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Anesthesiology > 3/4: Inhalant Anesthesia Equipment > Flashcards

3/4: Inhalant Anesthesia Equipment Flashcards

1
Q

What are 4 purposes for the anesthetic machine and breathing circuit?

A
  1. Deliver oxygen
  2. Deliver inhalant anesthetic
  3. Remove CO2
  4. Provide means for intermittent positive pressure ventilation (IPPV)
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2
Q

What are the 5 main components of the anesthetic machine?

A

FROGS:

  1. Flowmeter
  2. Regulator
  3. VapOrizer
  4. Gas supply
  5. Scavenger
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3
Q

What are the parts of the high pressure system?

A
  1. Oxygen cylinder
  2. High pressure hoses
  3. Cylinder pressure gauge
  4. Regulator for cylinder
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4
Q

What are the parts of the intermediate pressure system?

A
  1. Flowmeter
  2. Oxygen flush valve
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5
Q

What are the parts of the low pressure system?

A
  1. Vaporizer
  2. Breathing system
    1. Common gas outlet
    2. Common gas inlet
    3. Inspiratory and expiratory valves
    4. Breathing tube
    5. Reservoir bag
    6. Y-piece
    7. Pop-off valve
    8. Scavenging tubing
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6
Q

What is the pressure of the high pressure zone? Intermediate pressure? Low pressure?

A

High = 1900-2200 psi

Intermediate = 37-55 psi

Low = <30 cm H2O

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7
Q

What can be used to determine the volume of gas contained within the oxygen cylinder?

A

Pressure indicated on the cylinder pressure gauge

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8
Q

T/F: You can tell how much nitrous oxide is left in the tank by reading the pressure gauge.

A

False;

Nitrous oxide is partially stored in liquid form; P gauge reads 745 until all liquid is gone, and then you just have the gaseous form.

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9
Q

What are the possible cylinder sizes for oxygen?

A

E and H

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10
Q

What is the color for oxygen in the U.S.?

A

green

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11
Q

What is the capacity and pressure of an H tank?

A

6900 L

2200 psi

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12
Q

What is the capacity and pressure of an E tank?

A

660 L

1900 psi

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13
Q

What gas is denoted by yellow?

A

medical air

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14
Q

What gas is denoted by blue?

A

nitrous oxide

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15
Q

What is the diameter index safety system (DISS)?

A

Each plug has a different diameter and different thread to keep you from plugging in the wrong line.

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16
Q

What is the pin index safety system (PISS)?

A

2 holes on the cylinder stem, 2 holes on the yoke;

Unique pin location for each medical gas

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17
Q

What are the pin locations for oxygen? Air? Nitrous oxide?

A

Oxygen = 2, 5

Air = 1, 5

Nitrous oxide = 3, 5

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18
Q

Where is the regulator located?

A

Between high and intermediate pressure systems

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19
Q

What does the regulator do?

A

Reduces pressure from gas cylinder (1900-2200 psi) to working pressure (37-55 psi).

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20
Q

What does the flowmeter do?

A

Controls rate of medical gas passing through the vaporizer

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21
Q

Why is the flowmeter tube narrow at the bottom and wider at the top?

A

As the float moves up the tube, more gas can flow around the float, producing higher flow rates.

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22
Q

Flow rate is determined by position of _____.

A

the float

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23
Q

How is the flowmeter calibrated?

A

As a unit: flow tube, scale, and float

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24
Q

How would you read this?

A

At the center of the float = 2 L/min

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25
Q

How would you read this?

A

At the top of the float = 3 L/min

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26
Q

What is the flush valve used for?

A

Rapidly delivers large volumes (35-75 L/min) of oxygen to common gas outlet/breathing circuit;

Fills depleted reservoir bag, flushes out anesthetic gas in circuit

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27
Q

What area is the oxygen flush valve located in?

A

intermediate pressure

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28
Q

What does the oxygen flush valve bypass?

A

flowmeter and vaporizer

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29
Q

When is it never okay to use the oxygen flush valve?

A

When the patient is connected to the breathing circuit

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30
Q

What does the vaporizer do?

A

Converts liquid anesthetic into vapor and adds measured amount of the vapor to flow of gases going to patient

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31
Q

What two ways can gas go?

A
  1. Can bypass liquid anesthetic
  2. Can go into vaporizing chamber and pick up vapor molecules –> meets with bypass chamber –> common gas outlet
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32
Q

Where in relation to the breathing circuit is the vaporizer located in modern systems?

A

Outside the circuit (high-resistance)

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33
Q

What is the method of regulating output concentration in a modern vaporizer?

A

Precision/concentration-calibrated, variable bypass

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34
Q

What is the method of vaporization in a modern vaporizer?

A

Flow-over the wick

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35
Q

Vaporizers have _____ filling systems.

A

keyed

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36
Q

Where is the vaporizer in this system?

A

Out of circuit (VOC)

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37
Q

Where is the vaporizer in this system?

A

In the circuit (VIC)

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38
Q

VOC have a _____ construction.

A

complex

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39
Q

VOC have a _____ resistance to breathing.

