Anesthesia Machine Intro New Residents July 3, 2001

Advanced Anesthesia Machine Workshop CA-1 and everyone else

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

Department of Anesthesiology, Pain, and Peri-operative Medicine, Brigham and Women’s Hospital

Medical Liaison, Department of Biomedical Engineering Partners HealthCare System

Professor of Anaesthesia Harvard Medical School

© Copyright 2000-2015, James H Philip, all rights reserved

Anesthesia Delivery Systems What Do I Need to Know About My Machine and why?

Answer: A great deal, and more than most of us know. Your patients rightfully expect you to understand the equipment you use. This is not an ABA review lecture. This is a “What do I need to know for safe and effective anesthesia are” lecture.

Anesthesia Delivery System (ADS)

Life Support with oxygen spontaneous breathing mechanical ventilation Inhalant Drug Delivery Gas Vapor

Anesthesia Machine Review of what you learned in Basics Lecture & Workshop Formal lecture on Anesthesia Machines Long Q & A Interrupt me with questions I will decide whether to answer now or later

Anesthesia Machine Schematic Basics of AnesthesiaR Miller, M Pardo 6th Ed

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE

CALIBRATED VAPORIZERS

Fresh Gas Flow (FGF)

OXYGEN FLUSH VALVE [first]

ON/OFF SWITCH

CHECK VALVE PRESSURE

REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)

[Anesthetizing gases flow]

COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Anesthesia Machine Schematic (mod from Philip, 1976)

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

BWH backup: one O2, no N2O Tank room with more O2 tanks O2 tanks have 50 PSI outlet, also

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

O2

N2O

D S I

Wall outlets and supply hoses are DISS (Diameter Index Safety System) 55 PSI

55 psi

DISS

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Tank Pressure Gauge displays when tank is open

Tank Pressure Gauge

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Pressure Regulator reduces pressure to 35 PSI

working pressure 35 psi

Always less than

wall pressure to prevent emptying

55 psi

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Filter prevents particulates from injuring machine or patient Check valve prevents emptying tank to wall losing gas and pressure when using tanks CHECK VALVE

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Oxygen Flush valve connects from Regulated O2 pressure to Common Outlet FGF source

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

On / Off switch Powers Flow Controls

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Failsafe prevents delivery of N2O when O2 supply pressure is low or zero. Does not prevent hypoxic fresh gas or inspired gas

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

On / Off switch Powers Flow Controls Does not prevent delivery of O2 via Flush

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Needle Valves control flow

NEEDLE VALVE

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Mandatory flow of 50 or 250 mL O2 is present on some ADSs (GE machines – Aisys, Aestiva) (Not Draeger - Apollo, Fabius, Tiro)

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Rotameter indicates flow of gas viscosity near bottom, density near top Thus gas-specific Read widest point

ROTAMETER

ROTAMETER

Needle Valve and Rotameter

Rotameter

Pressure drop from below ball to above ball causes upward force Weight of ball causes downward force Ball height is where forces are equal

Rotameter

Ball in center of flow occludes like an orifice with turbulent flow and density dominating Ball near walls resists like a long skinny tube with viscosity dominating

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

High Pressure before needle valve, low pressure after

High Low Pressure

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Vaporizers add anesthetic vapor

P V

P V

Vaporizing Chamber

Bypass Flow

Variable-Bypass or Calibrated Vaporizer Tec 4,5 and Vapor 19

FGF FGF + Vapor

Flow to Vaporizing Chamber

P v = Saturated Vapor Pressure

Basic Principle of Operation Standard Modern Vaporizer

P

P V

Vaporizing Chamber

Bypass Flow

AKA : Direct Reading, Temperature-Compensated

FGF FGF +

Flow to Vaporizing Chamber

P v = Saturated Pressure

Variable-Bypass Vaporizer

Vapor

Drawn after Eisenkraft 1993 © 2005, James H Philip, all rights reserved

P

P V

Vaporizing Chamber

Bypass Flow

Modern Vaporizers havesplitting at outflow of Vaporization Chamber

Ohmeda Tec 4,5 and Drager Vapor 19 and 2000

Flow to Chamber

P v = Saturated Vapor Pressure

Ehrenwerth J, Eisenkraft JB, Berry JM. Anesthesia Equipment: Principles and Applications. Elsevier, 2013

