Basics Of Anesthesia Systems

Front 1

Anesthesia machine
7 components

Back 1

-Pipeline & cyclinder gas supp
-Vaporizers
-CO2 Absorber & gas mang. sys
-Ventilator
-Monitors/display

Front 2

Anesthesia System
What the machine does in respect to the patient.

Back 2

-Supplies set mix of gas & anesthetic vapor
-Controls pt RR, vol,pressures
-Monitor gas conc from mach.
(EtCo2, O2,
-Monitors pt
-safety features protect pt
-removes excess gas from breathing sys.

Front 3

Safety Standards (Boards)

Back 3

-1979 standards set for all mach in US.
-ANSI (American Natl' Standards Inst.)
-Released 1979 standards
-ASTM (Am. Soc. testing & materials)
ASTM F 1850 -Current gas mach standard

Front 4

Gas Supplies

Back 4

Gas cyclinders connected directly to anesth mach
-usually 2nd or emergency
-Central pipeline sys connect to wall & ceiling outlet

Front 5

Gas Cylinders

Back 5

-Compressed gas, high press gas or liquid
-Gauge (psig or kPa)
psig (pounds per sq in. should have min of 1000 psig)
-Tested q 5yrs at 1.66 capacity/over pressure

Front 6

Cyclinders

Back 6

-Regulators (reduce press)
-Cyclinder pres/vol E tank
(E= 2200 PSI)
-stored securely
-support violent burning flammable materials

Front 7

Central Pipeline Sys.
-Primary gas supply for anest sys

Back 7

-Tanks of liquid gas or large cylinders supply gas to central sys.

Front 8

Central Pipeline Sys. Standards psig for O2

Back 8

45--55

Front 9

Central Pipeline Sys.
-Manifold automactically switches when

Back 9

one bank is empty

Front 10

Central Pipeline Sys.
What is the safety mech of the sys

Back 10

includes sensors wired to alarm sys

Front 11

Safety sys
Color Coding Pin indexing
for tanks
O2 (Color & Pin #)

Back 11

Green 2-5

Front 12

Safety sys
Color Coding/Pin indexing for tanks
NO2 (Color & Pin #)

Back 12

Blue 3,5

Front 13

Safety sys
Color Coding/Pin indexing for tanks
Air (Color & Pin #)

Back 13

Yellow 1,5

Front 14

Safety sys
Diameter indexing - Pipeline

Back 14

Fitting for each gas has diff diameter

Front 15

Anest Systems
When O2 wall supply is connect to pipline inlet or cyclinder
Where is O2 always avail ?

Back 15

pneumatic outlets
Oxygen flush valve

Front 16

5 Pathways of Oxygen

Back 16

-Flowmetes
-Oxygen flush
-Fail-Safe system
-Low pressure alarms
-Vent driving gas

Front 17

On/Off Settings
ON
Oxygen press connects to

Back 17

low oxygen supply alarm & shutoff valves

Front 18

On/Off Settings
ON
O2 press opens shutoff valves
-

Back 18

premits flow of other gases to their flow control assemblies

Front 19

On/Off Settings
ON
O2 & secondary gases flow through

Back 19

flowmeters at the set flow rates

Front 20

On/Off Settings
ON
Mixed gas flows through vaporizer manifold
Where does it go?

Back 20

thru the vaporizer that is on and to common gas outlet.

Front 21

On/Off Settings
System Off
-Remaining gas vents downstream thru.

Back 21

exhaust blk

Front 22

On/Off Settings
System Off
Low oxygen supply

Back 22

alarm is activated

Front 23

On/Off Settings
System Off
All shutoff valves are

Back 23

closed

Front 24

On/Off Settings
System Off
Cuts off elec power to

Back 24

monitors & vent

Front 25

O2 Flush can deliver how much O2?

Back 25

35-70L of 100% O2

Front 26

Ventilator is driven by?

Back 26

Flow of O2

Front 27

Gas Supply module
enters on what section of the machine

Back 27

High press.

