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*Anesthesia Concepts 2 > Anesthesia Delivery System > Flashcards

Anesthesia Delivery System Flashcards

1
Q

How can CO2 be eliminated?

A
  1. washout with high flows of fresh gas

2. CO2 absorber

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2
Q

What are essential requirements in a breathing system. regarding

  1. gas delivery
  2. CO2
  3. dead space
  4. resistance
A
  1. deliver gases to alveoli in same concentration as set in shortest time
  2. eliminate CO2
  3. minimal dead space
  4. low resistance
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3
Q

What is the advantages to rebreathing of exhaled gases? What is a concern of rebreathing?

A

cheaper, adds humidification to gases but do not want to rebreathe CO2 - high FGF

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4
Q

What effect does dead space have on CO2?

A

dead space increases chance of rebreathing

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5
Q

How is gas delivered in an open system? What does this system not have? (3)

A

pt gets anesthetic gas plus gas in environment

no reservoir bag, no valves, no rebreathing

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6
Q

What are the 2 types of open systems? Give examples.

A
  1. insufflation - blow-by, tent, nasal cannula, steal induction
  2. open drop - ether mask (schimmelbusch) - historical, wire mask with cloth where anesthetic is dripped onto cloth and patient inhales
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7
Q

What are disadvantages of open systems?

A

no assist in ventilation
CO2/O2 accumulation under drapes
no control of anesthetic depth/FiO2
pollution

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8
Q

What is the “Steal” induction and is it a form of insufflation or open drop open system?

A
  • approach pt with gas mask slowly as they inhale gas and environment
  • insufflation system -
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9
Q

What are the 5 components of a semi-open system?

A
  1. facemask or ETT
  2. pop-off valve
  3. reservoir tubing
  4. fresh gas inlet
  5. reservoir bag
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10
Q

How do you prevent CO2 rebreathing in semi-open systems?

A

-with high fresh gas flows

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11
Q

How do you set the APL valve with spontaneous vs controlled ventilation?

A
  • open with spontaneous breathing

- partially closed with controlled ventilation

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12
Q

What are examples of semi-open system?

A

Mapleson (A-F) - various configurations
Bain
Circle

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13
Q

What does CO2 rebreathing depend on?

A
  • FG inflow rate
  • minute ventilation
  • spontaneous or controlled ventilation
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14
Q

What is the most efficient Mapleson model during controlled ventilation?
Where does FGF enter?
Where is the APL valve located?
What model is opposite of this?

A
  • Mapleson D
  • near facemask/patient
  • opposite end
  • Mapleson A
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15
Q

What should be the FGF for a Mapleson D with

  1. spontaneous respiration
  2. controlled ventilation
A
  1. FGF = 2-3 x MV
  2. FGF = 1-2 x MV
    (MV = RR x TV, normal = 5L x 2 = 10 L of FGF)
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16
Q

Which model is a T-Piece?
What does it NOT have? (2)
What would be the FGF for spontaneous?

A
  • Mapleson E
  • no reservoir bag, no APL valve (no manual ventilation?)
  • 2-3 x MV
17
Q

Which Mapleson is popular in pediatrics?

A
  • Mapleson F

- like Mapleson E (T-Piece) but has APL with reservoir bag

18
Q

Which Mapleson is the Bain Circuit a modification of?
What is FGF for the Bain Circuit?
Is it used in spontaneous or controlled or both?

A

-Mapleson D
-same as Mapleson D
1. FGF = 2-3 x MV - spontaenous
2. FGF = 1-2 x MV - controlled
Both

19
Q

What is a special feature in the Bain circuit FGF tubing?
What is the advantage to this?
What is the disadvantage of the Bain Circuit?

A
  • FGF tubing is within corrugated/breathing tubing
  • provide heat and humidity from exhaled gas to inspired gas
  • potential for inner tube leaks, kinking, disconnect
20
Q

Which Maples is the ambu bag a modified version of?
Can it deliver high FiO2?
Does it require FGF?
How do you refill the reservoir bag?