Variable-Bypass Vaporizer correct drawing

FGF + Vapor

Same fraction as at sea level Thus constant PP out

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Anesthetizing gases leave vaporizer and join O2 Flush gas (if in use) and exit via common outlet to fresh gas hose carrying Fresh Gas Flow

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE



ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

Flush Flow (last)


N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Check valve near common outlet is present on some ADSs GE Aestiva (MRI, AMIGO, ORs 7&8 for Heliox) These machines need a negative pressure leak test (NPLT)

CHECK VALVE

on some ADSs

Negative Pressure Leak Test (NPLT)

Detects a leak in Anes Machine Low Pressure System Low Pressure System is from Needle Valve to Common Outlet (CO) Low Pressure System is needle valve, rotameter, vaporizer, and some pipes Low pressure because the pressure drops across the needle valve opening Common leak sites are vaporizer mounting site and fill ports You test each vaporizer by itself. At least test the one you will use With FGF = 0, apply ans use negative-pressure squeeze bulb Bulb should not self-inflate

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Most machines today do not have Fresh Gas Check Valve

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE

Flush Flow (last)


COMMON OUTLET

N2O

750 psi

N2O

750 psi

O2

2000 psi

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

Questions on Gas Mixing?

Patient Breathing Circuit

Allows cyclic flow To and from the patient

(AKA breathing)

A

Manual Resuscitator is one of the few

Open Circuit ventilation systems you will ever use

Manual Resuscitator

Mapleson categorization of Non-rebreathing Circuits

A

B

C

D E

F

Bain

Modified from Miller, Pardo, 2013, © Elevier .See original text for details

Not presented here

Rebreathing Circuit is now almost universal

Miller drawing of semi-closed circuit

Miller drawing flipped

Sampled

Exhaust

CO2

Ab- sorb- ant

200 mL/min

Fresh

J Philip drawing of semi-closed circuit

Sampled

Exhaust

CO2

Ab- sorb- ant

200 mL/min

Fresh

Rare designs have Fresh Gas enter after Insp Valve GE ADU, Philips AX700

Sampled

Exhaust

CO2

Ab- sorb- ant

200 mL/min

Fresh

Semi-closed (rebreathing) circuit

Normal flow in breathing circuit

Flow goes forward In the direction of the valves Emptying and filling reservoir bag and lungs alternately

Sampled

Exhaust

CO2

Ab- sorb- ant

200 mL/min

Fresh

Normal flow in the breathing circuit - Inspiration

Sampled

Exhaust

CO2

Ab- sorb- ant

200 mL/min

Fresh

Normal flow in the breathing circuit - Expiration

1

2

Sampled

Exhaust

CO2

Ab- sorb- ant

200 mL/min

Fresh

Normal flow in the breathing circuit - Expiration

1

2

The Circle-Absorber System

Exhaust Expired

CO2

Ab- sorb- ant

Inspired Fresh

Gas Flows

VE

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

Sampled

Exhaust Expired

CO2

Ab- sorb- ant

200 mL/min

Inspired Fresh

Gas Flows

VE

Questions on Gas Flow?

Sampled

Exhaust Expired

CO2

Ab- sorb- ant

200 mL/min

Inspired Fresh

Gas Flows

VE

Low FGF

More rebreathing Inspired more dependent on Expired Inspired less dependent on Vaporizer

View the Breathing Circuit

The Circle-Absorber System

High Flow, Low Flow

Sampled

Exhaust Expired

CO2

Ab- sorb- ant

200 mL/min

Inspired Fresh

Gas Flows

VE

Partial Rebreathing Circuits are used in Anesthesia

Don’t throw away all the exhaled gas It contains expensive anesthetic vapors Reuse 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 dummies Requires knowledge and skill Makes us different from other care providers

EMT, Sedation RN, ED MD, Hospitalist, Others

Look at machines we have

Two Companies GE-Datex-Ohmeda Aestiva and all

others Draeger Fabius and all others

Newer ADSs both companies

GE Aisys Draeger Apollo

< 1998, Standard Anesthesia Ventilators

Tidal Volume and FGF were interdependent Increase in FGF caused Increase in Tidal Volume

Increased by the amount of fresh gas that flowed during inspiration

Fresh Gas Flow Independent of Ventilation 1998 - WYSIWYG What You Set Is What You Get

