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Intro to Anesthesiology > Anesthetic Machine Equipment > Flashcards

Anesthetic Machine Equipment Flashcards

1
Q

Considerations

A
  • anesthetic concentration control
  • build up of carbon dioxide
  • consumption of oxygen
  • atmospheric pollution
  • patient size
  • airway control
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2
Q

Liquid anesthetic dissolves ______

A

Organic compounds

  • skin cells/mucosa/eyes
  • wear protective equipment when refilling vaporizer
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3
Q

Is the oxygen source part of the anesthetic machine?

A

No

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4
Q

Anesthetic machine components

A
  • gas source
  • regulator
  • flowmeter
  • vaporizer
  • O2 flush and bypass valves
  • common gas inlet
  • CO2 absorbent canister
  • patient breathing circuit
  • adjustable pressure limiting valve
  • rebreathing bag
  • waste gas scavenger
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5
Q

Regulator

A

Decreases high pressure to intermediate pressure

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6
Q

Flowmeter

A

Allows you to adjust liters/minute of 100% O2 patient is receiving

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7
Q

Vaporizer

A

Contains liquid anesthetic

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8
Q

O2 flush

A

Oxygen from cylinder will bypass flow meter and vaporizer and go directly into the patient’s lungs (dangerous)
- used to remove excess anesthetic after patient is disconnected

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9
Q

Common gas inlet/outlet

A

Where fresh gas (O2 + vapor anesthetic) comes out into the anesthetic circuit

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10
Q

CO2 absorbent

A

Clear/look for color change in beads

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11
Q

Patient breathing circuit

A

Part that is attached to patient ET

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12
Q

APL/Pop-off valve

A

Allows extra pressure from circuit to be relieved

  • when closed all the way, there is no where for air to go (air enters rebreathing bag from patient)
  • when open it allows air to escape, preventing trauma to lungs
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13
Q

Rebreathing bag

A

Attached to anesthetic circuit

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14
Q

Waste gas scavenger

A

Attached to wall or activated charcoal

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15
Q

High pressure area

A

Up to 2200 psi = 150 atmospheres

- includes tanks, yokes, and hangers (regulator inlets)

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16
Q

Intermediate pressure area

A

35-50 psi = 2.3-3.4 atmospheres

- includes central pipeline hoses and regulator outlets to flowmeters and flush valve

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17
Q

Low pressure area

A

14.7 psi = 1 atmosphere = 760 mmHg

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18
Q

Medical gases

A
  • primary: banks of G or H cylinders, or bulk liquid tank

- secondary: small compressed gas cylinders attached to the hanger yoke

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19
Q

Carrier gases

A
  • oxygen
  • nitrous oxide
  • supplied in cylinders as a gas (O2) or liquid (NO) under pressure
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20
Q

Cylinder ID - color

A
  • oxygen: green (US) or white (EU, AU)

- NO: blue

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21
Q

Cylinders are ______, but not ______

A

Flammable; explosive

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22
Q

Gas supply safety

A

Noninterchangeable, gas-specific connections help prevent mixups

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23
Q

Gas cylinder handling

A
  • properly secured at all times (inclu. transport)
  • stored in cool, dry, clean, well-ventilated rooms constructed of fire-resistant materials
  • crack valve briefly before mounting on yoke to clear debris
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24
Q

Do NOT use ____ on cylinder valves

A

Oil!

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25
Q

Calculating volumes

A
  • H tanks = 6900 L at 2200 psi

- E tanks = 660 L at 2200 psi

26
Q

How many liters in an E tank reading 750 psi?

A

660 L at 2200 psi
____ at 250 psi
- 75 L at 2 L/minute
- 37 minutes left

27
Q

Pressure regulator

A

Aka: pressure reducing valve

  • reduce high cylinder supply pressure (up to 2200 psi) to a constant lower working pressure (35-50 psi)
  • constant flow rate of gas to the flowmeter (down stream)
28
Q

Flow meters

A

Thorpe tubes (15 psi)

  • change in annular opening size results in changes in L/min
  • Bobbins/indicators
29
Q

Flowmeter function

A
  • precisely measure gas flow
  • tapered glass tubes with floats
  • gas-specific –> parts can not be interchanged
  • oxygen flowmeter always closest to patient
30
Q

Oxygen flush valve

A

Bypasses vaporizer

  • delivers large volumes of oxygen to breathing circuit
  • is under higher pressure (caution!!)
31
Q

Vaporizer function

A

Provide a means for anesthetic vapor to be combined with the carrier gas in a controlled manner

32
Q

Vaporizers

A

Most inhalant anesthetics have saturated vapor pressures far exceeding the amount required for clinical anesthesia

  • for iso, saturated vapor pressure would be 240/760, or 31.6% –> 1 MAC equals 1.4%
  • change liquid anesthetic into saturated vapor
  • add specific amounts of anesthetic vapor to other gases being supplied to patient
33
Q

Vaporizer physics

A

Heat is required to vaporize liquids –> latent heat of vaporization!

