ANESTHESIA MACHINE

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????????????. ???????????????????? ????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? ???????????????????????????????. . Topics. 1. Overview of anesthesia machine2. Components and systems of anesthesia machine3. Machine checklist.
ANESTHESIA MACHINE

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1. ANESTHESIA MACHINE ??.??.?????? ????????? ??????????????????? ????????????? ??????????????????????????

2. ???????????? ???????????????????? ??????????? ??????????????????????????????????????????????????????????????? ???????????????????????????????????????????????? ??????????????????????????????????????????? ???????????????????????????????

3. Topics 1. Overview of anesthesia machine 2. Components and systems of anesthesia machine 3. Machine checklist

4. Overview of Anesthesia Machine

5. Overview of Anesthesia Machine

6. DEFINITION A device which delivers a precisely-known but variable gas mixture, including anesthetizing and life sustaining gases.

7. Overview of Anesthesia Machine

8. BASIC FUNCTIONS

9. Overview of Anesthesia Machine

10. Models The advent of the computer gives us a new generation of anesthesia gas machines, which have a great deal of added functionality in a small package, designed from the start to be microprocessor controlled. These gas machines are being purchased because they enhance patient safety more accurate basic components such as ventilators, vaporizers, flowmeters integrated, computer-controlled alarms feature advanced ventilation modes pressure control ventilation (PCV) synchronized intermittent mandatory ventilation (SIMV) pressure support ventilation (PSV) perform compliance and leak testing of the breathing circuit, and compensate for these to produce unmatched accuracy in delivered tidal volumes are smaller and lighter (in some cases) because they have integrated monitoring allow automated record keeping more easily than traditional designs electronic capture of fresh gas flow microprocessor integration feature improved monitors, and innovative new monitoring capabilities (spirometry) The advent of the computer gives us a new generation of anesthesia gas machines, which have a great deal of added functionality in a small package, designed from the start to be microprocessor controlled. These gas machines are being purchased because they enhance patient safety more accurate basic components such as ventilators, vaporizers, flowmeters integrated, computer-controlled alarms feature advanced ventilation modes pressure control ventilation (PCV) synchronized intermittent mandatory ventilation (SIMV) pressure support ventilation (PSV) perform compliance and leak testing of the breathing circuit, and compensate for these to produce unmatched accuracy in delivered tidal volumes are smaller and lighter (in some cases) because they have integrated monitoring allow automated record keeping more easily than traditional designs electronic capture of fresh gas flow microprocessor integration feature improved monitors, and innovative new monitoring capabilities (spirometry)

11. Overview of Anesthesia Machine

12. Manufacturing Standards 1988; American Society for Testing and Materials (ASTM) F1161-88 1994; ASTM F 1161-94 (discontinued in 2000) 2000; ASTM F 1850-00 - Backup for 30 min - Monitors: breathing system pressure , exhaled VT , ETCO2, Inhaled anesthetics conc., FiO2, O2 supply pressure, SaO2, BP, and ECG. - Prioritized alarm system; high, medium, low priority Standards for anesthesia machine and workstation provide guidelines for manufacturers regarding their minimum performance, design characteristics and safety requirementsStandards for anesthesia machine and workstation provide guidelines for manufacturers regarding their minimum performance, design characteristics and safety requirements

13. Topics 1. Overview of anesthesia machine 2. Components and systems of anesthesia machine 3. Machine checklist

14. Components and Systems

15. Components and Systems

16. Medical gas: Types

17. Machine gas inlet Most machines have gas inlets for oxygen, nitrous oxide, and air. Separate inlets are provided for the primary pipeline gas supply that passes through the walls of healthcare facilities and the secondary cylinder gas supply.