A

-Mapleson A with a non-rebreathing valve (only one with NR valve)
-yes.
-yes, dependent on MV
it is self-filling

21
Q

What are 6 advantages of the Mapleson System?

A
  1. simple
  2. light
  3. provides positive pressure ventilation
  4. low resistance
  5. portable
  6. more predictable anesthetic concentration than open system and decreased pollution
22
Q

What are disadvantages of Mapleson system?

A
  • calculate FGF which varies per circuit and mode of ventilation
  • anesthetic depth is variable
  • possible CO2 buildup with rebreathing, low FGF
  • FGF costly
  • Special assembly
23
Q

Which system does the anesthesia machine use?
What type of delivery system can it be used as?
What 2 things can adjust it into different systems?

A
  • semi-closed Circle system
  • semi-open, semi-closed, closed
  • APL valve adjustment, FGF rates per system
24
Q

What are 7 components of the circle system?

A
  1. FGF source
  2. insp/exp valves (unidirectional)
  3. insp/exp limbs/corrugated tubing
  4. y-piece connector
  5. adjustable APL
  6. reservoir bag
  7. CO2 absorber
25
Q

What is the size of the reservoir bag neck?

A

22 mm (female connection to )

26
Q

What is the reservoir bag made of?

A

neoprene or rubber

27
Q

What is the function of the reservoir bag?

A
  • accumulates expired gas
  • assist/contrl ventilation
  • visual/tactile monitor for observing spontaneous respiration
  • protects from excessive pressure
28
Q

What is the size/diameter of a T-Piece and an ETT?

A

T-piece = 22 mm male connection

patient end of ETT = 15 mm female connection

29
Q

What is the purpose of an APL valve?

A
  • releases gas to scavenge or atmosphere

- controls pressure in system

30
Q

How should the APL be positioned with

  1. spontaneous resp
  2. assisted vent
  3. mechanical vent
A
  1. open or partially closed only if reservoir bag is able to collapse
  2. partially open
  3. closed (if machine does not have mode switch)
31
Q

If unidirectional valves are working, where is dead space in the circle system?

A

between y piece and patient

32
Q

What are 3 rules for a circle system arrangement?

A
  1. unidirectional valves must be between patient and reservoir bag on ins/exp limbs
  2. FGF cannot enter between exp valve and patient
  3. APL valve cannot be between patient and insp valve
33
Q

When is a semi-open circle system used?

A

Not often, sometimes for sedation (with mask placed over face to increase FiO2)

34
Q

In a semi-open circle system is there rebreathing?
How?
What position is APL valve?
Does it conserve heat/gas?

A

No. High FGF (10-15 L/min)
open
no

35
Q 
What is the most commonly used circle system?
What flow rates does it use?
Does it conserve heat/gas?
Is there rebreathing?
How is APL valve position?
A
  • Semi-closed circle system
  • Low FGF (1-3 L/min)
  • conserves some heat/gas
  • some re-breathing (minus Co2)
  • partially closed and adjust as needed
36
Q

When is closed circle system used?
How are flow rates?
Is there rebreathing?
What position is APL?

A
  • third world countries
  • FGF at minimal to match metabolic O2 needs
    (i. e. 200 ml/min - O2 consumption calculation)
  • total rebreathing and conservation of all gases
  • APL is closed
37
Q

What is the formula for O2 consumption? (VO2)

A

10 x kg^(3/4)

38
Q

What are advantages of the circle system?

A
  • stability of inspired gas
  • conserve moisture
  • prevent pollution
  • can be used for closed-system anesthesia
  • can use low flows and no rebreathing of CO2
  • scavenge wastes
39
Q

What are disadvantages of circle system?

A
  • complex, 10 connections (risk for leaks, obstr, disc)
  • malpractice due to disconnects etc
  • increased resistance
  • less portable/convenient

*Anesthesia Concepts 2 (6 decks)

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