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JW: 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
Q

What is a good set point for the pressure limit of the inspiratory pressure?

A
  • 10 cmH2O above average inspiratory pressure
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26
Q

What is the housing of the anesthesia machine?

A
  • Clear plastic cylinder
  • Allows movement of bellows to be observed
  • Has scale on side for rough estimation of tidal volume
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27
Q

What is the function of the exhaust valve?

A
  • Communicates with the housing and allows driving gas to be vented to the atmosphere on exhalation
28
Q

What are the two kinds of bellows?

Which one is safer?

A
  • Ascending Bellows (standing) safer
  • Descending Bellows (hanging)
29
Q

Why are ascending bellows considered safer?

A
  • 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
Q

What is the most commonly used mode of ventilation?

A
  • Volume control
31
Q

What is volume control mode of ventilation?

A
  • Preset tidal volume is delivered (fixed parameter)
  • The machine will give a set tidal volume regardless of the patient’s condition
32
Q

Volume control mode can cause excessive ________ pressure.

A
  • inspiratory
33
Q

Volume control mode will have set:

A
  • Set Tidal Volume
  • Set Respiratory Rate
  • Set I:E Ratio
34
Q

What conditions would a volume control mode not be beneficial for the patient?

A
  • 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
Q

How much tidal volume should be delivered to a patient on a ventilator?

A
  • 4-6 mL/kg
36
Q

Describe pressure control ventilation.

A
  • Preset pressure is quickly achieved during inspiration.
  • Set PIP, RR, and I:E Ratio
37
Q

Describe tidal volume with pressure control ventilation.

A
  • Tidal volume varies with resistance and compliance
38
Q

What will insufflation of the abdomen do to inspiratory pressure?

A
  • Increase inspiratory pressure, which will cause a low tidal volume.
39
Q

What is the good thing about pressure control ventilation?

A
  • This vent setting protects lungs from barotrauma of excess pressure
40
Q

What is the bad thing about pressure control ventilation?

A
  • The pressure delivered in this mode might not develop enough tidal volume for the patient.
  • Increase risk for atelectasis
41
Q

What are ways to deliver more tidal volume in pressure control ventilation mode to patients with low lung compliance?

A
  • Increase PIP
  • Use Inverse I:E ratio, longer inspiration than expiratory time. The body will have time to adapt to increased pressure.
42
Q

Describe Volume Guarantee Pressure-Control.

A
  • Maintain Tidal Volume by adjusting PIP over several breaths.
  • Prevent sudden Tidal Volume changes d/t compliance (lost insufflation)
43
Q

What is Assist Control Ventilation?

A
  • Predetermined negative pressure will trigger breath
  • Breath is set tidal volume
44
Q

What is Intermittent Mandatory Ventilation (IMV)?

A
  • Mandatory ventilator breath is set
  • Additional native breaths at variable tidal volume
  • Allows breath stacking
45
Q

What is SIMV?

A
  • Synchronizes ventilatory-driven breaths with spontaneous breaths
  • Provides backup to weaning ventilator
  • Best for weaning
46
Q

What is Pressure Support?

A
  • PIP and inspiratory time set
  • Vt equates to the native effort
  • Need apnea alarm
47
Q

What are ways to use a ventilator during an MRI?

A
  • MRI compatible machines
  • Anesthesia machine kept outside in hallway
  • Machine bolted to wall
  • Aluminum tanks or pipeline gas supply
48
Q

General Hazards: What can cause ventilation failure?

A
  • Disconnection from power supply
  • Extremely high FGF
  • Fluid in electronic circuitry
  • Leaking bellows housing
49
Q

General Hazards: How can there be a loss of breathing system gas?

A
  • Failure to occlude spill valve
  • Leak in the system
  • Losing pipeline pressure
  • Losing cylinders

Need to do daily anesthesia machine check

50
Q

General Hazards: What can cause incorrect ventilator settings?

A
  • Inadvertent bumping
  • Not adjusted for new case
  • Not adjusted for position/pressure changes
  • Ventilator turned off for xrays (cholangiogram)
51
Q

Advantages of a ventilator

A
  • Allows anesthesia provider to devote energy to other tasks (free hands)
  • Decreases fatigue
  • Produces more regular rate, rhythm, and Vt
52
Q

Disadvantages of a ventilator

A
  • 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
Q

What is the trace gas concentration?

A
  • Concentration of a gas far below that needed for anesthesia or detected by smell
54
Q

Trace concentration units

A
  • PPM (parts per million)
55
Q

100% of gas is how many PPM?

A

1,000,000, PPM

56
Q

1% of gas is how many PPM?

A

10,000 ppm

57
Q

Higher levels of trace gas concentration are seen in…

A
  • Pediatric anesthesia
  • Dental surgery
  • Poorly vented PACU’s
58
Q

For years what did old studies conclude about trace gas exposure?

A
  • Spontaneous abortions
  • Spontaneous abortion in spouses
  • Infertility
  • Birth defects
  • Impaired performance
  • Cancer/mortality
  • Liver disease
  • Cardiac disease

These negative side effects of gas exposure has been mitigated with the scavenger system

59
Q

Scavenging system function.

A
  • Removes the collection of gases from equipment used to administer anesthesia or exhaled by the patient.
60
Q

Describe the passive scavenging system.

A
  • 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
Q

Describe the active scavenging system.

A
  • 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
Q

How can the ventilator cause hypercapnia?

A
  • Hypoventilation
  • Absorbent failure
  • Excessive dead space
  • Defect coaxial system
63
Q

How does an anesthetic agent overdose over with the anesthesia machine?

A
  • Tipped vaporizer
  • Vaporizer accidentally on
  • Incorrect agent in vaporizer
  • Interlock system failure
  • Overfilled vaporizer
64
Q

How does Hypoventilation occur on the ventilator?

A
  • Insufficient gas
  • Obstruction
  • Leaks
  • Main machine power off
  • Breathing system leaks (disconnections)
65
Q

What are ways to prevent inadvertent exposure to volatiles?

A
  • 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

JW: Principles of Anesthesia I (61 decks)

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