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Anethesia > Anesthesia Delivery Systems > Flashcards

Anesthesia Delivery Systems Flashcards

1
Q

Anesthesia Breathing System

A

Deliver oxygen and anesthetic gases to the patient and to eliminate CO2.
CO2 eliminated from the breathing circuit by washout with adequate fresh gas flow/FGF or by use of CO2 absorbent media

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2
Q

Eliminate CO2

A

Unconscious due to CO2 narcosis
We don’t want to get rid of extra oxygen or anesthetics but must rid of CO2
1) High flow of gas to wash it out
2) CO2 absorbs = chemical to absorb it

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3
Q

Requirements of Breathing System: Essential

A

Deliver the gases from the machine or device to the alveoli in the same concentration as set and in the shortest possible amount of time
Effectively eliminate CO2
Have minimal apparatus dead space = no gas exchange
Have low resistance; with high resistance increases work of breathing

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4
Q

Requirements of Breathing System: Desirable

A

Economy of fresh gas
Conservation of heat
Adequate humidification of inspired air
Light weight
Convenience during use
Efficiency during spontaneous as well as controlled ventilation
Adaptability for adults, children and mechanical ventilators
Provision to reduce environmental pollution

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5
Q

Requirements of Breathing System: Other considerations

A

Resistance: want low resistance
Short tubing, large diameter tubing, avoid sharp bends, caution with valves, minimize connections
Rebreathing: may be beneficial
Cost reduction
Adds humidification/heat to gases
BUT do not want rebreathing of CO2
Higher FGF = less rebreathing in any type of circuit

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6
Q

Requirements of Breathing System: Other considerations

A

Dead space: increase the chances of rebreathing CO2
Dead space ends: where the inspiratory and expiratory gas streams diverge
Dry gases/humidification
Manipulation of inspired content: concentration inspired most closely resembles that delivered from the common gas outlet when rebreathing is minimal or absent
Bacterial Colonization

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7
Q

Classification of Anesthetic Delivery System

A

Open
Semi-Open
Semi-Closed
Closed

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8
Q

Open System

A 
Characterized by:
No gas reservoir bag
No valves
No rebreathing of exhaled gas
2 Types: 
1) Insufflation/Blow by
2) Open drop
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9
Q

Insufflation of Oxygen under a Head Drape

A

Blow by: common gas outlet hook up to the circuit and blow common gas to the tube. Clear drape = not having breathing CO2 = can build up CO2 in drape. Supplemental gas to the airway

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10
Q

Insufflation: Steal Induction

A

Inhalation: environmental pollution: not oxygenating with this method

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11
Q

Insufflation

A

Blow by, tent, bronchoscopy port, nasal cannula and steal induction
Advantage: simplicity
Avoids direct patient contact
No rebreathing of CO2
No reservoir bag or valves
Disadvantage:
No ability to assist or control ventilation
May have CO2/O2 accumulation under drapes
No control of anesthetics depth/FiO2
Environmental pollution

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12
Q

Schimmelbusch Mask

A

True open circuit: consisted of bit of cloth saturated with either ether or chloroform or halothane and held over the patient’s face.
No supplemental oxygen = liquid anesthetics vaporizes
Problem: mask on and can get buildup of CO2 and lose concentration of oxygen = 21% and now mask

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13
Q

Semi-Open System

A
  1. Facemask or ETT
  2. Pop-off Valve
  3. Reservoir tubing
  4. Fresh gas inlet
  5. Reservoir bag
    Example: Mapleson A-F, Bain, Circle
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14
Q

Mapleson Functional Groups

A

Group 1: Mapleson A: popoff valve located near the face mask, FGF located at opposite ends
Group 2: Mapleson B & C: with pop-off valve and FGF located near facemask
Group 3: Mapleson D,E,F: FGF located near face mask and pop off valve located at opposite end. This is opposite of Mapleson A

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15
Q

CO2 Rebreathing

A

Fresh gas inflow rate
Minute ventilation of gas
Type of ventilation (spontaneous or controlled)

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16
Q

Mapleson D

A

Reversed configuration of Mapleson A
Both spontaneous and controlled ventilation
Spontaneous: FGF = 2-3 x MV
Controlled: FGF = 1-2 MV
Most efficeint during controlled Ventilation

17
Q

Which Mapleson to use?

A

Controlled Ventilation: D > B > C > A
Dead Bodies Can’t Argue
Spontaneous Ventilation: A > D > C > A
All Dogs Can Bite

18
Q

Mapleson E

A

No Reservoir bag; expiratory limb is the reservoir bag and no pop-off valve
Used in PACU setting

19
Q

Mapleson F

A

Modification of E with T piece adjustable pop-off valve at the end of the reservoir bag
Pediatric population

20
Q

Bain Circuit

A

Coaxial Modification of Mapleson D
FGF tubing within large bore corrugated tubing allows the exhaled gas to warm the inspired gas and preserves heat and humidity.
Used for controlled or spontaneous ventilation
Disadvantage: potential for inner leak, kinking or disconnect

21
Q

Ambu Bag

A 
Modified Mapleson A with non-breathing valve
Contain non-rebreathing valves
Capable of delivering high FiO2
Reservoir self filling
Requires high fresh gas flow
Depends on minute ventilation
22
Q

Advantage of Mapleson System

A

Simple components
Lightweight
Can provide positive pressure ventilation
Low resistance
Portable
If using inhaled anesthetics, more predictable anesthetic concentration and decreased room pollution

23
Q

Disadvantage of Mapleson System

A

Requires calculations of FGF which varies
Control of anesthetic depth is variable = anesthetic gases will be diluted as FGF increases
If FGF is not maintained, possibility of CO2 buildup and rebreathing is present
Minimal rebreathing of other gases
FGF costly
Requires special assembly and function is complex

24
Q

Circle System

A

Used on anesthesia machine
Hooked to the machine to make a circle
Tubing standard: 22 mm
Can be semi-open, semi-closed or closed system
Depends on the adjustment of APL valve
Fresh gas flow rate differs for each system
Prevent re-breathing of CO2 by chemical neutralization
Allows re-breathing of other exhaled gases

25
Q

Circle System: 7 Components

A
  1. Fresh gas flow source
  2. Inspiratory and expiratory unidirectional valves
  3. Inspiratory and expiratory limbs/corrugated tubing
  4. Y piece connector
  5. APL valve
  6. Reservoir Bag
  7. CO2 absorber
26
Q

Circle System Pathway

A

Form the patient through the

Anethesia (6 decks)

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