  • vapor pressure of a liquid varies with temperature
  • over time, temp and anesthetic vapor pressure will decrease
  • heat can be added by using substances with high specific heat and thermal conductivity
34
Q

Vapor classification

A

Output regulation!
- calibrated, temp, flow and backpressure compensated, variable-bypass type
–> cyprane tec series, ohio calibrated, drager vapor series, abingdon, bickford
Non-calibrated, non-compensated type (simple agent nonspecific)
- stephens, ohio #8

35
Q

Precision vs non-precision

A
  • precision: deliver same amount of vapor anesthetic throughout
  • non-precision: you do not know how much is getting into the lungs, changes with room temp
36
Q

Precision vaporizer

A

Known concentration

  • temperature compensated (manual or automatic)
  • flow compensated (manual or automatic)
  • high resistance
  • agent specific
37
Q

Non-precision

A
  • no temperature or flow compensation
  • not agent specific
  • precise concentration not known
38
Q

Precision (calibrated) vaporizer resistance

A

Constant output over time for a wide range of flows and environmental temperatures
- high resistance to flow

39
Q

Simple (noncalibrated) vaporizer resistance

A

Output varies with changes in temperature and flow through the vaporizer
- low resistance to flow

40
Q

Vaporizer location

A

Depends on resistance characteristics of vaporizer

  • calibrated vaporizers (high resistance): vaporizer placed out of circuit
  • noncalibrated vaporizer (low resistance): vaporizer in circuit
41
Q

Vaporizer troubles

A
  • filling errors: drain vaporizer, high O2 flow until dry
  • tipping beyond 45 degrees can allow liquid to enter gas lines: high O2 flow at low dial settings for 20 min
  • concurrent use of 2 vaporizers: excessively deep anesthesia
  • vaporizer connected backwards: excessively deep anestheia, liquid into lungs
42
Q

Circle breathing systems

A

2 one way valves to prevent rebreathing

  • adult
  • pediatric
  • large animal
43
Q

Non-rebreathing systems

A

CO2 pushed out of system with oxygen flow without rebreathing

  • needs a higher flow, O2 needs to be 150-300 kilos/min
  • mapleson F
  • jackson rees w/ modified Arye’s T
44
Q

Mapleson D requires a ______

A

Bain block

45
Q

Bain circuit

A

Recommended for patient’s that weigh less than 5 kilos

- could be used in larger patients but you would waste oxygen and anesthetic due to high flow rate

46
Q

Bain circuit limitations

A

Limited by the size of an animal that can be connected to it and the cost of gas/inhalant
- applies to any non-rebreathing system

47
Q

Reservoir/rebreathing bag

A
  • part of the circle
  • supplies peak inspiratory demands
  • can ventilate with it
  • monitor ventilation rate
  • connection is where a mechanical ventilator is attached
48
Q

One way valves

A

On inspiratory and expiratory limbs

- plastic disk needs to be present in order to be a one way valve

49
Q

One way valves are ______ in circle system, _____ in nonrebreathing system

A

Present; absent

50
Q

CO2 absorbent canisters

A
  • react with CO2 to remove it from the air
  • are not present in nonrebreathing systems
  • soda lime is the absorbent
  • usually lasts 6 hours
51
Q

Soda lime/barium lime

A

Exothermic reaction: heat not present when the soda lime is exhausted

  • granules contain indicators (dyes) which change color as the soda lime becomes exhausted (white to purple)
  • change in feel: exhausted granules are harder
52
Q

Overflow or pop-off valve

A

Escape route for excess gas and pressure

  • gases enter into scavenging system
  • valve is closed during mechanical ventilation
53
Q

Scavenging of waste gases

A
  • active evacuation
  • passive evacuation
  • absorption canister
54
Q

Scavenging systems

A
  • active = negative draw
  • piped to atm via connector in wall
  • interface: closed or open
55
Q

Circle system - advantages

A
  • less environmental pollution
  • heat/humidity conservation
  • slower changes in anesthetic plane
  • less gas consumption
56
Q

Circle system - disadvantages

A
  • many components

- high resistance due to the presence of the uni-directional valves and soda lime canister

57
Q

Universal F circuit

A

Coaxial circuit

- rebreathing system

58
Q

Wash-in of anesthetic gases

A

Change in gas concentration within enclosed spaces involves:

  • wash-in of new gas
  • time constant required for that change to occur
59
Q

Time constant

A

Rate of change of gas concentration within a breathing circuit can be predicted from the time constant

  • time constant = circuit volume/gas inflow rate
  • one time constant = 63% desired conc.
  • 3 time constants required to make a 95% change in concentration
  • 4 time constants = 98%
60
Q

Increasing the flow rate _____ the time constant

A

Decreases

61
Q

Checkout recommendations

A
  • evaluate high, intermediate, and low pressure areas of the anesthesia machine
  • check breathing circuit for leaks
  • occlude patient connection, close APL valve
  • inflate circuit with O2 to 30-40 mmHg
  • observe for leaks
  • open APL valve and note that scavenger is not obstructed

Intro to Anesthesiology (10 decks)

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