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Patient Monitoring/Instrumentation & SIM > Anesthesia Machine > Flashcards

Anesthesia Machine Flashcards

1
Q

Pressure exerted by blood against the interior walls of blood vessels

A

Blood pressure

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2
Q

Why is blood pressure important?

A

It assesses tissue perfusion

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3
Q

What are causes of hypotension?

A

Vasodilation, hypovolemia

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4
Q

What is the equation for Mean Arterial Pressure (MAP)?

A

MAP = (2(diastolic)+systolic)/3

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5
Q

What is a normal MAP?

A

70-100 mmHg

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6
Q

What is the equation for pulse pressure?

A

Systolic-diastolic

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7
Q

What is normal pulse pressure?

A

30-40 mmHg

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8
Q

When pulse pressure is <25% of the systolic pressure

A

Narrow pulse pressure

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9
Q

When pulse pressure is >50% of the systolic pressure

A

Wide pulse pressure

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10
Q

What are consequences to hypertension?

A
  1. Added strain on the heart
  2. Increased oxygen demand on the heart
  3. Possible stroke
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11
Q

What are consequences to hypotension?

A

Decreased tissue perfusion (possible stroke, MI, renal failure, etc)

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12
Q

Normal Sinus Rhythm (NSR)

A

60-100 bpm

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13
Q

Bradycardia

A

<60 bpm

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14
Q

Tachycardia

A

> 100 bpm

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15
Q

Normal SpO2

A

93-100% on room air

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16
Q

Normal EtCO2

A

35-45 mmHg

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17
Q

The amount of carbon dioxide in expired air

A

End tidal

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18
Q

2 functions of the capnograph

A
  1. To show end tidal (EtCO2)

2. To show respiratory rate (RR)

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19
Q

Normal respiratory rate for a spontaneously breathing patient

A

12-20 breaths per minute

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20
Q

Normal RR for a patient on the ventilator

A

8-12 breaths per minute

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21
Q

Normal core body temperature

A

36-38 C

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22
Q

Normal room temperature

A

23 C

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23
Q

What is the purpose for the anesthesia machine?

A
  1. To ventilate a patient with positive pressure ventilation

2. To deliver anesthetic gases to keep the patient asleep

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24
Q

What are the two types of gases in anesthesia?

A 
Volatile agents (Sevoflurane, Isoflurane, Desflurane)
Fresh gas flow (nitrous oxide, oxygen, air)
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25
Q

What does the anesthesia circuit do?

A

It connects the machine to the patient so that anesthetic gases can be inhaled

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26
Q

What does the anesthesia machine do?

A

Delivers anesthetic gases to the patient

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27
Q

Where the gases of the machine travel through to get to the patient’s airway

A

Inspiratory limb

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28
Q

Where the patient’s exhaled gases travel back to the machine

A

Expiratory limb

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29
Q

Filters out bacteria and viruses, humidifies dry gases

A

Humidifier

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30
Q

Measures the patient’s exhaled gases (oxygen, CO2, volatile agents)

A

Gas sampling line

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31
Q

Why is oxygen used to carry the volatile agent to the patient?

A
  1. Higher FiO2 compensates for atelectasis
  2. Some patients with lung disease may require higher FiO2 to have an adequate O2 level during anesthesia
  3. Higher FiO2 allows patient to maintain adequate oxygen saturation for longer periods in the case of apnea at the end of surgery
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32
Q

Why is nitrous oxide used to carry the volatile agent to the patient?

A
  1. It is the only anesthetic gas with analgesic properties

2. Allows lower concentrations of a volatile agent to be used

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33
Q

Why is air used to carry the volatile agent to the patient?

A

Allows for lower FiO2, which is good because:

  1. Too much oxygen for too long can cause toxicity
  2. Higher FiO2s can cause absorption atelectasis
  3. FiO2 above 30% and/or use of nitrous oxide can increase risk for airway fires in the case of lasers or cautery in the pharynx/larynx
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34
Q

What are the two sources for fresh gas flow?