Set the Tidal Volume - patient receives what you set Two ways to achieve this Fresh Gas Compensation- compensate for FGF

Active, feedback control of inspired tidal volume GE

Fresh Gas Decoupling – FGF goes elsewhere in I Passive separation of FGF during inspiration Draeger

Newer ADSs both companies GE Aisys Draeger Apollo GS

GE-Datex-Ohmeda Aestiva

GE Aestiva, Aisys

Pneumatic (oxygen)-driven bellows Inspiratory and Expiratory Flow Sensor

Feedback

from flow sensors to bellows drive

Bellows stops pushing when Measured Inspired Tidal Volume = Set Inspired Tidal Volume

If you press the Flush button Bellows stops Next breaths are confused

GE has many alarms that stop ventilation

Fresh Gas Compensation Active, feedback control of inspired tidal volume

Aestiva VOS All GE models have similar differential-pressure flow sensor

Variable-Orifice flow Sensor (VOS)

Pressure Transducer

P1 P2

Flow

F Accurate over a wide range of flow. Each one is calibrated in GE factory. Microchip stores the calibration curve.

P

Variable orifice


Pressure Transducer

P1 P2

Flow

F

P

Variable orifice

This is what makes the SmartVent™ smart This is GE’s core technology

Accurate over a wide range of flow. Each one is calibrated in GE factory. Microchip stores the calibration curve.


Pressure Transducer

P1 P2

Flow

F

P

Variable orifice

One drop of water will make this fail

Accurate over a wide range of flow. Each one is calibrated in GE factory. Microchip stores the calibration curve.

Water Management is important Use an HME or HMEF

Heat and Moisture Exchanger between patient and circuit

HME Wet Dry

Inspired gas may be wet

Draeger Ventilation

Fresh Gas Flow Decoupling Passive separation of FGF during inspiration

Tiro, Fabius, Apollo

Draeger E-Vent Draeger Fabius GS, Tiro, or Apollo

Piston


Piston


Piston

Constant Volume FGF Decoupling

COSY-2.5

E I

I/ E select

Draeger Fabius and

Apollo Circuit Insp Valve

Circuit Exp Valve

Mechanical Ventilation Piston displacement is constant and provides constant Tidal Volume Fresh Gas fills the reservoir bag during inspiration (“decoupled”) Piston draws in Fresh and Exhaled gas during “refill” in expiration Piston is ready to give the next breath Reservoir bag is always filled with circuit gas Switch between Mechanical and Manual Ventilation and give same gas Recruitment breaths recruit with same gas so outcome is measurable

Draeger Fresh Gas Flow Decoupling

Implications of “Decoupling”

Collateral damage Reservoir bag is in the circuit during ventilation Adds a second sequential mixing chamber Old gas stays in-play even when FGF is high This does not matter much during induction This matters a lot during emergence In emergence we desire Inspired agent concentration = 0 Even with bag ventilation, expired gas contaminates inspired Cleaning for MH-sensitive patients is difficult

Example Fabius, End of case, VCV, FGF = 12 LPM

Inspired does not fall to zero

Draeger has difficulty clearing the last bit of agent

Malignant Hyperthermia Preparation Target is FI Agent < 5 ppm Most ADSs require 10 minutes Fabius and Apollo require 1 hour (Inspired Charcoal agent absorber can overcome this)

Gunter JB, Ball, J Than-Win S. Preparation of the Draeger Fabius Anesthesia Machine for the Malignant–Hyperthermia Susceptible Patient. Anesth Analg 2008;107:1936 –45

Draeger has difficulty clearing the last bit of agent

Malignant Hyperthermia Preparation Target is FI Agent < 5 ppm Most ADSs require 10 minutes Fabius and Apollo require 1 hour (Inspired Charcoal agent absorber can overcome this)

Gunter JB, Ball, J Than-Win S. Preparation of the Draeger Fabius Anesthesia Machine for the Malignant–Hyperthermia Susceptible Patient. Anesth Analg 2008;107:1936 –45

Fabius and Apollo are similar

Draeger has not solved this yet

Charcoal Absorbers overcome this

Dynasthetics,Inc.

