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24 Principles of Anesthesia I > Exam 3- Anesthesia Machine II (7/13/23) > Flashcards

Exam 3- Anesthesia Machine II (7/13/23) Flashcards

1
Q

A ventilator is an automatic device that will provide what two things to the patient?

A
  • Patient ventilation
  • Patient oxygenation
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2
Q

On the anesthesia workstation, ventilators essentially replace what component?

A
  • The green reservoir bag
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3
Q

What ventilation mode was available from old ventilator models?

A
  • Only offered volume-controlled ventilation
  • No PEEP
  • Couldn’t provide high enough PIP
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4
Q

Barotrauma is an injury that results from ______

A
  • Injury resulting from high airway pressures
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5
Q

Compliance

A
  • Ratio of a change in volume to a change in pressure
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6
Q

Valve that opens to allow driving gas to exit the bellows housing

A
  • Exhaust Valve
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7
Q

What is Fresh Gas Compensation?

A
  • This is a way to prevent FGF from affecting tidal volume by measuring tidal volume and adjusting the volume of gas delivered by the ventilar.
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8
Q

The time during which lungs are held inflated at a fixed volume and pressure. (Inspiratory plateau)

A
  • Inspiratory pause time
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9
Q

I:E ratio

A
  • Ratio of the inspiratory phase time to the expiratory phase time
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10
Q

Normal I:E Ratio

A
  • 1:2
  • We spend more time expiring
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11
Q

Inverse ratio ventilation

A
  • Inspiratory phase time is longer than the expiratory phase time
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12
Q

The sum of all tidal volumes in one minute

A
  • Minute volume
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13
Q

Peak Pressure

A
  • The maximum pressure during the inspiratory phase time
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14
Q

Spill Valve

A
  • The valve in the ventilator that allows excess gases to be sent to scavenging system during exhalation
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15
Q

The energy that the patient/ventilator expends to move gas in and out of the lungs.

A
  • Work of breathing
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16
Q

Factors that affect delivered tidal volume.

A
  • Fresh gas flow
  • Compliance
  • Leak
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17
Q

On older vents, as FGF increases, what happens to tidal volume?

A
  • Tidal volume increase

Newer vents have excess FGF divereted during inspiration

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18
Q

How do newer vents compensate for system compliance?

A
  • New vents will alter the volume delivered to compensate for system compliance (pressure control)
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19
Q

How does a leak affect delivered tidal volume?

A
  • Leaks will cause a decrease tidal volume that can’t be compensated by the ventilator
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20
Q

Components to the ventilator.

A
  • Driving gas supply
  • Controls
  • Alarms
  • Pressure-limiting mechanism
  • Bellows (accordion-like device)
  • Housing
  • Exhaust Valve
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21
Q

What does the driving gas do to the bellows?

A
  • The driving gas is the gas external to the bellows that cause them to collapse.
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22
Q

What are the two standard alarms on the ventilator?

A
  • Low-pressure alarm
  • High-pressure alarm
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23
Q

What is the most common cause of low-pressure ventilator alarms?

A
  • Disconnection of a circuit
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24
Q

What are examples of high-pressure ventilator alarms?

