exposed to pipeline press)
Low Pressure System (distal to flowmeter needle valve)
Circle System
CO2 Absorber System
Unidirectional Valves
Ventilator
Scavenger System
The Machine
Ohmeda
N.A.Drager (Narkomed)
Anesthesia Machine:
Jackson Memorial Hospital
ventilator
Flow
meter
bellow
vaporizer
APL valve
Corrugated
tube
Soda lime
Scavenging
system
Basic Schematics
Intermediate
PNEUMATIC SYSTEM
1. HIGH PRESSURE
a. Hanger Yoke
b. Power Failure Indicator
c. Pressure Regulators
2. INTERMEDIATE PRESSURE SYSTEM
a. Master Switch (Pneumatic
component)
b. Pipeline Inlet Connections
c. Pipeline Pressure Indicators
d. Piping
e. Gas Power Outlet
f. Oxygen Pressure Failure Devices
g. Gas Selector Switch
h. Second-Stage Pressure Regulator
i. Oxygen Flush
j. Flow Adjustment Control
Pipeline Trouble
Pipeline sources are not trouble free:
contamination (particles, bacteria, viral,
moisture), inadequate pressure, excessive
pressures, and accidental crossover (switch
between oxygen and some other gas such as
nitrous oxide or nitrogen) are all reported.
DISS
Pipeline inlets are connected with DISS
(diameter index safety system) noninterchangeable connections.
The check valve, located down stream
from the pipeline inlet, prevents reverse
flow of gases (from machine to pipeline,
or to atmosphere), which allows use of
the gas machine when pipeline gas
sources are unavailable.
PISS
Diagram showing
the index positions
of a cylinder valve.
Oxygen: 2 & 5
Nitrous oxide: 3 & 5
Air: 1 & 5
CO2: 1 & 6
Body colour
Shoulder colour
Pressure (kPa)
(At room temp)
Oxygen
Black
White
13700
Nitrous Oxide
Blue
Blue
4400
Carbon dioxide
Grey
Grey
5000
Air
Grey
White/black
quarters
13700
Entonox
Blue
White/blue quarters
13700
Oxygen/helium
Black
White/brown
quarters
13700
LAPSE IN MAINTENANCE
Sudbury Ontario in the 1970s: 23 people died
because the N20 and O2 pipelines were crossed
over during repairs
O2 2,5
N2O 3,5
Check Valve
minimize transfilling
allows change of
cylinders during use
minimize leaks to
atmosphere if a
yoke is empty.
CHECK VALVES
Check Valve
CYLINDERS
The cylinder pressure regulator converts high,
variable cylinder pressure to a constant pressure
of approximately 45 psi downstream of the
regulator.
This is intentionally slightly less than pipeline
pressure, to prevent silent depletion of cylinder
contents if a cylinder is inadvertently left open
after checking its pressure.
Cylinder pressure gauge indicates pressure in the
higher-pressure cylinder only (if two are opened
simultaneously).
Anesthesia Components
Anesthesia Machine
Frame
Regulator
Placed on O2 tanks to decrease pressure from
tank
2 types of tanks
E Tanks
650L @ 1800PSI
H Tanks
7100L @ 2200PSI
Output pressure
adjusted with knob
E cylinder Characteristics
Gas US (International)
O2
N2O
Air
Green (white)
Blue
(blue)
Yellow (B & W)
PSI
Capacity (L)
PISS
1900
745
1900
660
1590
625
2-5
3-5
1-5
EXAMPLE
If cylinder gauge reads 1,000 psig, this represents
(1000/2000) X 660 = 330 L left in that tank. The rate of
consumption of O2 during mechanical ventilation is the
sum of the O2 flow meter setting and the patients
minute ventilation (VT in L x RR in breaths/min).
If FGF is 0.5 L/min O2 and 1.0 L/min N2O and VT is 0.7
L and RR is 10 bpm, then the minute ventilation is
7 L/min (0.7L x 10 bpm)
* The total O2 consumption is 7.5 L/min. The expected
time to exhaustion is thus approximately 330 L divided
by 7.5 L/min = 44 min (ignoring the gas sampled by the
gas analyzer and leaks)
Hospital Pipeline
Inlets
Contd.
These devices prevent hypoxia from some
problems occurring upstream in the machine
circuit (disconnected oxygen hose, low oxygen
pressure in the pipeline and depletion of the
oxygen cylinder)
Equipment problems that occur downstream
(for example leaks or partial closure of the
oxygen flow control valve) are not prevented by
these devices.
