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Intro to Anesthesia > 6) Breathing Circuits > Flashcards

6) Breathing Circuits Flashcards

1
Q

Why do we use the circle system in the OR

A
  • more economical and efficient
  • retains heat and humidity
  • prevents OR pollution
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2
Q

Basic functions of breathing circuit

A
  • interface between anesthesia machine and patient
  • delivers O2 and other gases
  • eliminates CO2 (FGF or absorber)
  • 3 essential components
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3
Q

3 essential components for breathing system

A
  • low resistance (corrugated tubing)
  • reservoir for gas that meets inspiratory flow demand
  • expiratory port or valve to vent excess gas
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4
Q

What can we add on breathing circuits?

A
  • HME
  • nebulizers
  • filters
  • pressure gauges
  • spirometer
  • add weight, dead space, resistance
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5
Q

Requirements of breathing circuit

A
  • deliver gases from machine to alveoli is the same concentration set in shortest possible time
  • allow for rapid adjustment in gas concentration
  • eliminate CO2
  • minimize dead space
  • low resistance
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6
Q

Breathing System features

A
  • economy of fresh gas
  • conservation of heat/humidity
  • light weight
  • portable
  • efficiency in SV and CV
  • adaptability
  • reduces environmental pollution
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7
Q

Open system

A

-no reservoir; no rebreathing; nasal cannula, open drop

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8
Q

Semi open system

A

-reservoir, no rebreathing, FGF > MV; Mapleson

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9
Q

Semi Closed

A

-reservoir, partial rebreathing, FGF

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10
Q

Closed system

A

Reservoir; complete rebreathing; scuba diver; circle system with very low FGF like 250mL/m

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11
Q

Steal induction

A

-use mask to blow by child not touching face

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12
Q

Insufflation

A
  • blow by bronch port while sharing airway with ENT
  • danger in O2 under drapes lead to fire
  • pollutes OR
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13
Q

What are pros and cons of Mapleson Circuits

A

Pros: lightweight, portable, can change depth of anesthesia rapidly, eliminates CO2, visualize ventilation with reservoir,
Cons: use high FGF so inefficient, unable to scavenge, does not conserve heat or humidity

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14
Q

What Maplesons are best for SV

A

-A, D, C, B

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15
Q

What Maplesons are best for CV

A

-D, B, C, A

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16
Q

CO2 rebreathing depends on

A
  • FGF rate in Mapleson
  • I:E ratio
  • mode of ventilation
  • CO2 production
17
Q

Describe the Bain Circuit

A
  • modified coaxial Mapleson D
  • FGF inflow tubing is within the correlated tubing
  • maintains heat and humidity
  • potential for disconnection
  • requires Pethick test to test for disconnection
  • can be used for SV/CV but more efficient in CV
18
Q

Mapleson E

A

T piece

  • no pop off valve
  • reservoir is the tubing
  • FGF 2-3x MV
19
Q

Jackson Reese

A
  • modified Mapleson F
  • has an APL valve at the end of the reservoir bag
  • popular in pediatrics
  • visual cue that patient is breathing
  • allows CPAP or hand ventilation
20
Q

Ambu Bag

A
  • critical piece of equipment and morning check
  • contains self inflating bag and non-breathing valve
  • can deliver high FiO2 with O2 reservoir
  • CO2 washout depends on MV
21
Q

Mapleson and Circle System Similarities and differences

A

Similarities: accepts FGF, supplies gas from a reservoir, eliminates CO2
Differences: Mapleson has bidirectional flow, does not use an absorber, depends on FGF to eliminate CO2, no valves

22
Q

What is a circle system

A
  • unidirectional flow via unidirectional valves
  • components arranges in a circle
  • can be modified to closed, semi-closed, semi-open system
  • prevents rebreathing by absorber
  • allows rebreathing of other gases
23
Q

What are the components

A

-FGF inlet, inspiratory limb, inspiratory valve, y piece, expiratory limb, expiratory valve, APL valve, reservoir, and CO2 absorber

24
Q

Explain FGF

A

-comes from CGO
-placed between CO2 absorber and unidirectional valve of inspiratory limb
-

25
Q

Unidirectional valves

A
  • promote unidirectional flow
  • cage prevents lateral or vertical displacement
  • dome allows for observation of movement
  • disk can get wet and stick
  • made of hydrophobic material
  • low resistance (1cm H2O)
  • malfunctioning valve increases resistance and dead space
26
Q

Reservoir bag

A
  • made of rubber or neoprene
  • not self inflating
  • piston ventilator place where breathing gases are mixed
  • 3L most common size (size must exceed inspiratory capacity to prevent negative pressure pulm edema)
  • visual assessment of SV
  • means for manual ventilation
27
Q

APL valve

A
  • permits PEEP during SV or allow for pressure-limited CV
  • releases gases to scavenge
  • user-adjustable: clockwise to close valve and increases pressure within the system (there is a pressure gauge on absorber)
  • SV: valve fully open; only close partially if reservoir bag collapsed
  • Assisted ventilation: valve partially open
  • MV: valve left open in case patient needs to go back
  • Keep PIP less than 20cm to prevent gastric insufflation
  • spring loaded or adjustable needle valve design, accurate, goes to 70cm H2O
28
Q

When you dial APL valve what do you look at for efficacy?

A

-bourdon gauge

29
Q

Characteristics of breathing tube itself

A
  • large bore corrugated tubing promotes flexibility
  • 22mm female fitting
  • patient end T piece is 22mm male, 15mm female coaxial female
  • flexible, lightweight, low resistance, reservoir
  • start at 1m can be stretched 2m; 400-800mL gas held;
30
Q

Semi open circle system

A
  • High FGF; no rebreathing
  • APL valve fully open
  • no conservation of waste gas or heat
31
Q

Semi closed circle system

A
  • most common
  • some rebreathing
  • low FGF (1-3L/min except sevo)
  • APL partially closed
  • conserves heat and gases
32
Q

Closed circle system

A
  • very long cases or 3rd world countries
  • complete rebreathing
  • FGF very very low ~250mL/min
  • APL valve closed fully
  • change of gas concentrations are VERY slow
33
Q

Advantages/Disadvantages of circle system

A

Advantages: stable concentrations of gases, conservation of heat and moisture, low resistance, can be used in different systems, economical, can scavenge
Disadvantages: many places for disconnections, complex design, potential of valve malfunction, increase resistance from Mapleson, increased dead space but ends at Y piece

Intro to Anesthesia (15 decks)

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