Anesthesia Machine Intro 2011

7/28/2019 Anesthesia Machine Intro 2011

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ADS1 Ready JHP

Anesthesia MachineIntroduction

James H. Philip, MEE, MD, CCE Anesthesiologist, Director of Bioengineering

Brigham and Women’s Hospital

Associate Professor of AnaesthesiaHarvard Medical School

PatientAnesthetist

HospitalWorld

Work-station

observe(senses)

Care Info(lab data,ima e..)

touchobserve(eyes, ears)

ADS, monitors,PIMS

Inhalant Drugs

IV Drugs, FluidsOther

Monitoring

requests

Clinic

CaInteraction

PatientAnesthetist

HospitalWorld

Work-station

observe(senses)

Care Info(lab data,ima e..)

touchobserve(eyesears)

ADS, monitors,PIMS

Inhalant Drugs

IV Drugs, FluidsOther

Monitoring

requests

Clinic

CaInteraction

Anesthesia Delivery System

Workstation - Patient Interactions

Airway control

BreathingCirculation

Drug delivery for anesthetization

Workstation - Patient Interactions

Airway control

Breathing - safe gasesCirculation

Drug delivery for anesthetizationvapors, gases, IV

Intravenous Liquid DeliveryMonitoring

Recording

ADS - Patient Interactions

Breathing - safe gases

Drug delivery for anesthetizationvapors, gases

Anesthesia Machine Evolution

1846 Morton Ether Inhaler

Inhaler had limitations

1846 version

This 1850 version

worked horizontalwith no hands required

Open Circuit Inhaler

Open Circuit = Non-rebreathingPatient breathes in the ether vapor,

breathes ether out (and it is discarded)Breathes in new ether vapor

Breathes it out again (discarded)

M l R it t

Manual Resuscitator

Open Circuit =

non-rebreathing Circuit =

what you set is what you getWhat you put into the circuit is what the patient gets

Give sufficient 100% oxygen flow to the reservoir bag(not to empty)

Reservoir bag gives 100% oxygen to the breathingbag

The Tidal Volume and Minute Ventilation isdetermined by the size and frequency of thesqueeze of your hand and a perfect seal.

Breathing

“circuit”

M l R it t

Manual Resuscitator

One-way valves make sure gas flows to the patient

A special valve allows exhaled gas to be removed

Breathing

“circuit”

Manual Resuscitators

Bag Reservoir Hose Reservoir

A bag reservoir

lets you see itprovides 100%

oxygen to thebreathing bag by

never emptyingandnever entrainingroom airBag Reservoir

Partial Rebreathing Circuits are

used in AnesthesiaDon’t throw away all the exhaled gas

It contains expensive anesthetic vaporsReuse as much as possible

somehow (learn more later)Remove (Absorb) CO2 and

Rebreathe the anesthetic

Partial rebreathing = semi-closed circuit

All ADSs use them

Rebreathing Ventilation

Is not for dummiesRequires knowledge and skill

Makes us different from other care providersEMT, Sedation RN,ED MD, Hospitalist,Others

1890added a

BreathingCircuit

Draeger

Foregger added CO2

absorbsion

1950added

a worksurface

Then,Drawers,

Temperature-compensatedvaporizers,

Circuit, Absorber,

Common

gasoutlet

1990Integrated

Monitors

andData

Recording

GE-Datex-

OhmedaCentralDisplay

(CD) ADS

Better ventilation for difficult patientsFGF-independent ventilationCorrects for circuit leaks

More sensitive to water vapor Monitors not integrated

GE Aestiva

At BWH, now in

L&D andMOR for HeliOx

for ENT Surgerywhere low densityHelium moves throughnarrow orifices

2000Draeger

Fabius(BWH

many ORs)

2005-2010 state-of-the-ar

GE Aisys MOR -many rooms

Draeger Apollo GS

MOR - 6 rooms

Not yet for CA1s

Basics of the Anesthesia Delivery System

Anesthesia Delivery System - ADS

Anesthesia MachineBreathing Circuit

Ventilator

A th i M hi

Anesthesia Machine

delivers gases and vaporsinto a breathing circuit 2001

Provides continuous flow of -

Oxygen for Life

Air to safely lower FIO2

Nitrous Oxide for partial anesthesia

Agent vapor for complete or partial anesthesia

(Continuous Flow) Anesthesia Machine

N O2 O2Air

(Continuous Flow) Anesthesia Machine

Vaporizer

12 3..

9mL/mL/mL/mL/m

Isoflurane

SevofluraneDesflurane FGF

(Fresh

Common

Outlet

Flow Tubes

Oxygen and Gas Delivery

Mechanical

Physical knobs

Rotameters,

GE Aestiva, Aespire

Mechanical

Physical knobs

Rotameters, Digital meters

Draeger Fabius

Draeger Apollo

Draeger Fabius

Draeger Apollo

Electronic

Virtual knobs

Digital meters

GE Avance, Aisys

% Oxygen in FGF

NOT inspired - be careful

GE Avance, Aisys

Vaporizer Types

MechanicalPenlon Sigma for isoflurane, sevofluraneGE Tec 3,4,5,7 for isoflurane, sevoflurane

GE Tec 6 for desflurane (electro-mechanical)Draeger Vapor 19, 2000 for all agentsDirect-reading, temperature-compensated