A
  • Kinking of the ETT
  • Occlusion of mask
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25
What is a good set point for the pressure limit of the inspiratory pressure?
* 10 cmH2O above average inspiratory pressure
26
What is the housing of the anesthesia machine?
* Clear plastic cylinder * Allows movement of bellows to be observed * Has scale on side for rough estimation of tidal volume
27
What is the function of the exhaust valve?
* Communicates with the housing and allows driving gas to be vented to the atmosphere on exhalation
28
What are the two kinds of bellows? Which one is safer?
* Ascending Bellows (standing) **safer** * Descending Bellows (hanging)
29
Why are ascending bellows considered safer?
* If there is a disconnection in the circuit, the bellows will fail to rise on exhalation, which will trigger the CRNA to know something is wrong. * For descending bellows, they will continue to descend even if there is a disconnection.
30
What is the most commonly used mode of ventilation?
* Volume control
31
What is volume control mode of ventilation?
* Preset tidal volume is delivered (fixed parameter) * The machine will give a set tidal volume regardless of the patient's condition
32
Volume control mode can cause excessive ________ pressure.
* inspiratory
33
Volume control mode will have set:
* Set Tidal Volume * Set Respiratory Rate * Set I:E Ratio
34
What conditions would a volume control mode not be beneficial for the patient?
* Conditions with decreased compliance and FRC * Obese/Pregnant patients * Trendelenburg/Lithotomy procedures * Patients with lung pathology * Patients that need to be weaned from the vent
35
How much tidal volume should be delivered to a patient on a ventilator?
* 4-6 mL/kg
36
Describe pressure control ventilation.
* Preset pressure is quickly achieved during inspiration. * Set PIP, RR, and I:E Ratio
37
Describe tidal volume with pressure control ventilation.
* Tidal volume varies with resistance and compliance
38
What will insufflation of the abdomen do to inspiratory pressure?
* Increase inspiratory pressure, which will cause a low tidal volume.
39
What is the good thing about pressure control ventilation?
* This vent setting protects lungs from barotrauma of excess pressure
40
What is the bad thing about pressure control ventilation?
* The pressure delivered in this mode might not develop enough tidal volume for the patient. * Increase risk for atelectasis
41
What are ways to deliver more tidal volume in pressure control ventilation mode to patients with low lung compliance?
* Increase PIP * Use Inverse I:E ratio, longer inspiration than expiratory time. The body will have time to adapt to increased pressure.
42
Describe Volume Guarantee Pressure-Control.
* Maintain Tidal Volume by adjusting PIP over several breaths. * Prevent sudden Tidal Volume changes d/t compliance (lost insufflation)
43
What is Assist Control Ventilation?
* Predetermined negative pressure will trigger breath * Breath is set tidal volume
44
What is Intermittent Mandatory Ventilation (IMV)?
* Mandatory ventilator breath is set * Additional native breaths at variable tidal volume * Allows breath stacking
45
What is SIMV?
* Synchronizes ventilatory-driven breaths with spontaneous breaths * Provides backup to weaning ventilator * Best for weaning
46
What is Pressure Support?
* PIP and inspiratory time set * Vt equates to the native effort * Need apnea alarm
47
What are ways to use a ventilator during an MRI?
* MRI compatible machines * Anesthesia machine kept outside in hallway * Machine bolted to wall * Aluminum tanks or pipeline gas supply
48
General Hazards: What can cause ventilation failure?
* Disconnection from power supply * Extremely high FGF * Fluid in electronic circuitry * Leaking bellows housing
49
General Hazards: How can there be a loss of breathing system gas?
* Failure to occlude spill valve * Leak in the system * Losing pipeline pressure * Losing cylinders ## Footnote Need to do daily anesthesia machine check
50
General Hazards: What can cause incorrect ventilator settings?
* Inadvertent bumping * Not adjusted for new case * Not adjusted for position/pressure changes * Ventilator turned off for xrays (cholangiogram)
51
Advantages of a ventilator
* Allows anesthesia provider to devote energy to other tasks (free hands) * Decreases fatigue * Produces more regular rate, rhythm, and Vt
52
Disadvantages of a ventilator
* Loss of “feel” (reservoir bag) * Older versions may not have all the desired modes * Components are hard to clean or fix * Lack user-friendliness * Noisy or too quiet * May require high-flow driving gases…expensive
53
What is the trace gas concentration?
* Concentration of a gas far below that needed for anesthesia or detected by smell
54
Trace concentration units
* PPM (parts per million)
55
100% of gas is how many PPM?
1,000,000, PPM
56
1% of gas is how many PPM?
10,000 ppm
57
Higher levels of trace gas concentration are seen in...
* Pediatric anesthesia * Dental surgery * Poorly vented PACU's
58
For years what did old studies conclude about trace gas exposure?
* Spontaneous abortions * Spontaneous abortion in spouses * Infertility * Birth defects * Impaired performance * Cancer/mortality * Liver disease * Cardiac disease ## Footnote These negative side effects of gas exposure has been mitigated with the scavenger system
59
Scavenging system function.
* Removes the collection of gases from equipment used to administer anesthesia or exhaled by the patient.
60
Describe the passive scavenging system.
* Entire volume is exhausted to the atmosphere. * Disposal tubing from the anesthesia machine is attached to the exhaust grill and removed with room air.
61
Describe the active scavenging system.
* Attached to central vacuum system * Must be able to provide high volume (30L/min) * Need plenty of suction outlets and close to anesthesia machine
62
How can the ventilator cause hypercapnia?
* Hypoventilation * Absorbent failure * Excessive dead space * Defect coaxial system
63
How does an anesthetic agent overdose over with the anesthesia machine?
* Tipped vaporizer * Vaporizer accidentally on * Incorrect agent in vaporizer * Interlock system failure * Overfilled vaporizer
64
How does Hypoventilation occur on the ventilator?
* Insufficient gas * Obstruction * Leaks * Main machine power off * Breathing system leaks (disconnections)
65
What are ways to prevent inadvertent exposure to volatiles?
* Change breathing system hoses and bag * Change fresh gas supply hose * Change absorbent * Use very high oxygen flows to flush the machine * Remove vaporizers * Use an axillary flowmeter for supplemental oxygen

24 Principles of Anesthesia I (27 decks)

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