Biomedical Engineering, Vol. 47, No. 1, May, 2013, pp. 2631. Translated from Meditsinskaya Tekhnika, Vol.

47, No. 1, Jan.Feb., 2013, pp. 2126.

Original article submitted November 16, 2012.

Multipurpose Device for Inhalation Anesthesia

I. K. Sergeev1*, U. G. Sterlin2, and V. V. Subbotin3

Development of anesthetic equipment for contemporary hospitals is urgently needed. Use of modular design pro
vides a more flexible approach to supplying surgical centers and municipal hospitals with effective anesthetic
equipment.

Sophisticated surgery requires advanced inhalation

anesthesia equipment. In recent years, there is a trend on
the domestic medical market towards substitution of
domestic anesthetic apparatuses with foreign models.
Thus, development of effective inhalation anesthesia
apparatuses is a priority direction in national public
health and medical industry. The main goal of this work is
to describe principles of development of modular units
providing a more flexible approach to supplying surgical
centers and municipal hospitals with effective anesthetic
equipment. This work was supported by the Ministry of
Industry and Trade of the Russian Federation (Project
No. 11411.0810200.13.19, code NEOTEC).

anesthesia, and monitoring of vitally important parame

ters of the patient. Automatic and friendly control of IAE
is a subject of particular attention. Such control should
maintain the vitally important parameters of the patient
at a stable level. The equipment should provide an alarm
power supply, new functional standards, electromagnetic
compatibility, safety, etc. Increased application of soft
ware and logical modules, improvement of the equipment
reliability and design quality, and extension of the age
range are among the requirements for newly developed
apparatuses.
Apparatuses for inhalation anesthesia should be
adapted to new safe and more effective anesthetics
(sevoflurane and xenon). Reversible inhalation methods
with low flow of fresh mixture (Low Flow and Minimal
Flow) are based on electronic dispensers and monitoring

Technical Structure of Apparatus

Inhalation anesthesia equipment (IAE) used in
domestic health service requires upgrading due to obso
lescence of many apparatuses. The new equipment
should be supplied to departments of surgery, resuscita
tion, and intensive therapy where the use of IAE is
mandatory. The lack of domestic IAE meeting the
requirements of contemporary medicine, as well as the
high cost of imported IAE models, make the problem of
development of new domestic inhalation anesthesia
apparatuses especially urgent.
There are new effective methods of inhalation anes
thesia and mechanical lung ventilation (MLV). IAE pro
vides a basis for integration of MLV methods, inhalation
1

Opticheskie Sistemy i Tekhnologii, Ltd., Moscow, Russia; Email:

sergeevik@rambler.ru
2
Yalamov Urals Optical and Mechanical Plant, Yekaterinburg, Russia.
3
Vishnevsky Institute of Surgery, Moscow, Russia.
* To whom correspondence should be addressed.

Fig. 1. General view and functional structure of apparatus.

26

00063398/13/47010026 2013 Springer Science+Business Media New York

Multipurpose Device for Inhalation Anesthesia

MLV unit
External panel
Mechanical clips

Fig. 2. Example of structure of monoblock MLV apparatus. All

functional elements are integrated in the same housing. This
maintains the circuit size at a minimal level.

of inhalation anesthetics in the respiratory gas mixture.

Electricallydriven MLV apparatuses provide autonomous
operation even in the absence of stationary gas supply or
under field conditions.
There is a trend toward an increase in the number of
monitored parameters of: 1) MLV and IAE apparatuses;
2) the patients state; and 3) the integrated apparatus
patient system. The patients state and the state of moni
toring equipment are controlled using artificial intelli
gence systems. Alarm signal is generated if the monitored
parameters go beyond safe limits. Largeformat color
TFTmonitors provide necessary level of ergonomics.
The apparatus described in this work is constructed
on the basis of medical and technological requirements
developed at the Vishnevsky Institute of Surgery, the
Russian Ministry of Health and Social Development, and
the Marketing Department of the Urals Optical and
Mechanical Plant. In particular, the requirements con
cerned ergonomics and specific conditions of use in
domestic medical organizations.
The apparatus was constructed taking into account
the structure of leading foreign analogs, among which
Drger FabiusGS was regarded as the closest. The cost of
the apparatus is comparable with the cost of the leading
apparatuses of foreign manufacture. Figures 1 and 2 illus
trate the general view and various aspects of operation of
IAE.
The device was designed taking into account specif
ic features of the anesthesiologists work. The require
ments for compatibility with other surgical equipment
were also taken into consideration [14]. Apparatuses in
the midrange price segment were selected as analogs for
comparative analysis (Table 1). The requirements speci
fied by experts at the Vishnevsky Institute of Surgery and

