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ANESTHESIA > 24 – Anesthesia Equipment > Flashcards

24 – Anesthesia Equipment Flashcards

1
Q

What are the functions of an anesthesia machine?

A
  • Delivery of O2 to patients
  • Delivery of anesthetic gas
  • Assistance with ventilation
  • Removal of exhaled CO2 from patient
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2
Q

Follow the air through the anesthesia machine

A
  1. O2 source (compressed gas)=high pressure
  2. Pressure gage
  3. Pressure reducing valve
  4. Line pressure gage
  5. Flow meter
  6. Vaporizer
  7. ‘fresh gas line’
    a. Non-rebreathing or rebreathing circuit (depends on SIZE OF PATIENT)
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3
Q

What are the basic components of the anesthesia machine?

A
  • Medical gas source (O2, air)
  • Regulator
  • Flowmeter
  • Vaporizer
  • Fresh (common) gas outlet
  • Breathing system
  • *divide into HIGH and LOW pressure part
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4
Q

What are your ‘2 options’ for medical gas source?

A
  • Oxygen
  • Medical air
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5
Q

Oxygen delivery

A
  1. Compressed gas
    a. E-cylinder (700L)
    b. H-cylinder (7000L)
  2. Liquid O2: can store more
    **pipeline pressure: 50-60psi
    **KEY TO CLOSE O2 tank (off=clockwise)
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6
Q

What is medical air?

A
  • Formed by drawing ambient air into the compressor
  • Considered ‘clean’ (runs through series o filters and separators to remove water, oil and other impurities)
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7
Q

What is the oxygen concentrator?

A
  • Use it to filter and extract room air
  • Removes N2, stores O2 as compressed gas
  • Requires electrical supply
  • *maximum of 5-10L/min (problem in large animal)
  • 92-95% O2
  • Need to change filters on regular basis
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8
Q

What are the safety features?

A
  • Colour coding
    o O2=white or/and green
  • Pin-index safety system (PISS): E-cylinder
  • Connecters (H-cylinder): Diameter index safety system (DISS)
    o Body, nut, stem
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9
Q

What is the regulators for an E-tank?

A
  • one-stage regulator
  • 2,200psi to 50-55psi
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10
Q

What is the regulator for the pipeline supply?

A
  • At the O2 sources
  • 50-55psi
  • *2 stage regulators allow for variable output pressure
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11
Q

What is the role of flowmeters?

A
  • Control rate of gas delivery of low-pressure area
  • Determine fresh gas flow (FGF)
  • Specific for gas (density, viscosity)
    o Color coded
    o O2=bigger nob, closest to vaporizer
  • L/min (read middle of ball, read at top of cylinder)
  • *operated by needle valve
  • *precision instrument
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12
Q

What is the role of the vaporizer?

A
  • Vaporizes anesthetic agent and delivers at set concentration (% output on dial)
  • Agent specific
  • *temperature compensated (via bi-metallic strip)
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13
Q

What are the 2 paths for a variable-bypass vaporizer?

A
  1. Entering bypass chamber
  2. Diverted into vaporization chamber
    *splitting depends on settings
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14
Q

What are some safety features of the vaporizer?

A
  • Colour coding
    o Yellow: sevoflurane
    o Purple: isoflurane
  • Key-indexed filler systems: don’t get exposed, very specific!
  • Lock on dial
  • Do NOT overfill
  • Do NOT TILT vaporizer
  • *do NOT want it to go into the bypass
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15
Q

Anesthetic breathing systems

A
  • Deliver O2 and anesthetic gases to patient
  • Allow elimination of CO2
  • Allow ventilation of lungs
  • Different types based on CO2 removal
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16
Q

Rebreathing systems

A
  • Use chemical reaction to remove CO2 with absorber
  • Used on animals LARGER than 10kg bodyweight
  • *allow low/minimal flow anesthesia
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17
Q

What is the advantage of rebreathing system?

A
  • Decrease use of volatile anesthetics
  • Improved T and humidity control
  • Reduced environmental pollution
18
Q

What are the disadvantages of rebreathing system?

A
  • Difficult to rapidly adjust anesthetic depth
19
Q

What are the components of a rebreathing system?

A
  • Inspiratory one-way valve
  • Inspiratory breathing tube
  • Y-piece
  • Expiratory breathing tube
  • Expiratory one-way valve
  • Reservoir bag
  • CO2 absorber
20
Q

Breathing tubes of a rebreathing system

A
  • Flexible, low resistance conduits between Y-pieces and one-way
  • *Corrugations reduce likelihood of obstruction if bent
  • Add length volume to system, increase resistance
  • *F-circuit: co-axial system (inspiratory inside expiratory )
21
Q

What are the O2 flow rates for a circle system?