18. Medical Gas: sources

19. Pipeline system The central gas pipeline supply system is the primary source of gas supply for the anesthesia machine. Oxygen is produced by fractional distillation of liquid air and stored as a liquid at -150 to -175oC in a large flask. Safety systems and regulators send oxygen to the hospital pipeline at ~50 psi; the "normal working pressure" of the anesthesia machine. Nitrous oxide is stored as a liquid, at ambient temperature, in large tanks (745 psi- H tank) connected to a manifold which regulates the pipeline pressure to ~ 50 psi.

20. Pipeline system

21. Pipeline system

22. Pipeline system

23. Pipeline system

24. Pipeline system

25. The tubing is color coded and connects to the pipeline inlet of the machine through a noninterchangeable diameter-index safety system (DISS) fitting that prevents incorrect hose attachment. The check valve, located down stream from the pipeline inlet, prevents reverse flow of gases (from machine to pipeline, or to atmosphere), which allows use of the gas machine when pipeline gas sources are unavailable. Pipeline system

26. Cylinder supply The commonly used sizes are; The H Cylinders - Sources of gas for small and infrequently used pipeline systems, - Intermediate or long-term sources of gas at the patient?s bedside, and - Backup source of oxygen, when stored in bulk, in case the pipeline of oxygen fails or is depleted.

27. Cylinder supply The commonly used sizes are; The H Cylinders - Sources of gas for small and infrequently used pipeline systems, - Intermediate or long-term sources of gas at the patient?s bedside, and - Backup source of oxygen, when stored in bulk, in case the pipeline of oxygen fails or is depleted.

28. Free-standing H Cylinder

29. Cylinder supply The E cylinders - Backup sources of gas supply to the anesthesia machine, attached directly to the anesthesia machine via a yoke.

30. Cylinder supply The E cylinders - Portable oxygen sources

31. Cylinder supply Characteristics of gas cylinders Material: Molybdenum steel Size: B, D, E, M, G, H or K Size E H Dimension 4.1/4? x 26? 9.1/4? x 51? volume 4.8 L 43.6 L Oxygen 1900 psig/660 L 2200 psig/ 6900 L Nitrous oxide 745 psig/1590 L 745 psig/15800 L

32. Cylinder supply Characteristics of gas cylinders (cont.) Color coding : Oxygen / Nitrous oxide / Air Components: Cylinder valve is the most fragile part and consists of - body - port (where the gas exits) - stem (shaft) - handle or hand wheel (to open the valve) - safety relief device - conical depression (opposite the port, it accepts the tip of the screw which secures the cylinder in the yoke) - PISS pins (Pin Index Safety System)

33. Cylinder Valve

34. Pin-Index Safety System (PISS)

35. Diameter-Index Safety System (DISS)

36. Cylinder supply Characteristics of gas cylinders (cont.) Cylinder markings: certain codes are stamped near the neck on all medical gas cylinders. 1.Cylinder specification: DOT, type and material used, service pressure (psi) 2. Serial number 3. Commercial designation 4. Manufacturing data: date of manufacture and original test date, inspector?s official mark, Cylinder qualifies for 110% filling 5. Manufacturer?s identifying symbol 6. Retest markings: Data of first 5 year hydrostatic retest, Retester identifying symbol, Cylinder requalifies for 110% filling, Cylinder qualifies for 10-year retest interval. 7. Neck ring owner?s identification

37. Cylinder supply

38. Cylinder supply

39. Cylinder supply Cylinder safety issues: Standard quality control of cylinder Prevention of wrong gas cylinder connections Securing cylinder against breakage Transfilling Cylinder hazards: : improper filling: empty, partially filled, overfilled to near bursting pressures : contamination: volatile hydrocarbon : unlabeled, painted over (illegible), incorrectly color coded : fitted with incorrect valve outlet port, loose/inoperable valve assemblies

40. Cylinder supply Machine cylindrical inlet Cylinders attach to the machine via hanger-yoke assemblies that utilize a PISS to prevent errors. Each yoke assembly includes index pins, a washer, a gas filter, and a check valve that prevents retrograde gas flow. The E cylinders attached to the anesthesia machine are a high-pressure source of medical gases. Cylinder pressure is usually measured by a Bourdon pressure gauge. A flexible tube within this gauge straightens when exposed to gas pressure, causing a gear mechanism to move a needle pointer.