Front 28

Gas Supply module
A gas supply module includes

Back 28

Pipeline branch
Cyclinder Branch
Press Gauges for pipeln & cyclinder supplies

Front 29

Pipeline gases go thru

Back 29

Pipeline Inlet (gas in)
Inlet filter
Pressure gauge (prevent leak backward)
Check valve

Front 30

Cyclinder Gas goes thru

Back 30

-Cyclinder yoke
-inlet filter
-press gauge
-check valve
-high press regulator

Front 31

Cyclinder Gas goes thru
A pressure relief valve vents to atmosphere if pipln press or reg cyclinder is

Back 31

too high

Front 32

The pipeline PSI =

Back 32

50 psi

Front 33

Pipeline & cyclinder gauges

Back 33

-Two supply pressures
-located after the inlet (O2, Air, N2O) filters/bef check valves
-color coded

Front 34

Bourdon Pressure gauges
Press inc. tube straightens if you up cyclinder too fast it can

Back 34

Break

Front 35

Primary Regulator
Cyclinders (psig)

Back 35

40-47 psig

Front 36

Primary Regulator
Pipeline psig

Back 36

45-55 psig

Front 37

Primary Regulator
What is the purpose

Back 37

Ensures check valve connect to higher pipeline supply

Front 38

Pipeline relief valve
IF press >

Back 38

>75psig

Front 39

Pipeline relief valve
IF press > 75psig
What happens?

Back 39

P relief valve opens & vents gas to atomsphere

Front 40

oxygen flush button
How much O2 does it deliver

Back 40

45-75 L/min 100% FiO2
-Flows direct to common gas outlet
-Works even when mach. off

Front 41

When might you want to use O2 flush button

Back 41

Prior to turning Pt for back surg. (Pt disconnected) can dilute anesth and inc chance of recall can occur

Front 42

Low oxygen supply alarm
-What areas does it include

Back 42

Warns low press. O2 press
-reservoir
-regulator
-reed
-adjustable flow regulator

Front 43

Shut off valve
Where is it located?

Back 43

-Between an additionl gas supply & a flow control valve

Front 44

Shut off valve
When is gases other O2 able to flow

Back 44

IF there is sufficient oxygen pressure present at valve (25 psi)

Front 45

Shut off valve
What happens if oxygen supply is too low

Back 45

the valve closes & blks the flow of any additional gas

Front 46

Flow control assembly
Manages mixture of gases (flowmeters) Includes

Back 46

-2nd regulators
-flow cont knobs
-flow cont needle valves
-link 25 proportion limiting cont sys
-flow tubes (thrope tubes, constant press variable vol tubes)

Front 47

Link 25 proportion limiting control system
The N2O gear has a __ pin
the O2 has a ___ pin Why?

Back 47

N20 = 14
O2= 29
This does not allow you to give hypoxic mix (3:1 = 25% usual = 30%)

Front 48

Link 25 proportion limiting control sys
Flow controls for O2 & N2O linked by link 25 system changes N2O:O2 flow 3:1
Maintains what % O2

Back 48

25% Oxygen

Front 49

Flowtube assembly
Low & High flow tubes

Back 49

-low flow measured
-placed @ right (o2 always downstream from other gases)

Front 50

Flowtube assembly
-When flow control valve on gas flow through the flow tube into

Back 50

the gas distribution manifold
(least chance of leak, this is why O2 is far right)

Front 51

Flowtube assembly
Where to read a Ball &
Float

Back 51

Center
Float is read at the top

Front 52

When doing a high pressure test what should be off

Back 52

gas flows

Front 53

Air, gases mix @ top of the

Back 53

manifold

Front 54

Vaporizer manifold
Gas flows from gas distribution manifold into

Back 54

vaporizer manifold to the right of the flow meter module

Front 55

Vaporizer manifold
Vaporizer manifold & connection sys form an interlock, what is the purpose

Back 55

Only allows having one vaporizer on at a time
A bar slides over to prevent other vaporizers from being on.
-Hold 3 vaporizers

Front 56

Vaporizer manifold
When the vaporizer is off each port valve is closed by a

Back 56

ball pressed against its seat

Front 57

Vaporizer manifold
Turned on
Port valves pressed open by

Back 57

pins on the vaporizer

Front 58

Vaporizer manifold
What prevents leaks in the vaporizer

Back 58

O-ring prevents leaks

Front 59

Vaporizer manifold
Turned on

Back 59

Fresh gas flows into vaporizer
agent is added
mix flow from vaporizer thru outlet port valve to common gas outlet

Front 60

Tec 4 Vaporizer
holds, specifics about vaporizer

Back 60

125 ml
-Glass tube volume
-one for each agent
-color coded by agent
-safety lock lever

Front 61

Tec 6 Vaporizer

Back 61

Used for desflurane
-holds 400ml
-0-18%

Front 62

Tec 6 Vaporizer
-maintains agent vapor from control valve & fresh gas at the same pressure when they are

Back 62

mixed in the rotary control valve

Front 63

Tec 6 Vaporizer
What measures pressures

Back 63

transducers
-adjust control valve to regulate downstream vapor pressure

Front 64

Problem solving

Back 64

-Incorrect filling
(service, run 5L O2 until no vapor detected)
-agent reuse (don't)
-tipping vaporizer (overdose when re-connected)
agent is in central mechanism not regulated
-Vent excess gas from the patient breathing circuit

