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Anesthesia Concepts > Anesthesia Systems > Flashcards

Anesthesia Systems Flashcards

1
Q

Requirements of breathing system 4

A
  • deliver gas to alveoli in same concentration as set at shortest time possible
  • eliminate co2
  • minimal apparatus dead space
  • low resistance
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2
Q

Desirable for breathing system to: 8

A

Economy of fresh gas, conserve heat, humidify inspired air, light weight, convenient, efficient in spontaneous and controllent vent, adapt to adults and peds, reduce pollution

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3
Q

How machines minimize resistance

A

Short tubing, large diameter, avoid sharp bends, caution w valves, minimize connections

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4
Q

Rebreathing

Why its good and bad

A

Reduces cost, adds humidification

Bad to rebreath co2

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5
Q

Higher fresh gas flow associated with what

A

Less rebreathing of any circuit

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6
Q

Dead space- increases chance of what

Where it is

A

Rebreathing co2. Where inspiratory and expiratory gas streams diverge

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7
Q

How to minimize dead space in system

A

Separate ins and exp limbs as close to pt as possible

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8
Q

Open systems characterized by 3

2 types

A

No: gas reservoir bag, valves, or rebreathing of exhaled gas

Insufflation/blow by, open drop

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9
Q

Ex of insufflation

A

Nasal cannula, head drape, steal induction (mask), bronchoscope port

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10
Q

Advantages of insufflation 4

A

Simple, avoids direct pt contact, no co2 rebreathing, no reservoir bags or valves

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11
Q

Disadvantages of insufflation 4

A

No ability to assist/control ventilation, may have co2/o2 accumulation under drapes, no control of anesthetic depth or fio2, environmental pollution

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12
Q

Schimmelbusch mask
What it is
Problems

A

Open circuit, cloth saturated with anesthetic over mask

Can cause hypoxia or too much drug

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13
Q

Open drop method
Example
Advantages 3

A

Ether mask

Simple, low cost, portable

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14
Q

Open drop method

Disadvantages 5

A

Poor control of inspired anesthetics, accumulate co2 under mask, hypoxia risk, spontaneous vent only, OR pollution and HCP risk

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15
Q

Semi open systems: 5 components

A 
Face mask or ETT
Pop off valve (APL) 
Reservoir tubing 
Fresh gas inlet 
Reservoir bag
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16
Q

Examples of semi open systems

A

Mapleson A-F
Bain
Circle

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17
Q

Group 1 maplesons
Which letters
Where stuff located

A

A

Pop off valve near face mask, FGF at opposite end

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18
Q

Group 2 maplesons
Which
Where stuff is

A

B and C

Pop off valve and FGF near face mask

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19
Q

Group 3 maplesons
Letters
Where stuff is
Opposite of what

A

D, E, F
FGF near face mask, pop off valve at opposite end
Mapleson A

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20
Q

Co2 rebreathing depends on 3

A

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

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21
Q

APL ___ to exhale w less resistance. ___ APL for positive end pressure

A

All the way open

Somewhat closed

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22
Q

Mapleson A best for what

A

Spontaneously breathing pts, dont need as much fresh gas flow, only need 1-2x minute ventilation of gas flow
`

23
Q

Mapleson d best for what

A

Controlled ventilation

24
Q

Mapleson D
Can be used for
FGF x mv what
Most __ mapleson during ___ ventilation

A

Spontaneous and controlled ventilation
2-3 spont, 1-2 controlled
Efficient, controlled

25
Q

Mapleson E (__ __)
Most commonly used where
No __ __ and no __ __ __
If spontaneous, fgf what

A

T piece
Icu and pack
No reservoir back or apl valve
2-3

26
Q

Mapleson f (__ __)
Modification of mapleson __
Difference
Popular for who

A

Jackson reese
E
Pop off valve and reservoir bag
Peds

27
Q

Bain circuit
Modification of which mapleson
FGF tubing is where and allows what

A

D
Fgf inside of large corrugated tubing
Exhaled gas warms inspired gas, preserves heat and humidity

28
Q

Bain circuit
Used for 2
FGF reqs
Disadvantage

A

Controlled or spontaneous vent
Same as mapleson d
Potential for tube leaks, kinking, disconnection

29
Q 
Ambu bag 
Modified mapleson \_\_ which what 
Capable of delivering what 
Reservoir is \_\_ \_\_ 
Requires \_\_ fresh gas flow 
Depends on \_\_ \_\_
A 
A, non rebreathing valve 
High fio2 
Self filling 
High 
Minute ventilation
30
Q

