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Surgery I > Anesthetic equipment > Flashcards

Anesthetic equipment Flashcards

1
Q

OBJ: ID the different parts of the anesthetic machine and understand the function of each

A
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2
Q

OBJ: ID the high, medium, and low pressure parts of the anesthetic machine

A
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3
Q

OBJ: follow the flow of O2 from the source (gas cylinder/wall outlet) through the anesthetic machine to the fresh gas outlet

A
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4
Q

OBJ: Understand the basic function and differences of anesthetic vaporizers

A
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5
Q

What is PSI

A
  • pounds per square inch
    • for compressed medical gases
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6
Q

What is cmH2O

A
  • cm of water
  • Airway pressure
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7
Q

what is mmHg

A
  • mm of mercury
  • blood pressure measurements
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8
Q

what is 1 PSI in mmHg? in cmH2O?

A
  • 1 psi = 52 mmHg
  • 1 psi = 70 cmH2O
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9
Q

What are the psi, cmH2O, mmHg of a full oxygen cylinder?

A
  • 2200 psi
  • 154,682 cmH2O
  • 113,784 mmHg
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10
Q

Are there standards for anesthesia machine manufacturing?

A
  • American Society for Testing and Material
    • HUMAN machines must meet ASTM standards
  • Vet machines not required to meet similar standards
    • International Standards Organization (ISO) standards are required to be met in some countries (NOT US)
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11
Q

What do Anesthesia Systems do?

A
  • Deliver Oxygen
  • Deliver anesthetic gases
  • Remove carbon dioxide
  • Provide a means of intermittent positive pressure ventilation (IPPV)
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12
Q

What are the common features of anesthesia machines

A
  • Gas source (oxygen)
  • Pressure regulator
  • Flow meter
  • Vaporizer
  • Fresh gas outlet
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13
Q

What are some sources for gas (O2)

A
  • Liquid Oxygen Bulk Tank
  • Medical Gas Piping system
  • High pressure cylinders
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14
Q

What are Liquid oxygen systems?

A
  • Liquid O2 in high use environments is much more economical
  • Small hospitals can use liquid O2 delivered in cylinder shaped carboys
  • Liquid systems re attached to a pipeline system to distribute O2 to the outlets in the hospital
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15
Q

What is a Medical gas piping system?

A
  • Serves all medical gas wall outlets and ceiling drops placed strategically around the hospital
  • Piping systems deliver gas in a preset, functional pressure range
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16
Q

What are high pressure Medical Gas Cylinders?

A
  • Color coded
  • Pin coded
  • Thread Diameter and size coding (CGA)
  • Handle all cylinders in a safe fashion
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17
Q

What does a Oxygen gas cylinder look like? state of O2?

A
  • Green Cylinder
  • Full - 2200psi
  • Physical state - compressed gas
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18
Q

What does a Medical air gas cylinder look like? state of medical air?

A
  • Yellow cylinder
  • Full - 2200 psi
  • Physical state - compressed gas
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19
Q

What does a NO gas cylinder look like? state of NO?

A
  • Blue cylinder
  • 745 psi @ 21 degrees
  • Physical state - liquid, gas interface
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20
Q

What are the pin codes on E-cylinders?

A
  • 2 pin on each yolk - 2 holes in each tank stem
  • Unique pin location for each medical gas
  • O2 - 2&5
  • NO - 3 & 5
  • Medical Air - 1 & 5
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21
Q

What does the pressure gauge do?

A
  • Indicates current cylinder pressure
  • Reflects gas quantity with compressed gases
  • Does NOT indicate quantity in gases in a liquid state with gas interface (N2O)
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22
Q

Why does a Nitrous Oxide cylinder always read 745 until suddenly reading 300 psi?

A

Nitrous Oxide is liquid vapor interface. PSI reads 745 (psi of vapor) until all the liquid is gone

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23
Q

What does the pressure regulator do? location?

A
  • Decreases pressure to 37 - 55 psi
  • Located between the high pressure system and the intermediate pressure system
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24
Q

What is the flowmeter assembly?

A

Controls, measures, ad indicates the rate of flow of gas passing through the flowmeter

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25
Q

What does the Oxygen Flush Valve do?

A
  • Delivers a high flow of oxygen to the breathing circuit
  • 35-75 liters/min
  • bypasses the flow meter
  • Bypasses the vaporizer
  • Dilutes and flushes out anesthetic gases from the breathing circuit
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26
Q

Where is the low pressure system of an anesthesia machine?

A
  • Downstream of the flowmeter
    • vaporizers
    • common gas outlet
    • circle or non-rebreathing circuit
  • Slight above atmospheric pressure
    • less than 1 psi
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27
Q

What do vaporizers do

A
  • Change liquid anesthetic into a vapor
  • And a controlled amount of anesthetic vapor to the flow of oxygen to the patient
28
Q

What were early vaporizers like?