Functional Support of Methods and Modes

The multifunctional apparatus of inhalation anes
thesia provides all MLV functions required from appara
tuses of this class [512]. The MLV algorithm is focused
on physicianformulated targets [1317]. The list of
methods provided by the apparatus is given in Table 2.
The system for supply of anesthetics to patient con
tains:
1) reversible and partially reversible loop;
2) hermetic respiration loop (max. leakage 
100 ml/min);
3) anesthetic evaporators outside the patient loop.
A new anesthetic evaporator model MINIVAP
UOMP was developed and successfully tested at the Urals
Orthogonal views
65 mm
35 mm

90 mm

Monoblock

the Russian Ministry of Health and Social Development

were also taken into account.
The system provides a number of innovative solu
tions whose efficiency was supported by the results of
technological testing. The innovations include:
1) smallsize evaporator for liquid anesthetics of all
types;
2) modern MLV software providing safe methods and
algorithms;
3) lownoise highefficiency MLV valve with high
rate and reliability;
4) demountable respiratory monoblock providing
easy cleaning;
5) new polymer materials providing easy service and
mounting;
6) autonomous work (builtin battery);
7) service readiness of the main units.

97 mm

145 mm

Flap lid

27

Inlet
Inlet and outlet
connections
Case with
evaporator
chamber

Filler tray

Handle
Level
Outlet

Name of
anesthetic

Fig. 3. General view of anesthetic evaporator MINIVAPUOMP.

28

Sergeev et al.

TABLE 1. Comparative Parameters of Inhalation Anesthesia Systems

Parameter

POLINARKONE
VITA, Korpus, Ltd.

AIA MK12
(Belarus)

FABIUSGS
Drger, Germany

DatexOhmeda ADU
Carestation, GE, USA

MAIA, UOMP

Dispenser type

Rotametric

Rotametric

Electronic

Electronic

Electronic

Medical gas consumption rate, liter/min

2

0.210.0

0.210.0

0.0210.0

010.0

0.110.0

N 2

0.210.0

1.010.0

0.0210.0

08.5

0.210.0

Air

No

010.0

No

010.0

0.215.0

No

No

No

No

0.28.0 (option)

Vapor2000 (~8 kg)

Aladin (23 kg)

MinivapUOMP (~2.5 kg)

Anesthetic evaporator Anesthesist4 (~8 kg) DatexOhmeda (~6 kg)

Anesthetics used

Halothane, isoflurane

Breathing circuit

External, demountable

Monoblock

Monoblock

Monoblock

Monoblock

Implemented breath
ing circuits

Nonreversible,
partially reversible

Nonreversible,
partially reversible

Partially reversible,
reversible

Partially reversible,
reversible

Nonreversible, partially
reversible, reversible

Lowflow anesthesia

Is not provided

Is provided

Is provided

Is provided

Is provided

No

Yes

Yes

Yes

Yes

Monitoring

IP. Patient monitor

509 (option):
ECG; NIAP; FiO2;
SpO2; pCO2; PR; ;
capno and plethys
mogram

V; MV; IP; F; ; R;
MLV parameters.
Patient monitor: ECG;
NIAP; FiO2; SpO2;
pCO2; N2O; PR; T;
anesthetic conc.;
capno and plethys
mogram

V; MV; IP; FiO2;

MLV parameters;
gas flow

V; MV; IP; F; FiO2;

MLV parameters; gas
flow; anesthetic conc.

V; MV; IP; F; ; R;
MLV parameters; gas
flow. Patient monitor:
ECG; NIAP; FiO2;
SpO2; pCO2; N2O; PR; T;
anesthetic conc.; capno
and plethysmogram

Ventilation modes

VCV, PCV, manual,

SPONT

VCV, PCV, SIMV,

manual, SPONT

VCV, PCV, manual

VCV,PCV,SIMV, PSV
VCV, PCV, Apn, PSV,
(option), manual,
Ass/Cont, SIMV, manu
SPONT
al, SPONT

Protection against
hypoxia

Halothane, enflurane, Halothane, enflurane, Enflurane, isoflurane,

isoflurane, sevoflurane isoflurane, sevoflurane sevoflurane, desflurane

Enflurane, isoflurane,
sevoflurane

Parameters of controlled MLV

Control
Respiration rate,
1/min

By volume, by pressure By volume, by pressure By volume, by pressure By volume, by pressure

By volume, by pressure

680

660

460

260

480

Minute ventilation,
liter/min

0.530

0.325

130

0.130

0.530

Inhalation volume,
liters

0.031.5

0.051.2

0.051.4

0.021.4

0.031.5

2:11:4 (discrete)

4:11:4

4:11:4

2:11:4.5

2:11:4 (discrete)

PEEP, cm H2O
column

025

035

020

520

025

Battery power

60 min

<3h

45 min

30 min

60 min

700 1400 600

550 1400 600

890 1300 820

840 1500 780

550 1300 600

85

75

105

130

~90

Ratio I:E

Dimensions, mm
Weight, kg

Multipurpose Device for Inhalation Anesthesia

29

TABLE 2.