A
  • 10-30ml/kg/min
22
Q

What is a low O2 flow rate for a circle system?

A
  • 4-10ml/kg/min
23
Q

Y-piece

A
  • Connects ET-tube to inspiratory and expiratory breathing tubes
  • Contributes to dead space
  • Septum may be present to decrease dead space
24
Q

Universal F breathing system

A
  • Co-axial (hose inside a hose)
    o Inner carriers fresh gas flow
  • less bulk and less DEAD SPACE
25
Q

Reservoir bag

A
  • Size: 6-10x tidal volume
  • Reservoir of gases during inspiration
  • Allows monitoring of respiratory movements
  • Ventilate lungs
26
Q

Breathing tubes/hoses

A
  • Provided connection and reservoir for gases
  • Apparatus dead space: potential area of CO2 collection
27
Q

Rebreathing system: denitrogenization

A
  • Required for all of them
  • Body and anesthetic machine are equilibrated with air
  • Once connect and 100% O2 flow
    o N2 moves down partial P gradient from body into breathing system
    o Takes 20mins
  • *high FGFs(fresh gas flow) used (30mg/kg/min) for first 20mins to ‘flush out N; and reduce risk of inhaling hypoxic mixtures
28
Q

One-way valve: rebreathing system

A
  • Prevent rebreathing of exhaled gas
  • Gases enter unidirectional valve from below and raise disc
  • *allow gas to pass in one direction only=adds resistance
    o Why use on larger patients only
29
Q

CO2 absorber: rebreathing system

A
  • Contains chemical absorbent for removing CO2 from exhaled gases
  • Exothermic reaction, produces water
  • pH increases (pH sensitive indicator=leads to colour change)
    o granules turn from white to purple as they become exhausted
  • usually lasts 8-10hrs
30
Q

Non-rebreathing systems

A
  • Use high gas flow to flush out CO2
    o 150-300ml/kg/min (10x plus higher than rebreathing)
  • *smaller patients
31
Q

What are the advantages of a non-rebreathing system?

A
  • Less resistance to breathing
  • Less mechanical dead space
  • Rapid manipulation of anesthetic depth
32
Q

What are the disadvantages of a non-rebreathing system?

A
  • Significantly higher waste of both carrier gas
  • High flow od dry cool gas (heat and humidity loss)
33
Q

What happens with failure to remove CO2 in a non-rebreathing system?

A
  • Inadequate fresh gas flow
  • Kinked inner tube Bain
  • Hidden tears or disconnections in coaxial systems
34
Q

What happens with failure to remove CO2 in a rebreathing system?

A
  • Stuck 1-way valves
  • Exhausted CO2 absorber in rebreathing system
35
Q

Circuit pressure gage (manometer)

A
  • *pressure generated in patient breathing circuit
  • Guide for positive pressure ventilation of lungs and system leak test
  • Not greater than 10-25 cmH2O pressure for lung ventilation
  • *highest number corresponds to peak inspiratory pressure reached (PIP)
  • *watch chest expansion of animal=give a normal breath
36
Q

Scavenging system

A
  • Conducts waste anesthetic gases away from workspace
  • Passive: charcoal canisters
  • Active: negative pressure system
  • *pink coloured hose for safety
37
Q

Adjustable pressure limiting (APL) valve (pop-off valve/exhaust valve/scavenging valve)

A
  • Allow excess gas withing breathing system to be vented into waste gas
  • *always leave open during spontaneous breathing
  • Only closed during lung ventilation and leak test
  • Attach scavenging hose to exhaust valve shroud
38
Q

O2 flush

A
  • Allow O2 to bypass flowmeters and vaporizers
  • O2 delivered at high flow and pressure (40-70L/min)
  • Only be used with CIRCLE SYSTEM
    o used to flush out circle system of anesthetic in emergency
  • can be used for leak test
  • NEVER use when a non-breathing system is connected to patient
  • *NOT when attached to patient
39
Q

What are ventilators used for?

A
  • Provide intermittent positive pressure ventilation (IPPV)
    o Dedicated person can provide IPPV
    o But this allows them to attend to other jobs
  • May require driving gas (O2, air) and electricity
  • *bellows replaces the rebreathing bag
40
Q

What are the indications to use a ventilator?

A
  • Open thorax: diaphragmatic hernia repair
  • Neuromuscular blockage: skeletal muscle paralysis

ANESTHESIA (27 decks)

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