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CHEM PHYS > Exam 4: Lecture 3 > Flashcards

Exam 4: Lecture 3 Flashcards

Scavenging system

1
Q

What did a NIOSH study as negative side effects for women working in the OR?

A

-spontaneous abortion
-liver/kidney disease
-cancer
-congenital abnormalities

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2
Q

NIOSH recommendation for halogenated agent exposure?

A

2 ppm

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3
Q

NIOSH recommendation for halogenated agent exposure if N2O is used?

A

0.5 ppm

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4
Q

NIOSH recommendations when N2O is the only anesthetic agent used?

A

25 ppm in the OR
50 ppm in dental offices

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5
Q

how much N2O and halogenated agent have been detected without scavenging system?

A

400-600 ppm N2O
5-10 ppm halogenated

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6
Q

how much can a scavenging system reduce exposure?

A

ten fold

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7
Q

how many air changes per hour do most ORs do?

A

20-25
air volume turned over in about 2.5 mins

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8
Q

what anesthetic circuit would increase the OR pollutant?

A

Mapleson circuits
semi-open?

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9
Q

sources of anesthetic gas contamination in high and intermediate pressure systems?

A

defective connectors, defective hanger yokes, bad seal
high pressure makes leaks more likely

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10
Q

sources of anesthetic gas contamination in the low pressure system?

A

N2O flowmeter, vaporizers, fresh gas delivery tubing, breathing circuit, CO2 absorber, unidirectional valves, ventilator, components of waste scavenging system

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11
Q

what is the relationship between peak pressures in the breathing circuit and the amount of gas the escapes through a leak in the low-pressure system?

A

direct linear
increased pressure
increased leak

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12
Q

how can the anesthesia ventilator leak anesthetic gas?

A

can leak internally and cause anesthetic gases to mix with the non=-scavenged driving gas of the ventilator

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13
Q

errors of anesthesia technique that can lead to anesthetic gas contamination?

A

changing absorbent mid case with high flows

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14
Q

how to prevent mask ventilation anesthetic gas contamination?

A

-don’t turn on the vaporizer or N2O until mask is on the patient
-turn flows as low as they go or pause while waiting for IV meds to take effect
-make sure mask fits well, good seal

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15
Q

how to decrease anesthetic gas contamination when you deep extubate a patient?

A

as the patient will continue to breathe anesthetic gases into the room, you should leave them attached to a well-fitting mask with 100% FiO2

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16
Q

how much N2O does cryosurgery leadk?

A

20-90 L/minute when used in surgery

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17
Q

do cardiopulmonary bypass machines have scavenging systems?

A

no
waste gas goes directly to the room
scavenging system may effect oxygen delivery?

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18
Q

what is the exhaled gas analyzer?

A

port on the vitals machine that draws gas directly from the patient circuit to analyze gas
-end tidal CO2
-delivered sevo
-most accurate measure of what is being administered

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19
Q

exhaled gas analyzers can draw how much gas if not scavenged?

A

100-300 mL/minute

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20
Q

what type of scavenging system does joint commission require?

A

active

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21
Q

when equipped with a properly functioning scavenging system, the trace concentration of anesthetic gases in an OR is reduced by how much?

A

90%

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22
Q

will scavenging system interfere with ventilation or oxygenation of anesthesia machine?

A

not if properly functioning

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23
Q

what must active scavenging systems have?

A

proper and adequate suction

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24
Q

how dos a passive scavenging system work?

A

driven by positive pressure from circuit and concentration system

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25
Q

two types of active scavenging system?

A

open and closed

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26
Q

what colors indicate waste scavenging coupler?

A

purple and yellow

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27
Q

what are the four parts of the waste gas scavenging system?

A

-relief valve through which gas leaves the breathing circuit
-conducting tubing to move the gas from the breathing circuit to the scavenging interface
-scavenging interface
-disposal line

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28
Q

potential complications of active open system?

A

suction could be in adequate and gas may leak back out into room

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29
Q

potential complications of active close system?

A

-increased pressure may backup into the circuit and back to patient leading to barotrauma
-may be caused by kink in system

30
Q

how does waste anesthesia gas leave the circuit during spontaneous or manual ventilation?

A

the APL valve
-when open more gases will leave
-when closed less will leave

31
Q

what does it mean to close the APL valve?

A

limit is usually 70 cm H2O
-would not allow patient to exhale as there would be too much pressure/resistance

32
Q

what does it mean to open the APL valve?

A

to release pressure
there would be no resistance
0 cm H2O

33
Q

what separates the manual and the ventilator circuits?

A

bypass switch

34
Q

how do anesthesia waste gases leave the circuit when the anesthesia ventilator is in use?

A

through the ventilator pressure relief valve
-works in a similar way to APL just different location based on what you are using

35
Q

what is a safe peak pressure?

A

below 35

36
Q

on ventilation mode, where is excess gas routed?

A

through APL valve or ventilator spill valve, depending on ventilation mode

37
Q

open scavenging interface system

A
38
Q

how does an open interface scavenging system protect the patient?

