anesthesia machines
TRANSCRIPT
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Anesthesia Machines
rev Jan 11 dmcmahon
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First actual use of ether - March 1842,by Dr Crawford Long in Georgia.
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First public use of ether - Oct 1846, by Dr Morton
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Diethyl ether -- first inhaled anesthetic
Chloroform used for Queen Victoriain childbirth, 1847.
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Anesthesia can be –> Local, often Local with Monitoring (“LMAC”)
> Regional
- spinal
- epidural
- nerve block specific
> General, which includes: - lack of awareness
- lack of sensation
- amnesia
- uneventful post-op recovery
- Usually obtained by inhaled agent thru a tracheal tube,
or can be by a drug infused IV (eg propofol)
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Inhaled Anesthetic Agents –
> Many are ethers (general formula R – O – R’)
> First was diethyl ether
> First vaporizer-delivered agent was halothane (1960’s)
> Followed by several others (1970’s – 1990’s)
> Vast majority of general anesthetics now given with
- isoflurane (“Forane”, Zeneca Labs)
- sevoflurane (“Ultane”, Abbott Labs & Baxter)
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Propofol - first injectable non-opioid general anesthetic
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GE / Datex / Ohmeda:
Aisys
Aespire 100
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North American Drager:
Fabius GS
Apollo
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Drager:
Fabius MRI
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The bare essentials of anesthesia delivery:
> Oxygen-carrying gas mixture
- could be room air
> Anesthetic agent vapor
- metered-out very precisely
> Ability to create positive airway pressure
- necessary for respiratory exchange
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Three machine hazards and their solutions:
1: Oxygen supply failure, leaving anoxic gas supply
- the “Fail-Safe Valve” or Oxygen Failure Protection Device (OFPD)
Shuts off all gas flows if the oxygen fails
2: Hypoxic or anoxic mixtures from the flowmeters
- the “Hypoxic Guard” or Oxygen Ratio Monitor-Controller (ORMC)
Assures that at least 25% oxygen is delivered
3: More than one agent vaporizer turned-on
- vaporizer lock-out mechanism; Allows only one vaporizer to be enabled
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Pressure Regulator
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Basic manometer (pressure meter)
Bourdon tube
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Gas Supply Check Valve
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Gas Pressure-Actuated Power Switch
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Flowmeter Needle Valve
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Flowmeter Tubes in Series
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Digital flowmeters - Drager Fabius GS
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Typical screen - Drager Fabius GS
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O2 failure shutoff valve (“FailSafe Valve”)
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Oxygen ratio controller
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Basic Anesthetic Vaporizer
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Basic Anesthetic Vaporizer
Delivering the volatile anesthetic –
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Modern Vaporizer, Closed
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Modern Vaporizer, Open
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Vaporizer Lock-Out Mechanism(Drager Co.)
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Vaporizer Lock-Out Mechanism(Drager Co.)
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Essential Monitors of the Anesthesia Machine:
> Delivered oxygen percentage
> Airway pressure
> Airway gas flow
(These monitor the machine, not the patient)
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CO2 Absorber Assembly - schematic
From machine
Patient’s lungs
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CO2 absorbent:
> Chemically removes CO2 from the patient’s respiratory gases.
> Consists of NaOH, KOH, and Ca(OH)2, which react with CO2 to form carbonates and water in two separate reactions.
> Includes a dye which changes to purple when the CO2-absorbing capacity is exhausted.
> Major brands:
SodaSorb©, Baralyme©, Amsorb©
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CO2 Absorber Assembly - Drager Co
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CO2 Absorber Assembly w/ VentilatorDrager Co.
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Aneroid Manometer for Airway Pressure
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Adjustable Pressure Limiting (APL) Valve
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Manual Ventilation:
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Manual Ventilation:
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Mechanical Ventilation:
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Mechanical Ventilation:
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Scavenging of
Waste Anesthesia Gas (WAG) :
> Required by NIOSH / OSHA
> NIOSH allows < 25 ppm of N2O (8-hour average)
> Gases must be actively drawn out of the local air
> Scavenging is integrated into the anesthesia machine
> Testing should be done at least annually
> Can be done with dosimeters from a commercial lab,
or with an IR detector made for air testing.
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Scavenging Relief Valve
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Virtual Anesthesia Machine: http://vam.anest.ufl.edu
> Univ of Florida, Dept of Anesthesiology
> From the Home Page, click on the Simulation & Workbook tab
> Requires one-time free registration (Annual fee for educators’ version)
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March 2009: APSF Newsletter
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Most common troubleshooting issues:
> Leaks in the absorber circuit and/or patient circuit
> Inadequate volume delivered from ventilator
> Water accumulated in ventilator tubing
> Flow meter inaccuracy or failure
Be pro-active:Get the owner’s book out and know the troubleshooting tables.
Know how to do a pre-op machine checkout.
Get factory service training
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> North American Drager
> GE-Datex-Ohmeda
Minor Players:
Major Players in Anesthesia Machines:
> Spacelabs (Blease from the UK)> DRE, Oceanic (compact types)
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Samurai
Origami
Fuji-Maximus
K Takaoka anesthesia machines –
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