Front 65

Pressure & volume
Control Modes
Volume controlled Mode

Back 65

-TV delivered
-Most common in OR
-Compliance changes (poss dec TV
-High pressure alarms (barotrauma)

Front 66

Pressure & volume
Control Modes
Pressure controlled Mode

Back 66

Breath delivered to set peak pressure

Front 67

Pressure controlled Mode
What population is used for

Back 67

Obese
Lap Cases

Front 68

Pressure controlled Mode
Lap Cases

Back 68

Inc to 40cm while abd inflated, because abd press is at 20cm, when trocars are out dec. to 20cm.

Front 69

Other Variables

Back 69

Insipratory Flow (6sec breaths I:E 3sec)
Peep (peep valve or on vent)
Insp sigh

Front 70

Insipratory Flow

Back 70

-Rate effects distribution of gas in lung
-Effects of exp times

Front 71

Ventilators
Power source

Back 71

compressed gas elec

Front 72

Ventilators
Drive Mech.
-Double circuit

Back 72

-pneumatically driven (air)
-compresses bellow
-empties contents

Front 73

Bellows
Ascending

Back 73

-expiration, easy detection of disconnect

Front 74

Bellows
Descending (hanging) (older)

Back 74

-decsend w/ exhale
-look full
-barotrauma poss if leaks
-drive gas into lungs

Front 75

Ventilator Cycle
Inhalation phase

Back 75

-bellows inflate w/ fresh gas
-recirc exhale gas (circuit)
-drive gas pressurizes bellows (pushes dn, forces gas mix into lungs

Front 76

Ventilator Cycle
Exhalation phase

Back 76

-Control module drive gas from bellow to exhaust port

-Allows gas to flow from lungs
- I:E ratio

Front 77

Control Module

Back 77

-select, vol. rate pressure limits
-Control components that allow inhale or exhale
-Display FIO2, Exp vol
-Display sound/alarms

Front 78

Control Module

Back 78

-Alt adjust
-Mech vent
-Set up
-TV
-RR
-Flow
-Press limit
-Insp pause

Front 79

TV = How much per kg

Back 79

6-8kg/ml

Front 80

Pressure monitoring

Back 80

-Cont. monitor airway press
-press sens inside vent cont module (flex tube to sensing port in breathing circ)
Circuit press monitored at inhale port of GMS absorber

Front 81

Alarms

Back 81

-Low press
-Sub atmosph press (too much scavenger)
-High press (cough, bronch, biting)
Sustained Press (one way valve obst)

Front 82

Volume monitor

Back 82

TV
Exp minute vol (Ve)

Front 83

Reverse Flow Alarm

Back 83

Warns of rev flow
-stick exhal valve
Position
-Distal pos of exp limb
Trigger
-Depends on TV setting

Front 84

Apnea alarm

Back 84

-depends on TV set
-initiated after first pos press breath

Front 85

Oxygen monitor

Back 85

-fuel cell to measure FIO2
-Calibrate at 21% daily (assure it gets to 90%, air alts calib.)
-100% monthly

Front 86

Bellows are all latex free and the same bellow can be used w/ ped as with adult
T/F

Back 86

True

Front 87

Carbon Dioxide absorption

Back 87

-Makes rebreathe imposs
-conserve gas/agents
-remove CO2
-Dec CO2

Front 88

Types of CO2 absorp

Back 88

Soda lime
Baralyme
Amsorb

Front 89

CO2 Absp
Soda lime

Back 89

-94% Ca+ hydroxide
-5% Na+ hydroxide
-1% K+ hydroxide
-Silca to harden granules
-ethyl violet as an indicator

Front 90

CO2 Absp
Baralime

Back 90

80% Ca+ hydroxide
20% Barium hydroxide
ethyl violet as an indicator

Front 91

CO2 absp

Back 91

-pH extreme high
-granule size
-4-8 mesh
-Water is required for chem rxn to occur (from circ)
-

Front 92

CO2 Absp
-Dessicate absorb
Precautions

Back 92

-Inc flow can dry out
-Airway fire
-rebreath CO2

Front 93

CO2 Absp
Incompatible

Back 93

Trichlorethylene
-dichloracetylene (neurotox)

Phosgene
-pulm irrt

Sevo
-degrades absorb
-Comp A (renal tox)

Front 94

What is the recc. flow with Sevo

Back 94

At least 2L

Front 95

Chem of Soda Lime
Step 1 Rxn (1st neutralization rxn)

