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Principles of Anesthesia 1 (Summer 2023) > Exam 2 (Breathing systems) > Flashcards

Exam 2 (Breathing systems) Flashcards

1
Q

What is an open cicuit?

A

No reservoir bag & no rebreathing

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2
Q

What is a semi-open circuit?

A

Reservoir bag but no rebreathing

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3
Q

what is a semi-closed circuit?

A

Reservoir bag & partial rebreathing

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4
Q

What is a closed circuit?

A

Reservoir bag & complete rebreathing

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5
Q

Where does the circuit mask fit on the face?

A

Between interpupillary line & groove between the mental process & alveolar ridge

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6
Q

What is the size of the Y-piece connector?

A

22mm

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7
Q

What are the benefits (3) of connectors/adapters?

A
  • Extend distance between Pt & breathing system
  • Change connection angle
  • Allows more flexibility/less kinking
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8
Q

What are the disadvantages (3) of connectors/adapters?

A
  • Increased resistance
  • increased dead space (distal to the Y-piece)
  • Additional locations for disconnects
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9
Q

What is the length of the breathing tubing & what is its internal volume?

A
  • 1 meter
  • 400 - 500mL/m
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10
Q

The breathing tubing has ___ resistance & is somewhat ___?

A
  • low
  • distensible
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11
Q

Circuit breathing tubing flow is ___ due to the ____?

A
  • turbulent
  • corrugation
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12
Q

Circuit pressure checks are done at ___ cm ____

A
  • 30
  • H₂O
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13
Q

In what case do unidirectional valves contribute to dead space?

A

When the valve does not close rapidly & all the way

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14
Q

Where are the unidirectional valves located?

A

Near the CO2 absorber, fresh gas inflow site & pop-off valve

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15
Q

What are the 5 requirements for unidirectional valves?

A
  • Arrows or directional words
  • Hydrophobic
  • Must open & close appropriately
  • Clear dome
  • Must be placed between Pt & reservoir bag
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16
Q

Traditional adult reservoir bags hold how much air?

A

3L

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17
Q

What is the max pressure for rubber reservoir bags?

A

40 - 60 cm H₂O

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18
Q

Do plastic reservoir bags have a higher or lower distending pressure than rubber?

A

2x that if rubber bags

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19
Q

What are the reservoir bag functions (5)?

A
  • Reservoir for anesthetic gases or O₂
  • Means of manual ventilation
  • Assistance with spontaneous ventilation
  • Visual/tactile monitor of ventilation
  • Protection from excessive positive pressure
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20
Q

What is the preferred location for the gas inflow site?

A

Between CO₂ absorbent & inspiratory valve

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21
Q

What does the APL valve control?

A

Pressure in the breathing system

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22
Q

The APL valve releases gases to the?

A

Scavenging system

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23
Q

What are the 3 APL valve requirements?

A
  • Clockwise= increase pressure
  • 1-2 clockwise turns from fully open to fully closed
  • Arrow must indicate direction to close valve
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24
Q

What is the purpose of the side or center tube in the absorber canister?

A

Returns the gas to the Pt

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25
Q

When the absorbent canister is all purple the contents are?

A

All carbonates & NO hydroxides

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26
Q

What are the 2 fast reaction hydroxides?

A
  • NaOH
  • KOH
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27
Q

What is the full product after CO₂ reacts with Soda Lime?

A

CaCO₃ + H₂O + heat

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28
Q

What are the 3 strong bases used in absorbents?

A
  • Ca(OH)₂
  • NaOH
  • KOH
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29
Q

100g of absorbent can absorb how much CO2?

A

~ 26L CO₂

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30
Q

What are the 3 advantages of Ensorb?

A
  • Produces NO Compund A
  • Reduced CO production
  • ## Destruction of inhaled gases
  • Ensorb is also called Calcium hydroxide lime
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31
Q

Which 2 absorbents do not contain NaOH?
- Spiralith
- Litholyme
- Sodasorb

A

Spiralith & Litholym

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32
Q

Which absorbent does not contain H₂O?

A

Spiralith

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33
Q

Which 2 absorbents do not contain LiCl?
- Spiralith
- Litholyme
- Sodasorb

A

Sodasorb & Spiralith

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34
Q

Spiralith is mostly made up of?

A

LiOH

35
Q

Which 2 absorbents do not contain NaOH & KOH?

A

Litholyme & Spiralith

36
Q

Which absorbent does not regenerate?

A

Litholyme

37
Q

Which absorbent does not produce compound A & CO?

A

Litholyme

38
Q

Which absorbents have lower exothermic reactions?

A

Litholyme & Spira-lith

39
Q

Which absorbent does not change colors?

A

Spira-Lith

40
Q

Which absorbent has a larger surface area for reactions?

A

Spira-Lith

41
Q

What decreases surface area & CO₂ absorption efficiency?

A
  • Excess liquid water within the canister
  • Channeling
42
Q

What 4 things can contribute to Compound A formation?

A
  • Low FGF (1 - 2L)
  • Increased absorbent temperature
  • High Sevo Mac values
  • Dehydrated absorbent
43
Q

What 2 gases result in the highest CO production?

A
  • Desflurane
  • Enflurane
44
Q

Sevoflurane combined with which absorbent can lead to high heat production & ultimately combustion.

A

Strong base absorbents like anhydrous LiOH (Spiralith)

45
Q

What is missing with Mapleson circuits?