A

high

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40
Q

What provides the carrier gas in a VOC?

A

fresh gas inflow

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41
Q

T/F: In a VOC, vaporizer output is not affected by patient’s ventilation

A

True

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42
Q

Which vaporizer is a precision vaporizer?

A

VOC

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43
Q

VOCs are inhalant agent _____.

A

specific

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44
Q

VOCs are _____ flow rate compensated.

A

temp/oxygen

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45
Q

Where are VICs located?

A

On inspiratory arm of the circle system

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46
Q

VICs have _____ construction.

A

simple

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47
Q

VICs have _____ resistance to breathing.

A

low

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48
Q

What provides the carrier gas in a VIC?

A

Inspiratory patient air flow

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49
Q

What inhalants can be used with a VIC?

A

multiple

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50
Q

Which vaporizer is a non-precision vaporizer? What does this mean?

A

VIC;

Anesthetic [] is unknown

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51
Q

What is the common (fresh) gas outlet?

A

Receives all gases and vapors from the machine and delivers mixture to breathing system.

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52
Q

The common gas outlet is a common location for _____; machines should be checked for _____ before each procedure.

A

disconnection, leaks

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53
Q

What are the functions of a breathing system?

A
  1. Allows fresh gas and inhalant to be delivered from the machine to the patient
  2. Eliminates the patient’s expired CO2 to scavenger
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54
Q

What does a breathing system consist of?

A

Breathing hose, reservoir bag, pressure relief valve

55
Q

What are the 2 types of breathing systems?

A

Rebreathing and non-rebreathing (NRB)

56
Q

What is the purpose of one-way valves in a circle system?

A

Used to produce unidirectional flow of gas through system

57
Q

Where does expired gas go in a circle system?

A

It is recycled back into system

58
Q

Where does expired CO2 go in a circle system?

A

Removed by CO2 absorbent

59
Q

What is the resistance in a circle system vs. a NRB?

A

It is higher in a circle system

60
Q

What is the ideal oxygen flow rate in a circle system?

A

30 mL/kg/min

61
Q

What is the Y-piece?

A

Connects endotracheal tube to breathing hoses of the rebreathing system

62
Q

Gases in the inspiratory tube are directed _____ patient on inspiration.

A

toward

63
Q

Gases in expiratory tube are directed _____ patient on expiration.

A

away from

64
Q

What happens to air flow if one of the valves in a circle system do not work?

A

Gas will not move in a circular fashion

65
Q

What is the fresh gas inlet?

A

Site of delivery of oxygen and anesthetic gas from common gas outlet of machine to the breathing system.

66
Q

Where is the fresh gas inlet located?

A

After CO2 absorbent and before inspiratory one-way valve

67
Q

What does the breathing circuit pressure manometer indicate?

A

P within breathing circuit

68
Q

Peak inspiratory pressure should not exceed _____ in small patients.

A

15-20 cmH2O

69
Q

What can the breathing circuit pressure manometer be used for?

A

To check for leaks in the machine and around the endotracheal cuff

70
Q

How is a leak test performed?

A
  1. Make sure all gas flows are set to 0
  2. Close pop-off valve and occlude Y-piece
  3. Turn flowmeter on and pressurize breathing system to 30 cmH2O
  4. Turn flowmeter off
  5. Do not use oxygen flush valve to completely inflate the reservoir bag
  6. P should not fall more than 10 cmH2O within 30 sec
  7. Open pop-off valve
71
Q

Where are common areas for leaks?

A

Reservoir bag, breathing hose, CO2 absorbent canister, vaporizer

72
Q

What is the recommended volume for a reservoir bag?

A

5-10 times patient’s tidal volume;

10-15 mL/kg

73
Q

What can happen if the reservoir bag is too large?

A

Can be difficult to observe respiration, and result in slower rates of change in anesthetic [] when vaporizer output changed (circle system)

74
Q

What can happen if the reservoir bag is too small?

A

Inadequate gas supply to meet peak inspiratory volume, unable to provide safety margin against P buildup within breathing system

75
Q

The pop-off valve is on the _____ side of the circuit.

A

expiratory

76
Q

What is the purpose of the pop-off valve?

A

Allows exhaled gases, waste gas, unused fresh gas to exit the circuit –> scavenger system

77
Q

What is the P required to open the pop-off valve?

A

1-2 cmH2O

78
Q

What can a completely closed pop off valve lead to?

A

Patient barotrauma or death

79
Q

What does the scavenging system do?

A

Removes waste gases from the immediate workspace

80
Q

In a passive system, where are waste gases diverted to and how?

A

To vent leading to outside work area by a hose connected to the APL

81
Q

What is used to inactivate halogenated anesthetics in a passive scavenging system?

A

Activated charcoal canister

82
Q

When are activated charcoal canisters changed?

A

When they gain 50g since before the first use

83
Q

How does an active scavenging system work?

A

Vacuum pump creates negative pressure to collect waste gas

84
Q

Active scavenging systems are more _____ and _____ to set up than passive systems.

A

complicated, expensive

85
Q

What is the most common CO2 absorbent?