GE breathing circuits are faster Induction Emergence


COSY-2.5

E I

I/ E select

Draeger Fabius and

Apollo Circuit Insp Valve

Circuit Exp Valve

GE Circuit configuration superimposed on Draeger Circuit

I/E

I/ E select

GE Circuit

Pneumatic bellows ventilator

GE Aisys Sevoflurane Induction

High FGF and vaporizer setting

Gas Monitor screen

Other Questions and Concerns

Explain Draeger (Apollo, Fabius, Tiro) Ventilation Alarms Explain Draeger Erratic Ventilation Observations Teach how to Pre-Use Check and open the “gas door” on GE Aestiva Explain how to properly start up and configure the GE Aisys Anesthesia Machine

Draeger (Apollo, Fabius, Tiro) Pressure Monitoring to detect disconnection

Rules If peak pressure exceeds the pressure threshold every 15 seconds then the ventilator is not disconnected If peak pressure does not cross pressure threshold for 15 seconds there is apnea based on failure to meet the pressure criterion - APNEA PRESSURE alarm sounds and flashes If pressure threshold is more than 6 cmH2O below peak pressure, PRES THRESHOLD LOW advisory lights up Press AUTO SET to set pressure threshold to 4 cmH2O below peak pressure. Alarm is now properly sensitive to apnea

PRESSURE THRESHOLD LOW alert

APNEA PRESSURE alarm

Draeger Erratic Ventilation Observations from sticky valves

Especially after giving nebulized Epoprostenol or (Veletri® or Flolan®) Poor PEEP Breath Stacking Multiple breaths, then apnea

E I

I/ E select

Draeger Fabius Apollo

Tyro Breathing

Circuit

Circuit Insp Valve

Circuit Exp Valve


COSY-2.5

E I

I/ E select

Draeger Fabius Apollo

Tyro Breathing

Circuit

Circuit Insp Valve

Circuit Exp Valve

This valve is sluggish

Draeger Fabius, Apollo,

Tiro.

Important observation

Slow to return to

PEEP

Draeger Valve Plate

Valve plate and valve moving well

Good PEEP Valve

P

F

Bad PEEP Vale

P

F

Pre-Use Check and open the “gas door” on GE Aestiva

Intranet for details: bwhanesthesia.org/Education/AnesthesiaTechnology Lectures are available to the public at http://etherweb.bwh.harvard.edu/education/resources/technology_resources.php

GE Aestiva CO2 Absorber

Aestiva Front view

Aestiva with imaginary door labels

Aestiva Door Open

Aestiva O2 Sensor removed

O2 Sensor re-inserted

Negative pressure bulb is in drawer

O2

2000 psi

O2 SERVICE

INLET 55psi

35 psi

35 psi

0, 50 or 250 ml/min

NEEDLE VALVE

FAILSAFE VALVE




ON/OFF SWITCH


REGULATOR

N2O SERVICE

INLET 55 psi

O2

N2O

FRESH GAS HOSE Oxygen

Flush Flow (last)

COMMON OUTLET

FILTER

WALL

DISS diameter

index safety system

CONNEC- TION

O2

N2O

D S I

O2

N2O

1000-2000 PSI Is OK

≤ 3:1

Do this with each vaporizers ON and OFF

Leaks detectable With negative pressure

Scavenging System Verify that there is a proper connection between the scavenging system and BOTH APL valve and ventilator relief valve Verify that the scavenging system is connected to the wall vacuum

active Anesthesia Gas Scavenging System (AGSS)

Adjust Needle Valve so bag

never overfills 3-Liter Bag

Rotating DISS Connector

Scavenging Hose connects to Waste Anesthesia Gas System

(WAGS)

How to properly start up and configure the GE Aisys Anesthesia Machine

http://bwhanesthesia.net/AisysBo http://bwhanesthesia.net/AisysBootupSequence.htmlotupSequence.html Reboot Do Machine Check Click: Start Case Default Settings depend on OR #: Vent View or Agent View Click Select and choose: Vent View, Agent View, Monitor, LMA During case, Click green Control Knob to switch: Agent View <->Spirometry

http://bwhanesthesia.net/AisysBootupSequence.html

http://bwhanesthesia.net/AisysBootupSequence.html

Thank you [email protected] Lectures are available at www.bwhanesthesia.org

Documents

Anesthesia Machine Intro New Residents July 3, 2001