A
  1. Wall supply

2. E cylinder (tank)

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35
Q

Where wall supply fresh gas flow starts

A

H cylinders under high pressure (2,000 psi for O2)

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36
Q

Pressure inside wall supply

A

50 psi (high pressure)

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37
Q

Pressure of flow inside the anesthesia machine

A

16 psi (low pressure)

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38
Q

Name of the knobs that turn on fresh gas flow gases

A

Rotameters or flow control valves

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39
Q

The portion of the anesthesia machine where fresh gas flow gases enter the pathway

A

Flowmeters

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40
Q

Flowmeters with a bobbin

A

Thorpe Tube Flowmeter

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41
Q

Why flowmeters are oriented with oxygen downstream

A

To prevent a hypoxic mixture from being delivered to the patient

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42
Q

The maximum nitrous oxide to oxygen ratio

A

3:1

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43
Q

The minimum oxygen concentration allowed with nitrous oxide

A

25%

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44
Q

Two index safety systems to prevent hooking up the wrong fresh gas flow

A
  1. Diameter Index Safety System (DISS) -wall supply

2. Pin Index Safety System (PISS) -gas tank

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45
Q

10 parts to the Low Pressure Pathway

A
  1. Flowmeters
  2. Common Manifold
  3. Vaporizers
  4. Fresh (common) gas outlet
  5. Inspiratory tubing of circuit
  6. Patient
  7. Expiratory tubing of circuit
  8. Rebreathing bag or ventilator
  9. CO2 absorber and APL valve
  10. Exhaled gas joins fresh gas outlet
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46
Q

Reduces the pressure of gas from wall supply to 16 psi

A

2nd stage regulator

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47
Q

Controls the amount of pressure within a circuit by taking excess gas away from circuit and preventing excess pressure build up

A

Scavenging system

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48
Q

Controls the amount of gas going to scavanging

A

APL valve (Adjustable Pressure Limiting valve)

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49
Q

APL valve controls:

A
  1. The amount of fresh gas flow that goes to scavenging
  2. The amount of gas that a patient rebreathes
  3. The amount of pressure in a circuit
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50
Q

APL is open

A

Increases the volume of gas that goes to scavenging and decreases the volume of gas and pressure that stays in the circuit
Makes it impossible to breathe for the patient because the bag won’t inflate

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51
Q

APL is partially closed

A

Decreases the volume of gas that goes to scavenging and increases the volume of gas that stays in the circuit
Increase pressure in the circuit
Perfect for positive pressure ventilation

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52
Q

APL is fully closed

A

No gas can go to scavenging
Pt will rebreathe their exhaled gas
The volume and pressure of lungs and circuit will become dangerously high

53
Q

What does pressing the Oxygen Flush Valve do?

A

Allows 50psi (high pressure) to enter the circuit at a rate of 35-75 L/min

54
Q

Why use the oxygen flush valve?

A

If there was a leak in the circuit making it difficult to build up pressure within the circuit AFTER the APL valve is closed

55
Q

What are examples of possible circuit leaks?

A
  1. ETT cuff deflated
  2. Loose mask seal
  3. Cap off humidifier
  4. Gas sampling line connections
  5. Disconnected inspiratory or expiratory limbs
56
Q

How can you increase circuit pressure?

A
  1. Turn up the fresh gas flow
  2. Close the APL valve
  3. Press the oxygen flush button
  4. Avoid a leak in the circuit
57
Q

What are guidelines for circuit pressure?

A

When the APL valve is open, the pressure gauge reads 0 cmH2O
When the APL valve is closed, the pressure gauge shows an increase in pressure and reads higher when a positive pressure breath is delivered by bag or ventilation

58
Q

What are the guidelines for delivering positive pressure ventilation?

A
  1. Do not exceed 20cmH2O pressure when ventilating via mask or LMA -why? air could possibly enter the stomach at higher pressures
  2. Do not exceed 40cmH2O pressure when ventilating via ETT -why? Barotrauma of the lungs can occur at high pressures
59
Q

What is bag mode?

A

Manual/Spontaneous mode
The ventilator is not turned on and is not part of the circuit
When the pt inhales, the breathing bag deflates
When the pt exhales, the breathing bag expands
The breathing bag may be used to provide positive pressure breaths if needed

60
Q

What is ventilator mode?

A

The ventilator will be delivering positive pressure breaths.

On newer machines, both the ventilator and the breathing bag are part of this circuit

61
Q

When would you use ventilator mode?

A

For prolonged cases where positive pressure ventilation is needed

62
Q

When would you use bag mode?

A
  1. For short term positive pressure ventilation for temporary apnea such as after induction/before intubation, failed intubation, oversedation, loss of airway after extubation or other unexpected apnea
  2. When positive pressure ventilation is needed on a patient that is not intubated
  3. Spontaneous ventilation
63
Q

When is it okay to use the ventilator with mask ventilation?

A

If there is no provider in the room to squeeze the bag

64
Q

How can you help a patient “tolerate” the ventilator?

A

Long term- administer muscle relaxants, give higher doses of narcotics
Short term- give propofol

65
Q

Refers to a patient breathing on their own, rather than the anesthetist breathing for them

A

Spontaneous ventilation

66
Q

Refers to an anesthetist squeezing the bag (delivering positive pressure) as the patient starts to inhale

A

Assist ventilation

67
Q

Why would you use assist ventilation?

