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SA Anesthesiology > L1: Anesthetic Equipment (Granone) > Flashcards

L1: Anesthetic Equipment (Granone) Flashcards

1
Q

Machine divisions

A

1) High pressure (gas from cylinders/pipeline w/ pressure reduced to working pressure)
2) low pressure (once gas blends w/ anesthetic vapor and flowmeters, common gas outlet, and vaporizer)
3) breathing system
4) scavenging system

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2
Q

High pressure system components

A

1) Gas sources: pipeline, cylinders
2) Pressure regulator (first stage)
3) Oxygen flush valve
4) Flow control valve

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3
Q

PSI of oxygen when it comes out the wall

A

50-55 PSI

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4
Q

PSI And volume of full normal size “E” tank of O2

A

2200 PSI, 660 L

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5
Q

PSI and volume of large “H” tanks of O2

A

6900 L O2

2200 PSI

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6
Q

PISS =

A

Pin index safety system

-prevents interchanging of wrong tank w/ wrong gas

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7
Q

Pressure of cylinder contents proportional to:

A

Volume of gas in cylinder

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8
Q

Pressure of nitrous oxide in tank

A

745 PSI

pressure drops when 25% of contents remain; pressure drop proportional to volume

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9
Q

Chars. Of pressure reducing valve

A

-reduces gas pressure to working machine pressure (2200 PSI to 40-50 PSI of constant pressure w/o no flowmeter fluctuations)

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10
Q

Oxygen flush valve chars.

A
  • direct connection b/w high pressure system and patient breathing circuit
  • O2 to common gas outlet or patient circuit
  • bypasses vaporizer
  • delivers 35-75 L/min (unregulated)
  • dilutes out system gas/anesthetic
  • risk of over-pressurizing! Can cause pneumothorax, volutrauma, barotrauma
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11
Q

Flow control valves char.

A
  • component of high pressure system and flowmeter
  • gas passes through small orifice to flowmeter
  • don’t overtighten knob
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12
Q

Flowmeter chars.

A
  • May be more than one on a machine if multiple gases
  • calibrated for a specific gas
  • controls rate at which specific gas is delivered (L/min)
  • Bobbin w/ a tapered tube
  • rise proportional to gas flow through tube
  • read bobbin at top, read ball in center
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13
Q

Mannifold

A
  • connects flowmeter(s) to vaporizer
  • order of flowmeters become important: oxygen should be downstream and closest to the vaporizer so no matter what there is a greater chance a flow will reach the p
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14
Q

Vaporizers char.

A

-turns liquid anesthetic into vapor and delivers at clinically useful concentrations

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15
Q

MAC of iso

A

1.2-1.3%

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16
Q

Classifications of vaporizers

A

1) Concentration calibrated
2) Flow over (DNK)
3) Thermocompensated - doesn’t fluctuate output based on outside temp.
4) Out of circuit
5) Agent specific - designed for only iso or only sevo
6) Plenum

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17
Q

Desflurane vaporizer chars.

A
  • has high saturated vapor pressure
  • low boiling point (23.5 C)
  • must always be plugged in
  • must be heated and vaporized to deliver adequate anesthesia to patient
  • expensive and has restrictions
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18
Q

Main fxs of breathing systems

A

delivery of inhalant and oxygen to patient, w/ removal of CO2 and excess anesthetic gases

19
Q

4 breathing system categories

A

Open
Semi-open
Semi-closed
Closed

20
Q

Open breathing system chars.

A
  • No reservoir for supplied gas/anesthetic
  • No reservoir for waste anesthetic gas
  • ie: cotton ball soaked in inhalant in chamber
21
Q

Semi-open breathing system chars.

A
  • may or may not have reservoir for anesthetic gases
  • no rebreathing of expired gases
  • no CO2 absorption
  • Ex: Bain, Jackson-Rees, Ayre’s T piece
22
Q

Semi-closed breathing system chars.