A
  • Gauze masks or glass jars in which oxygen flowed through tor over the anesthetic
  • limited or no control of anesthetic concentration
  • usually adjusted “to effect”
    • ie put mask on, pull mask off
29
Q

What do modern vaporizers do?

A
  • Volatilize liquid inhalant anesthetic
    • isoflurane
    • sevoflurane
  • Delivers precise concentrations that are chosen using the dial
  • Controls the concentration delivered to the breathing circuit
30
Q

What are some properties of Modern Vaporizers?

A
  • Agent specific
  • Precision - puts out what dial is set to
  • Variable bypass
  • ‘flow over’ vaporization with a wick
  • Out of the breathing circuit
  • Temperature compensated
  • Flow compensated
31
Q

What are multiple agent vaporizers?

A

sevoflurane or isoflurane may be used separately in the same vaporizer

32
Q

What are the methods of regulating output concentration?

A
  • Variable bypass
    • most common method in veterinary applications
  • Measured flow
    • complex
    • Not recommended for professionals who are not dedicated anesthetists
33
Q

How is the anesthetic gas vaporized?

A
  • Flow-over
    • gas flows over the liquid anesthetic
      • with a wick (most common)
        • increases surface area
      • without a wick
34
Q

What do wicks in a vaporizer do?

A
  • Increase surface area for vaporization
  • efficient in broad range of temperature
  • insure complete saturation of gas passing through the vaporization chamber
35
Q

How do Vaporizers outside of the breathing circuit work?

A
  • Fresh gas inflow provides carrier gas
  • Not affected by ventilation of patient
  • Safer for IPPV
  • No water condensation in vaporizer
  • Requires a precision vaporizer
36
Q

What vaporizers inside the breathing circuit?

A
  • Vaporizer is on the inspiratory arm of the breathing circuit
  • Inspiratory patient air flow provides the carrier gas for the anesthetic
  • An increase in ventilation increases the vaporization of the anesthetic, thus increasing the concentration in the circuit non-precision
  • Anesthetic concentration is unknown
  • Water condenses in the vaporizer and into the liquid inhalant anesthetic
37
Q

What is the fresh gas outlet?

A
  • after the vaporizer
  • oxygen flows out
    • has not been inhaled or exhaled
38
Q

What are the different breathing systems for anesthesia machines?

A
  • Circle breathing system
  • Non-rebreathing system
39
Q

What is a circle breathing system?

A
  • Basic components are arranged so that gases move in only one direction
  • Gases flow in a circular pathway through separate inspiratory and expiratory channels
  • CO2 exhaled by the patient is removed by an absorbent
  • Small amount of O2 and anesthetic is continuously delivered to the circle system to maintain anesthesia
  • O2 and anesthetic mix with the gases moving in a circular fashion that have been inhaled and exhaled
  • More economical to use than a non-rebreathing system
  • Vaporizer setting does not represent the inspired concentration of anesthetic
  • Unless measured, the inspired concentration of anesthetic is unknown
40
Q

What are the components of a Circle breathing system?

A
  • Y piece
  • Breathing tubes
  • Uni-directional valves
  • Fresh gas inlet
  • Canister (CO2 absorber)
  • Relief (pop off) valve
  • Rebreathing bag
  • Pressure gauge
41
Q

What is a y-piece?

A
  • Adapts to endotracheal tube connector
    • 15 mm female (for small animal circuits)
  • Connects to breathing tubes
    • 22 mm male (for small animal circuits)
42
Q

What are the breathing tubes?

A
  • Corrugated to prevent crimping
  • Construction:
    • light weight plastic
    • 22 mm inside diameter
    • Rubber no longer used - absorbed anesthetic
43
Q

What are the sizes of Y-piece and breathing tubes for large animals?

A
  • 2” corrugated tubing
  • Specialized connectors for large endotracheal tubes
  • Leur connector for gas sampling connection
44
Q

What are Unidirectional valves?

A
  • 2 valves in each circle system
    • inspiratory directional valve
    • Expiratory directional valve
  • Valves direct gas flow toward the patient in one breathing tube and away from the patient in the other tube
  • Both valves must function properly to insure that gas moves in a circular fashion
45
Q

What is the Fresh gas inlet to the circle breathing system?

A
  • Hose connects the fresh gas outlet on the anesthesia machine to the fresh gas inlet on the breathing system
  • Location varies:
    • CO2 absorber canister
    • Inspiratory arm
    • Other options
46
Q

What is the CO2 Absorber and canister?