A
  • CO₂ absorber
  • Unidirectional valves
  • separate inspiratory & expiratory limbs
46
Q

Which Mapleson circuit is the best for spontaneous breathing?

A

Mapleson A (Magill’s system)

47
Q

Which circuit is the worst for controlled ventilation?

A

Mapleson A (Magill’s system)

48
Q

Which circuit does not contain corrugated tubing?

A
  • Mapleson C
  • C ya later corrugated tubing
49
Q

Which circuit is the best for controlled ventilation?

A

Mapleson D

50
Q

What does the FGF need to be with the Mapleson D circuit?

A

2 -2.5x minute ventilation

51
Q

What makes the Bain circuit unique?

A
  • It creates inspiratory & expiratory limbs
  • Also, the FGF is moved away from the Pt
52
Q

Which circuit does not have an APL valve?

A

Mapleson E & F

53
Q

What is the Mapleson E used for?

A

In spontaneously breathing Pt’s to deliver O2

54
Q

What is the Jackson Rees circuit?

A

Adding a Reservoir bag, with a hole at the end, to the Mapleson E circuit

55
Q

Which Mapleson circuits have the APL valve close to the Pt’s mouth?

A

Mapleson A, B & C

56
Q

Which Mapleson circuits waste a lot of FGF at the end of expiration?

A
  • B & C
  • A (if using for controlled ventilation)
57
Q

Which 2 Mapleson circuits are least likely to be used for spontaneous ventilation?

A

B & C

58
Q

How is the resistance to gas flow in Mapleson circuits?

A

Low resistance to gas flow

59
Q

What are the disadvantages to Mapleson circuits?

A
  • Need high FGF
  • Do not conserve heat & humidity
  • No scavenging system (Except D)
  • Not suitable for MH Pt’s (as FGF might not go high enough to blow off CO₂)
60
Q

How much expired gas is rebreathed with Low flow anesthesia?

A

~ 50% after CO₂ removal

61
Q

What are the 3 advantages of Low-flow anesthesia?

A
  • Decreased use of VA’s
  • Improved temp & humidity control
  • Reduced environmental pollution
62
Q

What are the 3 disadvantages of Low-flow anesthesia?

A
  • Difficult in rapidly adjusting anesthesia depth
  • Possibility of accumulating unwanted exhaled gases
  • VA degradation byproducts
63
Q

What are advantages of Circle systems?

A
  • Can use Low-flow anesthesia
  • CO₂ elimination
  • Stable inspired gas concentration
  • Conservation of moisture, heat & gases
  • Prevents OR pollution
64
Q

What are the disadvantages of Circle systems?

A
  • Complex design
  • CO or Compound A
  • May compromise Vt during controlled ventilation
  • Increased law suits (D/t misconnections/disconnections)
65
Q

What are the hazards for Ambu bags?

A
  • Barotrauma due to Breath stacking
  • Significant variation in Vt, PIP, PEEP
  • Non-rebreathing valves generate resistance
66
Q

What are the concerns with bacterial filters?

A
  • Create high airflow resistance
  • Prevent water penetration leading to increased resistance & efficiency
  • Obstructions
  • Leakage in housing of gas line filter
67
Q

When is a Inspiratory filter placed?

A

When machine has previously been contaminated

68
Q

What Pt’s need a Airway filter at the Y-piece?

A
  • Covid Pt’s
  • PUI Pt’s
69
Q

What is relative humidity?

A

Percent saturation; amount of water at certain temperature

70
Q

What is absolute humidity?
What is the value covered in class?

A
  • Mass of water vapor in gas in mg H₂O/L
  • 44 mg H₂O/L
71
Q

Where is the isothermic saturation boundary?

A

Just below the carina

72
Q

Cool inspired air can lead to what?

A

Bronchospasms

73
Q

What can happen with underhumidification?

A
  • Secretions thicken
  • Ciliary function decreases
  • Impairs surfactant activity
  • Mucosa susceptible to injury
  • Body heat loss
  • ETT obstruction
  • increased resistance & work of breathing
74
Q

What can happen with overhumidification?

A
  • Water intoxication
  • inefficient mucociliary transport
  • Obstruction to sensors
  • Increased risk for pulmonary infection
  • surfactant dilution
  • atelectasis
75
Q

What do Heat & moisture exchangers do?
Where are they placed?

A
  • They conserve some exhaled heat & water & returns them to Pt
  • They are placed between Y-piece & ETT
76
Q

HME’s can cause what issues?

A
  • Low EtCO₂ readings
  • Increase resistance & dead space
  • Reduced efficiency with large tidal volumes
77
Q

Hygroscopic HME’s are most efficient for?

A
  • Retaining heat & moisture
  • H for heat
78
Q

Hydrophobic HME’s are more efficient for?

A

Filtering of pathogens

79
Q

What is the downside to Hygroscopic HME’s?

A
  • Prone to becoming saturated
  • Increased inspiratory & expiratory resistance
80
Q

When are humidifiers used?

A
  • Neonates
  • Pt’s with difficult respiratory secretions
  • hypothermic Pt’s
81
Q

Condensation can lead to what?

A

Decreased tidal volumes

82
Q

Where are humidifiers placed in a circle system?

A

On the inspiratory limb between the unidirectional valve and Y-piece

83
Q

What devices has a higher chance for water aspiration?

A

Humidifiers

Principles of Anesthesia 1 (Summer 2023) (14 decks)

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