Back 95

CO2 + H2O -> H2CO3

Front 96

Chem of Soda Lime
Step 2 Rxn

Back 96

H2CO3 + 2NaOH (or KOH) -> Na2CO3 (or K2CO3) + 2 H2O + Energy

Front 97

Chem of Soda Lime
Step 3 Rxn
(2nd neutralization rxn)
Regen activator take place CaCO3 is an insoluble precipitate

Back 97

Na2CO3 +(or K2CO3) +
Ca(OH)2 -> CaCO3 + 2 NaOH (or KOH)

Front 98

Chem of Barium hydroxide lime (Baralyme)
1

Back 98

Ba(OH)2-8H2O + CO2 -> BaCO3 + 9H2O + energy

Front 99

Chem of Barium hydroxide lime (Baralyme)
2

Back 99

9 H20 + 9 CO2 -> 9 H2CO3
(direct rxn and by NaOH, KOH if present)

Front 100

Chem of Barium hydroxide lime (Baralyme)
3

Back 100

9 H2CO3 + 9 Ca(OH)2 -> CaCO3 + 18H2O + energy
CaCO3 is an insol precp.

Front 101

Changing Absorb

Back 101

-Wear gloves
-loosen clamp
-remove discard top canister
-promote bottom canister to top, fresh canister on bot.
-Check circ for leaks
-Always remove wrap (if not no flow)
- Don't change mid case

Front 102

What if absorb change color in middle of case

Back 102

Inc flows to bypass the absorb.

Front 103

Clincial signs of Co2 exhaust

Back 103

-rise in HR & BP
- hyperpnea
-resp acid
-dysrhy
-SS of sns activiation
Flush, cardiac irreg, sweating
-inc bleed
-elev. CO2

Front 104

Anest circ

Back 104

-link mach to pt
-eliminate CO2
-Mapleson classification
- many diff in use
-mod maple still in use
-know current apps for mod mapleson

Front 105

Delivery System

Back 105

-Connection to Pt
-Breathing tubing
-Unidirectional valves
-breathing bags
-pop off valve (adj press limit valve)
-CO2 absorp
-Bact filter

Front 106

Circle system

Back 106

-Allows rebreathing of anesth gases
-lower FGF rates
-less pollution
-Requires CO2 absorp
-Conserv heat & humidity

Front 107

Components of Circle Sys

Back 107

-Fresh inlet gas
-Inhal check valve
-Inspiratory limb
-Y-Piece
-Expiratory limb
-Exhalation check valve
-APL valve (adj press limit)
-Bag/Vent selector switch
-CO2 cannister

Front 108

Four Basic Circuits

Back 108

Open
Semi-Open
Semi Closed
Closed

Front 109

Open Systems (open drop ether)

Back 109

-Insuffllation
-blow anest gas over face
-no direct contact
-no rebreath of gases
-vent cannot be control
-unkn amt delivered

Front 110

Open systems
Open drop anesth

Back 110

-gauze covered wire mask
-anesth dripped
-inhale air passes thru gauze & picks up anesth
-conc varies
-re-breath poss
-environ pollution

Front 111

Semi open sys

Back 111

-breathing sys which entrains room air
-self inflating resuscitatior sys
-Mapleson ABCDEF
-Bain

Front 112

Semi closed sys

Back 112

-gas enters from mach (part leaves via scavenger
-Circle sys

Front 113

Closed sys

Back 113

- only enough gas enters to meet metablolic need
-Scavenger is closed
-closed circle sys
(saves money, agent O2 supply)

Front 114

Closed Sys Anesth

Back 114

-Tech not commonly used
-APL is closed & only enough O2 is added to meet metabolic needs
-Anesth added based on sq root of time
-Conserves anesth gas & eliminates time

Front 115

Scavenger Sys
OSHA Fact sheet on Waste Anest Gases (WAGS)

Back 115

-Gives NIOSH recc to OHSA
-Occ exposure limited to
2ppm (halogenated agent)
25 ppm N20

Front 116

Scavenger Sys

Back 116

-Releases excess press from sys
-prevents OR pollution
-Gases leave thru APL
-May put too much neg press on sys (suction sys)
(Part of mach chk make sure it does not go below zero)

Front 117

Scavenging connections

Back 117

waste gas from circ
-vented thru APL valve when in bag
-pop off valve in bellows assembl when vent
-flows thru hoses connect to 19 or 30mm intake ports of the waste gas manifold
-Vented

Front 118

Scavenging sys
Two types

Back 118

Active
Passive

Front 119

Scavenging sys
Active

Back 119

vented thru hosp vaccuum sys (used mostly)

Front 120

Scavenging sys
Passive

Back 120

vented thru hosp vent duct
(tube has to be 18in high)