A
  • Removes carbon dioxide from expired gas
  • Canister should be greater than 2 times patient tidal volume
  • Patient expired gas will enter at the top OR bottom of canister depending on the machine
  • Intra-granular air space must be greater than the maximum tidal volume (recommend 2x)
47
Q

What is the Surgivet soda lime canister?

A
  • Flow through canister is “U” shaped
  • Flow enters top on right side
  • At bottom canister flow truns upward
  • Flow exits top left side
48
Q

What is Soda Lime (Carbolime™)

A
  • Absorbs CO2
  • Soda lime
    • 4% Sodium Hydroxide
    • 12-19% water
    • 75-80% calcium hydroxide
    • Ethyl violet indicator
    • Soda lime will not generate, do NOT reuse after exhausted even if it turns white
49
Q

How does one know when the Soda Lime is exhausted?

A
  • Color change when granules can no longer absorb CO2
  • Nonreversible - soda lime does not regenerate function
  • Usually a violet color indicator
  • Will return to white after patient is removed from the circle system
  • Observe at the end of surgery, change soda lime is ⅓ of canister shows violet
50
Q

What is the Reservoir bag?

A
  • Must exceed patients largest tidal breath
  • small animal - 4x tidal breath size
  • Calculate tidal breath as 10-15 ml/kg
  • compliant material
51
Q

What is the Breathing circuit Manometer?

A
  • Indicates pressure in the breathing circuit
  • Graduated in cmH2O
  • Older manometers were graduated in mmHg
52
Q

What is the Pop-off valve (pressure relief valve)?

A
  • Relieves the breathing system of excess gas if input exceeds uptake by the patient
  • on expiratory side of breathing circle
  • Resistance (minimal <1-2 cm H2O)
  • 19 mm scavenging outlet
  • Unidirectional Flow
  • Modern valves are stem and seat (not just a on and off function)
53
Q

What are the dangers of Pop-Off valves?

A
  • Pop-off valves are closed to give a breath to the patient or to check endotracheal tube seal
  • Closed during mechanical intermittent positive pressure ventilation
  • should be OPEN at all other times
  • Failure to open pop-off valves may result in barotrauma and death
54
Q

What is the flow of gases during inspiration in a circle system?

A

no anesthetic added yet

55
Q

What are the flow of gases during exhalation in a circle system?

A

no anesthetic added yet

56
Q

How do gasses flow when aneshetic agent is added to the circle system?

A

anesthetic = yellow

57
Q

What are the recommended flowmeter settings for Circle systems? Why?

A
  • 30 ml / kg / min
  • Usual mode and oxygen glow after initial 10 - 15 minutes of inhaled anesthesia
  • WHY:
    • supply patients metabolic needs for oxygen
      • anesthetized dogs need 5 - 8 ml / kg / min
    • Higher flows are used to enable us to build increase the anesthetic concentration within the circle breathing circuit more quickly
      • patient inspires combo of fresh gas and rebreathed gas
    • Use higher flow adds expense and increases the amount of waste gas
      • we will increase the flow above 30 ml / kg / min if we are trying to change the
58
Q

Where does the excess gas in the circle system go?

A

goes out pop-off

59
Q

What are the advantages of Non-rebreathing systems compared to circle systems?

A
  • Low resistance to breathing
  • Simple design
  • usually no valves
  • light weight
  • inexpensive
60
Q

What are the disadvantages of Non-rebreathing systems compared to circle systems?

A
  • High gas flow
    • poor economy
    • loss of body heat
    • loss of humidity
  • If carrier gas flow (O2) is too low, rebreathing of CO2 occurs
61
Q

What are the common non-rebreathing circuits?

A
  • Bain Circuit
  • Modified Jackson Rees
  • Arye’s T-piece
  • Norman Elbow
62
Q

What is the Bain circuit adaptor?

A
  • Airway pressure manometer
  • Pop-off valve
  • Custom pressure relief valve
  • Bain breathing circuit
  • Fresh gas connecting hose
63
Q

How does gas move through the Bain breathing circuits?

A
64
Q

What should the carrier gas flow be set to for a non-rebreathing system?

A
  • 200 ml / kg / min
  • Rebreathing of expired gas containing CO2 is eliminated if appropriate fresh gas flows are supplied
65
Q

What is scavenging waste anesthetic gas?

A
  • Attach scavenge system to waste gas outlet on pop-off valve
  • There are passive and active systems for scavenging
    • Passive-
      • activated charcoal canister
    • Active-
      • attached to a vacuum system
      • vents to outside atmosphere
      • Need an interface to prevent positive and negative pressure being reflected back to the breathing circut
66
Q

How does activated charcoal scavenge waste gas?

A
  • Charcoal absorbs halogenated anesthetics
  • Charcoal Canister increases in weight as it absorbs anesthetics
    • Change charcoal when 40 grams have been absorbed
    • total capacity is 50g

Surgery I (37 decks)

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