A

For patients that aren’t taking deep enough breaths on their own and need assistance

68
Q

How do you use assist ventilation?

A

Can use bag mode (manual/spontaneous) or Pressure Support

69
Q

Refers to an anesthetist breathing for a patient with positive pressure ventilation

A

Control/Manual ventilation

70
Q

What settings can you control on the machine?

A
  1. Tidal volume (Vt)
  2. Respiratory Rate (RR)
  3. Peak Inspiratory Pressure (PIP)
  4. Positive End Expiratory Pressure (PEEP)
  5. Continuous Positive Airway Pressure (CPAP)
  6. Inspiratory to Expiratory Ratio (I:E)
  7. Inspiratory Time (Ti)
71
Q

What is a normal tidal volume?

A

Traditionally, 5-10 ml/kg

Recently, 6-8 ml/kg with higher RR

72
Q

Describe the volume/pressure relationship in the lungs

A

The pressure inside the lungs is proportional to the volume delivered
The higher the tidal volume, the higher the inspiratory pressure

73
Q

Slower respiratory rates lead to:

A

Longer breaths
Longer inspirations
Lower pressure

74
Q

Faster respiratory rates lead to:

A

Shorter breaths
Shorter inspirations
Higher pressure

75
Q

The maximum amount of pressure you are willing to give in order to expand the patient’s lungs with a ventilator breath

A

Peak Inspiratory Pressure (PIP), or Pmax

76
Q

Common causes of High Peak Inspiratory Pressure

A
  1. R mainstem intubation
  2. Bronchoconstriction/bronchospasm
  3. Coughing/bucking on the ventilator
  4. Trendelenburg
  5. Insufflation pressure from laproscopic surgery
  6. Increased resistance through the ETT
  7. Too high of tidal volume
  8. Too fast of respiratory rate/too short inspiratory time
77
Q

The first sign of R mainstem intubation**

A

Elevated peak inspiratory pressure

78
Q

Leaving a small amount of positive pressure in the lungs at the end of expiration

A

Positive End Expiratory Pressure (PEEP)

79
Q

Purpose of PEEP

A

To prevent atelectasis

80
Q

Normal amount of PEEP

A

5cmH2O

81
Q

Leaving a small amount of positive pressure in the lungs at all times

A

Continuous Positive Airway Pressure (CPAP)

82
Q

When would you use CPAP?

A
  1. Preoxygenation in obese patients
  2. Intubated patients undergoing lung surgery
  3. Laryngospasms
  4. In the recovery room for patients with sleep apnea
83
Q

Normal I:E ratio

A

1:2 Expiratory time is 2x as long as inspiratory time

84
Q

True/false: We can increase inspiratory time by decreased respiratory rate

A

True

85
Q

What does increasing inspiratory time do?

A

Decreases peak inspiratory pressure

Decreases expiratory time

86
Q

What is a consequence to increasing inspiratory time?

A

Shorter expiratory time can cause incomplete exhalation, which can cause overinflation of the lungs (Auto PEEP)

87
Q

How do you prevent Auto PEEP in COPD patients?

A

Increase expiratory time (1:2.5)

88
Q

Normal inspiratory times?

A

Young patients: fast respiratory rates and low lung volumes require shorter inspiratory times (0.3-0.5 seconds in neonates)
Adult patients: slower respiratory rates and high lung volumes require longer inspiratory times (2 seconds)

89
Q

Faster respiratory rate does what to inspiratory times and peak pressure?

A

Faster respiratory rate = shorter inspiratory times and higher peak pressure

90
Q

What is volume control ventilation?

A

The ventilator will deliver the tidal volume you set regardless of the amount of pressure it takes

91
Q

How do you prevent using too high of a pressure in volume control ventilation?

A

Set a limit for the amount of positive pressure the vent can generate

92
Q

What are the consequences to volume control ventilation?

A
  1. You can create high peak inspiratory pressures if airway resistance is increased or if there is increased resistance to diaphragm expansion
  2. You can accidentally overinflate a small patient’s lungs
93
Q

What is pressure control ventilation?

A

You set the amount of positive pressure you want generated with each breath and the lungs will expand until that pressure is reached

94
Q

What are advantages to pressure control ventilation?

A
  1. The ventilator will never exceed that amount of positive pressure (pulmonary injury is less likely)
  2. The lungs should never become overinflated (or receive too high of a tidal volume), because the breath will be delivered with an acceptable amount of pressure
95
Q

What are consequences to pressure control ventilation?

A
  1. You don’t know what tidal volume the ventilator will give

2. Tidal volumes can change when things in surgery change (tidal volume will be lower with increased resistance)

96
Q

In volume control ventilation, how will increasing the respiratory rate change the tidal volume and peak inspiratory pressure?