Flowmeters
-Thorpe tube is an older term for flowmeters.
-Components: needle valve, indicator float, knobs, valve
stops.
-Flow increases when the knob is turned counterclockwise
(same as vaporizers).
-At low flows, the annular-shaped orifice around the float is
(relatively) tubular so (according to Poiseuille's Law) flow is
governed by viscosity. (laminar flow)
-At high flows (indicated on the wider top part of the float
tube), the annular opening is more like an orifice, and
density governs flows. (turbulent flow)
FLOW
1) rotometers
2) non-rotating floats
3) ball floats
Sequence of flowmeters tubes is very important
to decrease chance of hypoxic mixture.,
Gas flow is from left to right, O2 on right side.
Any leak in flowmeters will vent other gas out or
entrain air before O2 is added to gas mixture decreasing
chance that O2 will be lost or diluted.
Flowmeter assembly
When the flow control valve is
opened the gas enters at the
bottom and flows up the tube
elevating the indicator
The indicator floats freely at a
point where the downward
force on it (gravity) equals the
upward force caused by gas
molecules hitting the bottom
of the float
CONTD.
Needle valve can be damaged if it is closed
with force
Flowtube (Thorpe tube) is tapered (narrower
at bottom) and gas-specific
If gas has 2 tubes, they are connected in series
with a single control valve
CONTD
Care of flowmeters includes ensuring that:
floats spin freely
qualified service personnel regularly maintain gas
machines
an O2 analyzer used always (of course, the readings are
erroneous during use of nasal cannula)
one never adjusts a flowmeter without looking at it
one includes flowmeters in visual monitoring sweeps
one turns flowmeters off before opening cylinders,
connecting pipelines, or turning machine "on".
Proportioning Systems
Mechanical integration
of the N2O and O2
flow-control valves
Automatically
intercedes to maintain a
minimum 25%
concentration of oxygen
with a maximum
N2O:O2 ratio of 3:1
Safety in flowmeter
subassembly
Each flowmeter is housed in an
independent, colour coded pin specific
module
Oxygen flowmeter is placed downstream
Backpressure check valve
Link device
Backlight display
VAPORIZERS
Vapor Pressure (VP) Molecules escape from a
volatile liquid to the vapor phase, creating a
saturated vapor pressure at equilibrium
VP is independent of Atmospheric Press
VP increases with Temperature
VP depends ONLY on the Physical Characteristics of
the Liquid & on its Temperature
CLASSIFICATION
Variable bypass
Fresh gas flow from the flowmeters enters the
inlet of any vaporizer which is on. The
concentration control dial setting splits this stream
into bypass gas (which does not enter the
vaporizing chamber), and carrier gas (also called
chamber flow, which flows over the liquid agent)
CLASSIFICATION
Flow over
Carrier gas flows over the surface of the liquid
volatile agent in the vaporizing chamber (as
opposed to bubbling up through it (as in the
copper kettle and Vernitrol)
CLASSIFICATION
Temperature compensated
Equipped with automatic devices that ensure steady
vaporizer output over a wide range of ambient
temperatures
Agent-specific
Only calibrated for a single gas, usually with keyed
fillers that decrease the likelihood of filling the
vaporizer with the wrong agent
Out of circuit
As opposed to (much) older models such as the Ohio
#8 (Boyle's bottle) which were inserted within the
circle system.
Circle System
Circle System- CO2 absorber housing and absorber, unidirectional valves,
inspiratory and expiratory ports, fresh gas inlet, APL valve, pressure gauge,
breathing tubes, Y-piece, reservoir bag, bag/vent switch selector, respiratory gas
monitor sensor.