A
  • DOES have reservoir for anesthetic gases
  • absorption of carbon dioxide
  • can have low (22 ml/kg/min) flow of fresh gas
  • low flow is metabolic requirement for oxygen
  • Ex: circle breathing system
23
Q

Closed breathing system chars.

A
  • has reservoir for anesthetic gases
  • absorbs CO2
  • has complete rebreathing of expired gases, excluding CO2
  • O2 flow meets patient metabolic O2 requirements
24
Q

Advantages of closed breathing system

A
  • more economical
  • conservation of heat and humidity
  • reduced anesthetic gas pollution
  • reduced risk of barotrauma
  • aid in diagnosis of hypermetabolic state
25
Q

Disadvantages of closed breathing system

A
  • balance of fresh gas supplied and patient demands
  • delay in concentration change to system
  • increased risk of hypercapnia
  • accumulation of unwanted gases
26
Q

Type of system most commonly used?

A
  • semi-closed system
  • circle breathing circuit in which patient’s gases are recirculated
  • high fresh gas flow rates usually in excess (ends up in scavenge)
27
Q

Components of a circle rebreathing system

A
  • adjustable pressure limiting valve (APL)
  • CO2 absorbent canister and granules
  • 2 unidirectional flow rates
  • vaporizer(s)
  • reservoir bag
  • pressure manometer
  • corrugated breathing circuit and Y-piece
28
Q

Universal F-circuit

A
  • Coaxial rebreathing system
  • inner tube –> inspiratory limb
  • outer tube –> expiratory limb
  • used in patients up to 90kg
29
Q

Vaporizer out of Circuit (VOC) chars.

A
  • delivers precise concentration of vapor
  • sits out of circuit
  • agent specific
  • maintenance flow rate with circle system = 10-20 ml/kg/min
  • ie. Like in shelter medicine
30
Q

Advantages of VOC

A
  • Output not affected by patient ventilation changes

- known anesthetic conc. Delivered

31
Q

Disadvantages of VOC

A
  • expensive

- system conc. Changes may be slow

32
Q

Vaporizers IN circuit (VIC) chars.

A

-output dependent upon anesthetic agent volatility, temp., and minute ventilation

33
Q

Effect of temp, resp. Rate, and anesthetic depth on VIC output

A

increased output with inc. temp./RR/depth

34
Q

Chars. Of “Draw-over vaporizers”

A
  • patient vent. Moves fresh gas through vaporizer to volatile anesthetic
  • not agent specific
  • doesn’t deliver precise conc.
  • calibration not equal to output
35
Q

Advantages of VIC

A
  • inexpensive
  • less pollution
  • humidified inspired gases
36
Q

Disadvantages of VIC

A
  • inspired anesthetic conc. Varies based on fresh gas flow rate, temp, and ventilation
  • circuit conc. Unknown
37
Q

Effect of IPPV on anesthetic conc. With VIC

A

Increases system concentration

drop the vaporizer setting by 50% so they don’t get over-ventilated

38
Q

Chars. Of Non-rebreathing systems

A
  • valveless
  • high O2 rates remove CO2 from system (there is no CO2 absorbent, and if inadequate fresh gas flow, becomes RB system)
  • use in patients 7-10 kg
39
Q

Mapleson A (Magill)

A
  • type of non-RB system
  • adjustable pressure limiting valve (APL) close to p
  • good for spontaneous ventilating patients
  • difficult to use
40
Q

APL valve

A

Adjustable pressure limiting valve

  • limits the amt. of pressure buildup that can occur during manual ventilation
  • aka “pop-off valve”
41
Q

Mapleson A: lack modification

A
  • type of Non-RB system
  • like normal mapleson, except APL close to machine end via added piece of tubing
  • increased volume and weight
42
Q

Mapleson D (Bain)**

A
  • type of Non-RB system
  • inner tube provides fresh gas
  • outer tube conducts exhaled gases away from patient
  • reservoir bag attaches to Bain manifold
43
Q

Mapleson F: Jackson-Rees

A
  • type of Non-RB system
  • reservoir bag has open end; can’t remove waste gas safely
  • gas goes into the room

SA Anesthesiology (12 decks)

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