A

Tidal volume: No change

PIP: Increase

97
Q

In pressure control ventilation, how will increasing the respiratory rate change the tidal volume and peak inspiratory pressure?

A

Tidal volume: Decrease

PIP: No change

98
Q

In volume control ventilation, how will changing the I:E ratio from 1:2 to 1:3 change the tidal volume and peak inspiratory pressure?

A

Tidal volume: No change

PIP: Increase

99
Q

In pressure control ventilation, how will changing the I:E ratio from 1:2 to 1:1 change the tidal volume and peak inspiratory pressure?

A

Tidal volume: Increase

PIP: No change

100
Q

What patients are at risk for experiencing high peak inspiratory pressure?

A
  1. Obese patients
  2. Patients undergoing laproscopic surgery
  3. Patients in Trendelenburg
101
Q

What are techniques for reducing inspiratory pressure during positive pressure ventilation?

A
  1. Ensure the patient is paralyzed or deeply anesthetized
  2. Intubate with a larger diameter ETT
  3. Place the patient in pressure control ventilation
  4. Increase inspiratory time
  5. Decrease the respiratory rate and/or tidal volume -will decrease minute ventilation and can cause SpO2 and EtCO2 to drop
  6. Cut the length of the ETT
  7. Ask the surgeon to decrease insufflation pressure/Trendelenburg
102
Q

The ability of a container to expand when pressure is added to it

A

Compliance

103
Q

True/false: Something with high compliance will expand more easily

A

True

104
Q

What is the compliance equation?

A

pulmonary compliance = change in volume (ml) / change in pressure (cmH2O)

105
Q

The ability of a container to return to it’s original volume after the pressure inside the container is released

A

Elasticity

106
Q

True/false: Things with low elasticity will deflate rapidly

A

False

107
Q

True/false: Things with high compliance will have low elasticity

A

True

108
Q

Why do COPD patients and smokers have compliant lungs?

A

The lungs can expand great, but are slow to deflate. It is difficult for them to exhale and air can get “trapped” in the alveoli

109
Q

If a patient has a pulmonary compliance of 15 ml/cmH2O and they’re being ventilated (positive pressure ventilation) with 30 cmH2O, what is their tidal volume?

A

15 ml/cmH2O = V/30cmH2O

V= 450 ml

110
Q

Forced exhalation against a closed glottis

A

Valsalva maneuver

111
Q

The Valsalva maneuver results in:

A
  1. Increased intrathoracic pressure
  2. Decreased venous return (preload)
  3. Decreased arterial blood pressure
112
Q

Why would a patient “bear down” or “blow through a straw”?

A

To complete the Valsalva Maneuver as a vagal response for SVT

113
Q

How does an anesthetist perform a Valsalva Maneuver?

A
  1. Close the APL valve
  2. Deliver positive pressure through the breathing bag
  3. Hold for several seconds at 30-40 cmH2O
114
Q

Indications for performing the Valsalva Maneuver

A
  1. “Recruits” alveoli to treat atelectasis
  2. Allows a surgeon to see an air leak after lung surgery
  3. Allows a surgeon to check for a dura leak after neurosurgery
115
Q

Measures the patient’s exhaled tidal volumes

A

Spirometer

116
Q

Analyzes which gases and what concentrations are being used

A

Spectrometer

117
Q

Reveals the FiO2

A

Oxygen Analyzer

118
Q

Prevents an accidental overdose of nitrous oxide if the O2 wall supply falls below 25 psi

A

Fail safe valve

119
Q

Prevents positive pressure ventilation from being transmitted back to the vaporizers and flowmeters

A

Check valve

120
Q

Used in MAC cases for supplemental oxygen

A

Auxiliary oxygen flowmeter

121
Q

The most important thing to set up in the OR

A

Suction

122
Q

Indicates the presence of a problem even though no problem exists

A

False positive result

123
Q

Occurs when an alarm indicates there isn’t a condition present when in reality, there is

A

False negative result

124
Q

True/false: Alarms with high sensitivity will have a higher false positive rate

A

True

125
Q

True/false: Alarms with high specificity has a lower false positive rate

A

True

126
Q

When does the low pressure oxygen alarm go off?

A

When the wall supply pressure goes below 30 psi

127
Q

When does the low inspired oxygen alarm go off?

A

When the FiO2 is low

128
Q

When does the high circuit pressure go off?

A

When too much positive pressure is being delivered while ventilating the patient

129
Q

When does the sustained airway pressure alarm go off?

A

When there is a continuous increase in circuit pressure

Patient Monitoring/Instrumentation & SIM (12 decks)

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