A

Soda lime

86
Q

What is the makeup of soda lime?

A

80% calcium hydroxide

15% water

4% sodium hydroxide

87
Q

How does a soda lime absorbent work?

A

CO2 passes thru soda lime –> forms calcium carbonate –> ethyl violet in absorbent changes color as the pH changes

88
Q

When should absorbent be changed?

A

Observe at end of surgery and change if 1/3 violet

89
Q

How is CO2 eliminated in a NRB?

A

By high fresh gas flows

90
Q

What is the ideal oxygen flow rate in a NRB?

A

200 mL/kg/min

91
Q

Where does inhaled gas pass through in a NRB?

A

Inner tube

92
Q

Where does exhaled gas pass through in a NRB?

A

outer tube

93
Q

What is the purpose of an endotracheal tube?

A

Transfers oxygen and inhalant from anesthetic machine into patient’s lungs

94
Q

ET tubes help to maintain a _____ airway.

A

patent

95
Q

ET tubes help facilitate _____ _____ ventilation.

A

positive pressure

96
Q

ET tubes protect the lungs from _____.

A

aspiration

97
Q

ET tubes help prevent _____ of work environment.

A

contamination

98
Q

What are the main parts of an ET tube?

A

Murphy eye, radiopaque marker line, pilot balloon, adapter

99
Q

What is the purpose of the Murphy eye?

A

It is useful if the tube is obstructed against tissue or something else;

Provides another way for the gas to flow in and out

100
Q

What size ET tube should be used?

A

Largest that will fit without causing trauma

101
Q

ETT size can be based on width of _____ _____.

A

nasal septum

102
Q

Other than the nasal septum width, how else can you estimate ETT size?

A

Palpate the cervical trachea

103
Q

How many ETTs should you have available?

A

min of 3

104
Q

How is the length of the ETT measured?

A

From tip of patient’s shoulder to tip of the nose (minimize mechanical dead space)

105
Q

What is a high-volume, low-pressure cuff?

A

Tracheal wall pressure is similar to intracuff pressure

106
Q

What is a low-volume, high-pressure cuff?

A

Better protection against aspiration; intracuff pressure does not equal tracheal wall pressure

107
Q

What do tracheal pressures >48 cmH2O do?

A

impede capillary blood flow

108
Q

What do tracheal pressures <15 cmH2O do?

A

Increase risk of aspiration

109
Q

When are guarded tubes useful?

A

In procedures where the ETT is likely to be compressed/kinked

110
Q

What are disadvantages that occur when there is a leaky cuff?

A

Airway not protected from aspiration, difficult to keep patient anesthetized, pollutes environment

111
Q

How is a cuff tested for proper inflation?

A

Administer least amount of air to inflate cuff and provide airtight seal so there is no leak when manual breath is given at 15-20 cmH2O

112
Q

What can an excessive pressure in the cuff lead to?

A

tracheal necrosis

113
Q

What does SGAD stand for?

A

supraglottic airway device

114
Q

What does LMA stand for?

A

laryngeal mask airway

115
Q

What are 2 alternatives to tracheal intubation?

A

SGADs and LMAs

116
Q

What spp can SGADs and LMAs be used in?

A

cats and rabbits

117
Q

SGADs and LMAs do not enter _____ or _____.

A

larynx, trachea

118
Q

SGADs and LMAs form a seal around the _____.

A

glottis

119
Q

Where should a laryngoscope be positioned?

A

At the base of the tongue, under the epiglottis, push down and pull forward

120
Q

What is a ventilator?

A

Device designed to provide/augment patient ventilation;

Controls rate, volume/pressure, inspiratory/expiratory time of each breath

121
Q

What replaces the rebreathing bag in a ventilator?

A

Bellows

122
Q

What respiration phase occurs when the ventilator bellows collapse?

A

inspiratory

123
Q

What respiration phase occurs when the ventilator bellows expand?

A

expiration

124
Q

What is the suggested ventilator setting in small animals? Horses?

A

SA = 8-15 bpm with inspiratory time <1 second

Horses = 6-10 bmp with inspiratory time 1-2 seconds (peak P 20-30 cmH2O)

125
Q

What are CV effects of IPPV?

A

Decreased venous return/CO/BP

126
Q

What type of system do induction chambers connect to?

A

NRB

127
Q

What is the FIO2 provided by masks?

A

35-60%

128
Q

Why should you not force a face mask onto a struggling patient?

A

It increases patient’s metabolic oxygen consumption

129
Q

What is a disadvantage of using a face mask?

A

Do not have an airway

130
Q

What is a closed circle breathing system?

A

Uses absolute minimum oxygen flow rate to meet patient’s metabolic oxygen requirements

We don’t use this

131
Q

What is the flow rate for a closed system?

A

3-5 ml/kg/min

132
Q

What is the flow rate for a semi-closed system?

A

50-100 ml/kg/min initially;

20-30 ml/kg/min maintenance

133
Q

What is the flow rate for a NRB system? Why is this necessary?

A

200 mL/kg/min;

High rate necessary to ensure expired gases not re-breathed

Anesthesiology (12 decks)

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