Advantages of maplesons

6

A

Simple, lightweight, can provide positive pressure, low resistance, portable, more predictable and less room pollution w anesthetics

31
Q 
Disadvantages mapleson 
Requires: 
Control of what is variable: 
Possibility of what if fgf not maintained:
Poor conservation of what
2
A 
Calculation of fgf which varies with type of circuit and vent mode
Anesthetic depth 
Co2 build up 
Heat and humidity 
Costly, special assembly
32
Q

Circle system
Can be used as: depends on what, what varies for each
Prevents what
Allows what

A

Semi open, semi closed, or closed. Apl valve adjustment and fgf
Rebreathing of co2
Rebreathing of other exhaled gases

33
Q

Circle system components: 7

A

Fresh gas flow source
Ins and exp unidirectional valves
Ins and exp limbs/corrugated tubing
Y piece, Apl, reservoir bag, co2 absorber

34
Q

Order of circle system path 7

A

Y piece, ins limb, inhalation check valve
Fresh gas inlet, co2 canister, apl valve
Reservoir bag

35
Q

Reservoir bag
Made of what
Neck is what
Tail is what

A

Neoprene or rubber
22 mm female fitting into male system
End opposite neck

36
Q

Reservoir bag

Functions 4

A

Accumulation of gas during exhalation
Assist/control vent
Visual/tactile monitor to see breathing
Protects against excessive pressure

37
Q

Breathing tubes
Material 2
Size, what fits to machine
Pt end is what

A

Plastic or rubber
22 mm female fits w machine
T piece 22 mm male 15 mm female coaxial fit

38
Q

Breathing tubes

Functions 4

A

Reservoir, flexible, lightweight connection, low resistance

39
Q

APL valve
Releases gas where
Clockwise does what
Provides control of what in system, where gauge is

A

Scavenge or atmosphere exhaust port
Closes valve and increases pressure
Pressure, on absorber

40
Q

Apl valve:
spontaneous resp- Valve should be what
What for assist vent
Mechanical vent

A

Spont: fully open, partially closed only if reservoir bag collapses
Assist: partially open, bag squeeze on ins
Mech: valve closed

41
Q

Peak airway inspiratory pressure

A

15-20 mmhg

42
Q

If unidirectional valve working properly only dead space in circle system is where

A

Between y piece and patient

43
Q

Adding extensions where increases dead space

A

Beyond y piece near pt

44
Q

Circle system must follow rules:
Unidirectional valves between what on what
FGF cant enter system where
APL cant be located where

A

Pt and reservoir bag on ins and exp limbs
Between exp valve and pt
Pt and ins valve

45
Q 
Semi open circle system 
When used 
What doesnt occur 
What it requires 
No conservation of what
APL is
A 
Not often, for sedation 
Rebreathing 
High flow of gas, 10-15 to eliminate re breathing 
Gases and heat 
All the way open
46
Q 
Semi closed circle system 
\_\_ \_\_ breathing system 
Requires what kind of flow rate 
\_\_\_ heat and gas 
Some \_\_ \_\_ of agents 
Apl valve what
A 
Most common 
Low flow rate, 1-3 lpm 
Conserves 
Re breathing 
Partially closed, can be adjusted
47
Q 
Closed circle system 
Where its used 
Inflow gas matches what 
Rebreathing is what 
Conservation is what
Apl valve is
A 
3rd world countries 
Metabolic needs of pt 
Total rebreathing after co2 absorbed 
Total of exhaled gases 
Closed
48
Q

O2 consumption how to calculate

A

10 x kg ^3/4

49
Q

Advantages circle system

A

Stability of inspired gases, conserves moisture and heat, prevents or pollution, can be used for closed system anesthesia, can be used w low flows w no rebreathing co2, economy of anesthetics and gases, can scavenge waste gases

50
Q

Disadvantages circle system

A

Complex, 10 connections (leak potential), malpractice claims, potential malfunctioning valves, increased resistance of breathing, less portable than mapleson

51
Q

Circle system leak test, how to

A

Set gas flows to zero, occlude y piece, close apl, pressurize circuit to 30 cm h20 using flush valve, make sure p holds 10 seconds, listen for sustained pressure alarm, open apple valve and make sure pressure decreases

52
Q

Circle leak test doesnt do what

A

Assess integrity of unidirectional valves

53
Q

Circle system test: flow test

A

Attach breathing bag to y piece, turn on vent, assess integrity of unidirectional valves

54
Q

Do which circle system check every case

A

Flow test

Anesthesia Concepts (12 decks)

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