ElectronicGE Aladin for all agents

Anesthesia Machine

AnesthesiaMachineSchematic

N2OSERVICE

SIMPLIFIED ANESTHESIA MACHINE SCHEMATIC DIAG

2000psi

SERVICEINLET55psi

35 psi

50 or 250ml/min

NEEDLEVALVE

FAILSAFEVALVE

CALIBRATEDVAPORIZERS

Fresh Gas Flow (

OXYGENFLUSHVALVE[first]

ON/OFFSWITCH

CHECK VALVE PRESSURE

REGULATOR

SERVICEINLET55 psi

FREGAS

Flush Flow(last)

[Anesthetizinggases flow]

COMMON

OUTLET

750psi

2000psi

FILTER

DISSdiameter

indexsafetysystem

CONNEC- TION

Patient Breathing Circuit

Allows cyclic flow

To and from the patient(AKA Breathing)

Patient Breathing Circuit

First address spontaneous

and manual ventilation

Circle absorption anesthetic

breathing circuit

flipped

The Circle-Absorber System

Sampled

Exhaust

Expired

sorb-ant

200 mL/min

InspiredFresh

Gas Flows

Rebreathed

Exhaust

Expired

sorb-ant

200 mL/min

InspiredFresh

Gas Flows

Rebreathed

Exhaust

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

Exhaust

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

To Patient

Exhaust

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

From Patient

Exhaust (APL)

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

Exhaust (APL)

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

Manual ventilation requires Exhaust Pressure > 0

Exhaust (APL)

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

Gases (O2, N2O, Agent)

Exhaust

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

No CO2

rebreathed

Exhaust

Expired

sorb-ant

InspiredFresh

Gas Flows

Rebreathed

No CO2

Exhaust

Expired

sorb-ant

Inspired

Gas Flows

RebreathedGases

No CO2

Exhaust

Expired

sorb-ant

Inspired

Gas Flows

Gas is sampled from circuit near patient for I/E measure

Sampled

Exhaust

Expired

sorb-ant

200 mL/min

Inspired

Gas Flows

Mechanical Ventilation

Set with a switch (Elec or Mech)Exhaust Valve is out of circiut

Reservoir bag isIn circuit with Draeger piston

Out of circuit with GE bellows

Low FGF

More rebreathing

Inspired more dependent on Expired

Inspired less influenced by Vaporizer

The Anesthesia Workspace

Draeger Apollo

GE Aisys at BWH

Workspace Setup

MRSMAIDMachine

Suction

Monitors

Airway

Workspace Setup

MRSMAIDMachine

Suction

Monitors

Airway

Workspace Setup

MRSMAIDMachine

RoomSuction

Monitors Airway

I VDrugs

Suction off if:

DISS hose unscrewedWall switch off

Hose disconnect from Canister

Canister switch off

Insert seated incorrectly

Any hole open

Flap valve closed

because unit was shaken

or canister is full

Flexible hose kinkedFlexible hose stepped on

Perform Machine-Assisted Tests

GE Modulus 2 Plus - none

GE Aestiva - Minor 12 Hour switch off and on

Circuit Oxygen Sensor Cal via SmartVent ventilator

GE Aisys - Major Most circuit tests are automated

Bellows volume & pressure can feel the circuitand make great ventilation modes

Draeger Fabius - Major

Most circuit tests are automatedVentilator Piston can feel the circuitand make great ventilation modes

Draeger Apollo – Major

almost everything

CALIBRATE OXYGEN

MONITOR

Oxygen Monitor on & sensor in air with hole plugged.

Calibrate to 21%. Reconnect sensor in circuitThere is no separate oxygen monitor on Aisys or Apollo

These include integrated gas monitoring including FiO2

obtained by sampling the gas at the wye (AKA “ Y” )The separate sensor is a Clark Electrode

The sampled gas monitor is

Polarographic for the symetrical oxyen molecule andInfra-red absorbsion for all other assymetrical moleculesCO2, N2O, Isoflurane, Sevoflurane, Desflurane

CHECK MACHINE FOR GAS

DELIVERYMachine On

Oxygen flows smoothly

Disconnect oxygen hose

Oxygen alarm sounds

Switch ON oxygen tank. Verify P > 1000 psi and Alarm

silences.

Tank off with wrench

Turn oxygen flow up

Alarm sounds oxygen failure

Connect oxygen hose to silence alarm.

Turn up nitrous and observe alarm and/or control.Negative Pressure Test - later

CHECK CIRCUIT FOR INTEGRITY

Attach circuit including reservoir bag

Occlude “ Y” with thumbFlush and fill bag to 30 cmH2O.

Test pressure alarms

Open relief valve and verify that reservoir bag empties

Observe scavenger bag fil l and empty

CHECK FUNCTION

CHECK VENTILATOR FOR FUNCTION

Ventilate Test Bag and observe no volume loss.

CHECK SCAVENGER FOR FUNCTION

Check that reservoir bag fil ls and empties. Check valvesnot stuck.

This pre-use check is basic

We believe this will keep you and your patient safe

for the next few weeksFollowing the automated tests on Fabius, Aisys, Apollo

wil l test all the functions of your anesthesia machine

We will have an Anesthesia Machine Workshopnext month

Thank you

Anesthesia Machine Intro 2011

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