Circle System
CO2 Absorber System: Housing (canister support), Absorbent, baffles, side tube
Unidirectional Valves-aka Flutter valves, one way valves, check valves, directional valves,
dome valves
Canister-Air space 50%, void space 42%, pore space 8%
Soda Lime: 4% Sodium Hydroxide, 1% potassium hydroxide, 14-19% H2O,
and calcium hydroxide to make 100%,
Silica and kielselguhr for hardness
Indicator for color change with exhaustion of CO2 absorption capabilities
CO2+H2OH2CO3
2NaOH+2H2CO3+Ca(OH)2 CaCO3+NaCO3+4H2O
heat released 13,700 cal./mole CO2 absorbed
Barium Hydroxide Lime: 20% Barium hydroxide, 80% calcium hydroxide,
and +/- potassium hydroxide,
Indicator for color change with exhaustion of CO2 absorption capabilities
Ba(OH)2 . 8H2O+CO2BaCO3+9H2O
9H2O+9CO2 9H2CO3
9H2CO3+9Ca(OH) 2 9CaCO3+18H2O
2KOH+H2CO3 K2CO3+2H2O
Ca(OH)2+K2CO3 CaCO3+2KOH
Regeneration (color change loss) with rest can occur. Appears new but is exhausted
Circle system
canisters unlocked
Circle System
Advantages:
Disadvantages:
Complex design = potential for malfunction
High resistance (multiple one-way valves) = higher
work of breathing
Circle system
Unidirectional Valves
Ohmeda Machine
Narkomed Machine
Ventilator
Ventilator Components: Driving gas supply, injector, controls, alarms,
safety-release valve, bellows assembly, exhaust valve, spill valve,
connection for ventilator hose
Bellows assembly
Ventilator controls
CONTD.
Bernoullis Principle
At constriction:
Flow is higher
Pressure is lower
Ventilator
Bellows Assembly:
Housing- Usually made of hard rigid clear plastic
Bellows; ASCENDING-standing, upright. Compressed downward
during inspiration. ASCEND DURING EXPIRATION
Pressure is always positive. PEEP 2-4 cm H2O.
DESCENDING-hanging, inverted. Compressed upward during
inspiration. DESCEND DURING EXPIRATION. Weight of bellows results in
negative airway pressure during exhalation until bellow refilled.
IMPORTANT difference between ascending and descending is that when there is a major leak
or disconnect, the ascending bellows will collapse (unless prevented by scavenging system).
When a disconnection occurs with a descending bellows system,
the ventilator will continue its upward movement anddownward
movements, drawing in room air and driving gas during its
descent and discharging it during the upward movement.
Gas flow during upward movement may generate enough
pressure such that the low pressure alarm is not activated.
What type is
shown?
Scavenger System
Scavenger System consists of: 1) gas collecting assembly, 2) a transfer
means, 3) the interface, 4) gas disposal tubing, 5) gas disposal assembly.
(some or all components may be combined).
ASTM standard fitting size for scavenger
hoses 19 mm ( international standard 30mm) to prevent incorrect
connection to breathing hoses (22mm).
2
4&5
1
4&5
Scavenging Systems
Protects the breathing
circuit or ventilator
from excessive positive
or negative pressure.
Scavenging Systems
IN A NUTSHELL
ESSENTIAL FEATURES
PURPOSE
CONTD.
Essential features
Purpose
Danger
Unpleasant Surprises
Steps 4-7:
Low Pressure Systems
*4. Check Initial Status of Low Pressure System
a. Close flow control valves and turn vaporizers off.
b. Check fill level and tighten vaporizers' filler caps.
*5. Perform Leak Check of Machine Low Pressure System
a. Verify that the machine master switch and flow control valves are OFF.
b. Attach "Suction Bulb" to common Fresh gas outlet.
c. Squeeze bulb repeatedly until fully collapsed.
d. Verify bulb stays fully collapsed for at least 10 seconds.
e. Open one vaporizer at a time and repeat 'c' and 'd' as above.
f. Remove suction bulb, and reconnect fresh gas hose.
*6. Turn On Machine Master Switch and all other necessary electrical equipment.
*7. Test Flowmeters
a. Adjust flow of all gases through their full range, checking for smooth operation of floats and
undamaged flowtubes.
b. Attempt to create a hypoxic 02/N20 mixture and verify correct changes in flow and/or alarm.
Breathing System
*9. Calibrate 02 Monitor
a. Ensure monitor reads 21% in room air.
b. Verify low 02 alarm is enabled and functioning.
c. Reinstall sensor in circuit and flush breathing system with 02.
d. Verify that monitor now reads greater than 90%.
10. Check Initial Status of Breathing System
a. Set selector switch to "Bag" mode.
b. Check that breathing circuit is complete, undamaged and unobstructed.
c. Verify that C02 absorbent is adequate.
d. Install breathing circuit accessory equipment (e.g. humidifier, PEEP valve) to be used
during the case.
11. Perform Leak Check of the Breathing System
a. Set all gas flows to zero (or minimum).
b. Close APL (pop-off) valve and occlude Y-piece.
c. Pressurize breathing system to about 30 cm H20 with 02 flush.
d. Ensure that pressure remains fixed for at least 10 seconds.
e. Open APL (Pop-off) valve and ensure that pressure decreases.