41. Electrical power supply Main electrical power is supplied to the machine through a single power cord which can become dislodged. New gas machines must be equipped with battery backup sufficient for 30 minutes of limited operation. What functions remain powered during this period is device-specific. Convenience receptacles are usually found on the back of the machine so that monitors or other equipment can be plugged in. These convenience receptacles are protected by circuit breakers (usually) or fuses.

42. Components and Systems

43. PROCESSING High pressure system Cylinder supply to pressure regulator Intermediate pressure system Pipeline supply to proportioning system Low pressure system Flowmeters to common gas outlet

44. PROCESSING: Gas Machine Piping

45. HIGH PRESSURE SYSTEM

46. INTERMEDIATE PRESSURE SYSTEM

47. LOW PRESSURE SYSTEM

48. HIGH PRESSURE SYSTEM Consist of those parts which receive gas at cylinder pressure Hanger Yoke (Connecting Yoke) for Cylinders PISS Gasket Check valve Cylinder pressure gauge Cylinder pressure regulators (1st-stage regulators) Oxygen: from up to 1900 psig to 45 psig Nitrous oxide: from up to 745 psig to 45 psig

49. HIGH PRESSURE SYSTEM

50. HIGH PRESSURE SYSTEM

51. HIGH PRESSURE SYSTEM

52. INTERMEDIATE PRESSURE SYSTEM Receive gases at low, relatively constant pressures (37-55 psi) Pipeline Inlet Connectors DISS Check valve Pipeline pressure gauge Gas power outlet for anesthesia ventilator Anesthesia machine piping system Master switch

53. INTERMEDIATE PRESSURE SYSTEM

54. INTERMEDIATE PRESSURE SYSTEM Oxygen Fail-Safe Valve (Nitrous Oxide Shutoff Valve) Oxygen Supply Failure Alarm Caution : NOT always prevent Hypoxic gas mixture Oxygen Flush valve Second stage pressure regulator Flow control valve Proportioning system Link 25 (OhmedaTM) , Oxygen Ratio Monitor Control (Draeger)

55. Oxygen Fail-safe Valve

56. Flow Control Valve (Needle Valve)

57. Proportioning System

58. Flow pathway of oxygen

59. LOW PRESSURE SYSTEM Include components distal to the flow meter needle valves Flow meter tubes Thorpe tube indicator Vaporizers Check valve Common gas outlet

60. LOW PRESSURE SYSTEM

61. Flow meter tubes

62. Flow meter tubes

63. ANESTHESIA VAPORIZER

64. ANESTHESIA VAPORIZER Function: -Produce a controlled and predictable concentration of anesthetic vapor in the carrier gas passing through the vaporizing chamber. Operating principle: Variable bypass vaporizers - Total FGF enters and splits into carrier gas and bypass gas, then join at the vaporizer outlet. - Splitting ratio is controlled by ..concentration control dial, and ..automatic temperature compensation valve

65. ANESTHESIA VAPORIZER Factors affecting vaporizer output: 1. FGF (fresh gas flow) rate -constant output over FGF rate of 250 ml/min to 15 L/min 2. Ambient temperature -linear output from 20 ? 35 degrees C 3. Intermittent back pressure causing pumping effect -prevention by check valve smaller vaporizing chamber tortuous inlet chambers

66. ANESTHESIA VAPORIZER Safety features of anesthesia voporizer: Agent specific and concentration-calibrated Vaporizer interlocks Liquid level indicated, designed to prevent overfilling Keyed fillers No discharge of liquid anesthetic occurs from the vaporizer even at maximum fresh gas flow

67. ANESTHESIA VAPORIZER

68. Components and Systems

69. BREATHING SYSTEMS Anesthetic gas exits the anesthesia machine via the common gas outlet and enters a breathing circuit. The function of the circuit is to deliver oxygen and anesthetic gases to the patient and to eliminate carbon dioxide. The carbon dioxide may be eliminated by gas inflow or by sodalime absorption.