A

from positive pressure associated with obstruction and negative pressure associated with waste disposal
-less likely for vent to become obstructed

39
Q

closed scavenging interface system

A

less OR pollution, but less safe for patient

40
Q

complications of inadequate suction in a closed scavenging interface system?

A

pressures can accumulate and put the patient at risk for barotrauma
-both positive and negative pressure relief valves

41
Q

complications of too much suction in a closed scavenging interface system?

A

negative pressures can be transmitted to the patient
-could pull on the parenchyma, microvascular trauma

42
Q

what does the reservoir bag on the closed scavenging interface system show?

A

-distended: suction is too low
-flat: suction is too high

43
Q

what protects the patient and ventilator from excessive positive or negative pressure?

A

relief valves interposed between the breathing circuit and the hospital’s vacuum

44
Q

what does a closed scavenging system include?

A

-reservoir bag
-spring loaded valves that prevent the hospital evacuation system from exerting too high or low pressure

45
Q

what happens if there is insufficient suction in a closed scavenging interface system?

A

-excessive pressure build up in the reservoir
-pop off valve opens
-waste gas will be vented into the room

46
Q

in a closed scavenging interface system, how will the reservoir bag behave normally?

A

bag will distend during exhalation and empty during inhalation

47
Q

what will an over pressurized, overfilled reservoir bag on a closed system predict?

A

a block somewhere

48
Q

can open waste scavenging systems be active or passive?

A

active

49
Q

can we adjust the relief valve in an active closed scavenging system?

A

no, we can only adjust the suction

50
Q

in an active scavenging disposal system, how much air should wall suction be capable of drawing?

A

> 30 L/min

51
Q

what should active waste scavenging disposal interfaces be equipped with?

A

at least one negative pressure relief valve (closed) or ports open to atmosphere (open)

52
Q

why is it preferable to have a dedicated separate vacuum system for waste anesthetic gases?

A

distributes suction to other sources, diluting it

53
Q

for general anesthesia what is required for dental offices?

A

waste gas disposal and medical vacuum separate from dental vacuum

54
Q

hazards of scavenging?

A

-excessive negative or positive pressure applied to pulmonary tract
-errors in assembly of the scavenging system
-open systems can become blocked
-hoses can become kinked

55
Q

how to test the low-pressure system for leaks?

A

-remove breathing hoses and bags from anesthesia manual circuit
-connect the two unidirectional valves with short piece of corrugated hose
-close APL valve, occlude the bag mount opening
-slowly turn on the oxygen flowmeter until the breathing circuit reaches a pressure of 40 cm H2O
-titrate oxygen flow down to find minimum flow necessary to maintain this pressure for 30 seconds

56
Q

what should your low pressure leak be?

A

less than 200 mL/min
-this would contribute no more than 4 ppm of N2O

57
Q

why is PACU an anesthesia gas exposure zone?

A

patients are still breathing out some residual gas for a short time, but there is no active filtration in PACU like in the OR

58
Q

where should you sample from to test OR safety?

A

measuring N2O at the level of the anesthesia workstation correlates well with personal sampling

59
Q

what is time weighted average and how to sample?

A

TWA sample may be obtained by continuously pumping ambient air into an inert bag at a constant low rate of flow (4L/hour) with a bag capacity of 20-30L
-this concentration represents the average exposure over the collection period

60
Q

what is the time weighted average of nitrous?

A

25 ppm
you can go over temporarily, but you must compensate with less exposure

61
Q

is it bad if you can smell sevo?

A

yes
olfactory thresholds for N2O and halothane are 10-30%

62
Q

how much do inhaled anesthetics account for of the carbon footprint of an average surgical procedure?

A

1/3
5% of hospitals total greenhouse gases

63
Q

decay times of anesthetic gases?

A

-sevo: 1.1 year
-iso: 3.2 years
-desflurane: 14 years

64
Q

global warming potential measure of anesthetic gases?

A

-sevo: 130
-iso: 510
-des: 2540
-N2O: 289

65
Q

on a MAC-hour basis, nitrous and desflurane are how much greater in global warming potentials than sevo and iso?

A

20x

66
Q

greenhouse gas effects of propofol are how much smaller than desflurane or nitrous?

A

4 orders of magnitude smaller

67
Q

environmental concern recommendation

A

-avoid N2O as a carrier gas
-avoid unnecessarily high FGF
-reserve des and N2O only for cases they could reduce mortality
-use sevo or iso
-reconsider N20 for labor patients
-use IV and regional when appropriate
-low flow techniques

68
Q

what is the physiologic requirement of oxygen under anesthesia?

A

250 mL/min
meaning you could run .3 to .5 mL/min of O2 during the case

69
Q

do your metabolic requirements increase or decrease under anesthesia?

A

decrease

70
Q

what can climate change lead to?

A

primary cause of disease
-asthma
-cardiopulmonary complications
-infectious disease
-food and water supply instability

CHEM PHYS (7 decks)

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