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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
What does the Oxygen Flush Valve do?
* 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
26
Where is the low pressure system of an anesthesia machine?
* Downstream of the flowmeter * vaporizers * common gas outlet * circle or non-rebreathing circuit * Slight above atmospheric pressure * less than 1 psi
27
What do vaporizers do
* Change liquid anesthetic into a vapor * And a controlled amount of anesthetic vapor to the flow of oxygen to the patient
28
What were early vaporizers like?
* 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
What do modern vaporizers do?
* Volatilize liquid inhalant anesthetic * isoflurane * sevoflurane * Delivers precise concentrations that are chosen using the dial * Controls the concentration delivered to the breathing circuit
30
What are some properties of Modern Vaporizers?
* 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
What are multiple agent vaporizers?
sevoflurane or isoflurane may be used separately in the same vaporizer
32
What are the methods of regulating output concentration?
* Variable bypass * most common method in veterinary applications * Measured flow * complex * Not recommended for professionals who are not dedicated anesthetists
33
How is the anesthetic gas vaporized?
* Flow-over * gas flows over the liquid anesthetic * with a wick (most common) * increases surface area * without a wick
34
What do wicks in a vaporizer do?
* Increase surface area for vaporization * efficient in broad range of temperature * insure complete saturation of gas passing through the vaporization chamber
35
How do Vaporizers outside of the breathing circuit work?
* 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
What vaporizers inside the breathing circuit?
* 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
What is the fresh gas outlet?
* after the vaporizer * oxygen flows out * has not been inhaled or exhaled
38
What are the different breathing systems for anesthesia machines?
* Circle breathing system * Non-rebreathing system
39
What is a circle breathing system?
* 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
What are the components of a Circle breathing system?
* Y piece * Breathing tubes * Uni-directional valves * Fresh gas inlet * Canister (CO2 absorber) * Relief (pop off) valve * Rebreathing bag * Pressure gauge
41
What is a y-piece?
* Adapts to endotracheal tube connector * 15 mm female (for small animal circuits) * Connects to breathing tubes * 22 mm male (for small animal circuits)
42
What are the breathing tubes?
* Corrugated to prevent crimping * Construction: * light weight plastic * 22 mm inside diameter * Rubber no longer used - absorbed anesthetic
43
What are the sizes of Y-piece and breathing tubes for large animals?
* 2" corrugated tubing * Specialized connectors for large endotracheal tubes * Leur connector for gas sampling connection
44
What are Unidirectional valves?
* 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
What is the Fresh gas inlet to the circle breathing system?
* 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
What is the CO2 Absorber and canister?
* 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
What is the Surgivet soda lime canister?
* Flow through canister is “U” shaped * Flow enters top on right side * At bottom canister flow truns upward * Flow exits top left side
48
What is Soda Lime (Carbolime™)
* 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
How does one know when the Soda Lime is exhausted?
* 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
What is the Reservoir bag?
* Must exceed patients largest tidal breath * small animal - 4x tidal breath size * Calculate tidal breath as 10-15 ml/kg * compliant material
51
What is the Breathing circuit Manometer?
* Indicates pressure in the breathing circuit * Graduated in cmH2O * Older manometers were graduated in mmHg
52
What is the Pop-off valve (pressure relief valve)?
* 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
What are the dangers of Pop-Off valves?
* 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
What is the flow of gases during inspiration in a circle system?
no anesthetic added yet
55
What are the flow of gases during exhalation in a circle system?
no anesthetic added yet
56
How do gasses flow when aneshetic agent is added to the circle system?
anesthetic = yellow
57
What are the recommended flowmeter settings for Circle systems? Why?
* 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
Where does the excess gas in the circle system go?
goes out pop-off
59
What are the advantages of Non-rebreathing systems compared to circle systems?
* Low resistance to breathing * Simple design * usually no valves * light weight * inexpensive
60
What are the disadvantages of Non-rebreathing systems compared to circle systems?
* 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
What are the common non-rebreathing circuits?
* Bain Circuit * Modified Jackson Rees * Arye's T-piece * Norman Elbow
62
What is the Bain circuit adaptor?
* Airway pressure manometer * Pop-off valve * Custom pressure relief valve * Bain breathing circuit * Fresh gas connecting hose
63
How does gas move through the Bain breathing circuits?
64
What should the carrier gas flow be set to for a non-rebreathing system?
* 200 ml / kg / min * Rebreathing of expired gas containing CO2 is eliminated if appropriate fresh gas flows are supplied
65
What is scavenging waste anesthetic gas?
* 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
How does activated charcoal scavenge waste gas?
* 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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