70. OUTPUT: BREATHING SYSTEMS

71. Circle absorption System The Circle system can be either closed (fresh gas inflow exactly equal to patient uptake, complete rebreathing after carbon dioxide absorbed, and pop-off closed) semi-closed (some rebreathing occurs, FGF and pop-off settings at intermediate values), or semi-open (no rebreathing, high fresh gas flow [higher than minute ventilation])

72. Circle absorption System Advantages low FGF required, low pollution & cost from gases & inhalation agents PaCO2 depends on ventilation only keep heat and moisture Disadvantages complex, difficult to disinfections high resistance due to unidirectional valve more possibility of leakage or disconnections in circuit

73. Circle absorption System -components fresh gas inflow site inspiratory & expiratory unidirectional valves inspiratory & expiratory corrugated tubing Y connector Pop-off, adjustable pressure-limiting valve, or APL valve) Carbon dioxide canisters and absorbents Reservoir bag Bag/ventilator selector switch

74. Circle absorption System

75. Circle absorption System

76. Circle absorption System Carbon dioxide absorbents Type: Soda lime Activator is NaOH or KOH. Silica and kieselguhr added as hardeners. Indicators for SodasorbTM (such as ethyl violet) are colorless when fresh, and purple when exhausted, because of pH changes in the granules.

77. Circle absorption System Carbon dioxide absorbents Type: Baralyme Activator Ba(OH)2, octahydrate; no hardeners, slightly less efficient. Colorless or pink changing to blue-gray with exhaustion.

78. Circle absorption System Advantages low FGF required, low pollution & cost from gases & inhalation agents PaCO2 depends on ventilation only keep heat and moisture Disadvantages complex, difficult to disinfections high resistance due to unidirectional valve more possibility of leakage or disconnections in circuit

79. Non-rebreathing Systems

80. Non-rebreathing Systems Advantages Simply, light weight, easy to positioning Remote anesthesia Low resistance Disadvantages Require high FGF, more pollution loss more heat and water from airway Carbon dioxide retention

81. Modified Mapleson breathing system Ayre?s T-piece circuit (Mapleson E) most suitable in oxygen therapy caution : require high flow of humidified oxygen Jackson Rees circuit (Mapleson F) most suitable in pediatric anesthesia (BW < 20 kg.) require high flow 2-3 times of minute ventilation

82. Components and Systems

83. SCAVENGING SYSTEM Definition: The collection and removal of vented anesthetic gases from the OR. Scavenger and operating room ventilation efficiency are the two most important factors in reduction of waste anesthetic gases (WAGs).

84. SCAVENGING SYSTEM Type: Active Suction applied Require a means to protect patient?s airway from suction or build up of positive pressure Passive waste gases proceed passively down corrugated tubing through the exhaust grill of the OR. Require a means to protect patient?s airway from build up of positive pressure only.

85. SCAVENGING SYSTEM Scavenging interface The most important component. Protects breathing system from excess positive or negative pressure. Reservoir is highly desirable with active system. Closed interface communicates with atmosphere only through valves.

86. OUTPUT: SCAVENGING SYSTEM

87. OUTPUT: SCAVENGING SYSTEM Closed scavenging interface

88. Topics 1. Overview of anesthesia machine 2. Components and systems of anesthesia machine 3. Machine checklist

89. Machine Checklist Pre-anesthesia checklist 2008 Electronic and automated checklist Local department checklist procedures Minimum test under life-threatening conditions

90. WHY negative pressure leak test?

91. Negative pressure leak test

92. Negative pressure leak test

93. Future Anesthesia Machine

94. Questions from audience


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