TABLE 3. Results of Testing of Anesthetic Evaporator

Methods of controlled MLV (CMLV)

Controlled volume
Plateau (retarded inhalation)
Inverse ratio Tin/Tex
Limit Rpeak:
 exhalation mode is activated at Rpeak = VP_R
 without activation of exhalation (at Rthr)
 with Rpeak < Rthr > Rpl
Minimal Rpeak
Controlled pressure
Inverse ratio Tin/Tex
Additional methods
PEEP
Periodic increase in the FRC (inhalation)
Measurement of FiO2
Accessory MLV methods
With synchronization by pressure
Automatic transfer to CMV and back
Ventilation with support of pressure
The same with automatic transfer to AssVCV
Periodic forced ventilation methods
Synchronous IMV + PEEP
Synchronous IMV + PS + PEEP
Periodic support mediated by pressure
Spontaneous breathing

8 liters/min

CMV
VCV
IRV
PLV
"
"
"
VCV + Pmin
V
PC IRV

0.00

0.00

(vol. %) (vol. %) (vol. %)

0.00

Permissible error
(GOST)

0.00

0.00

0.4

0.80

1.00

0.90

0.00

0.20

0.4

2.30

3.20

2.75

0.20

0.70

0.5

4.30

5.50

4.90

0.75

0.45

1.0

5.00

5.60

5.30

0.75

0.15

1.15

6.20

6.00

6.10

0.63

0.83

1.36

7.30

6.60

6.95

0.18

0.88

1.5

PEEP
VCV + Sigh

volume is selected with regard to the consumption of

anesthetic during surgery, the number of operations per
day, and the hospital norms for anesthetic storage and
consumption.
According to ecological requirements specified in the
Kyoto protocol, pollution with halogencontaining sub
stances (including modern anesthetics) should be reduced
to a minimum. In case of inhalation anesthesia, the con
sumption rate of anesthetic gases should be reduced to
0.2 liter/min. For this purpose, a closed loop should be
used. The anesthetic consumption per operation is 35 ml.
The testing program and methods were consistent
with GOST R IEC 606012132001 (including p.
108.8.1.4: Evaporator Flushing at Maximal Concentration
2 liter/min for 3 min). The testing results are given in Fig.
4 and Table 3 (for sevoflurane).
According to the test results, stability and concentra
tion range of enflurane (from 0 to 5 vol. %) and sevoflu

AssV
Ass/Cont
AssVVCV
PS
PS + Apn
IMV
SIMV
SIMV + PS
IPS
SB

Optical and Mechanical Plant (Fig. 3). Development of

this evaporator constituted an important innovative com
ponent of this work. An important parameter of MINI
VAPUOMP is the anesthetic volume. The evaporator
Calibration of arbitrary scale
2 lit/min, low conc.
8 lit/min, high conc.
Calibr. scale

Determination of anesthetic concentration error

8 lit/min, high conc.

8 lit/min, low conc.

Measured concentration of anesthetic,

vol. %

Measured concentration of anesthetic,

vol. %

2 lit/min, high conc.

8 lit/min, low conc.

Absolute error

Arbitrary scale
Calibrated scale

Fig. 4. Results of testing of anesthetic evaporator MINIVAPUOMP.

30

Sergeev et al.

Fig. 5. Arrangement of ventilation parameters and digital and graphical information about the hemodynamic state on integrated monitor
screen of multifunctional apparatus.

rane (from 0 to 8 vol. %) at continuous flow and temper

ature (20 3) are consistent with GOST R IEC 60601
2132001.
The innovative structure of the anesthetic evaporator
provides stable input of anesthetic under the following
conditions:
stable division of gas flow within the range 0.2
10 liter/min;
balanced gas saturation with anesthetic vapor in
evaporator chamber;
thermal stabilization of evaporator chamber;
thermal and baric compensation of anesthetic at
chamber output and bypass line.
These innovations provide the following advantages:
versatility (any liquid anesthetic can be used);
portability;
economic and ecological features (minimal emis
sion to atmosphere);
minimal cost.
IAE provides additional monitoring options: visuali
zation of the pressuretime and flowtime curves, as well
as pressurevolume and flowvolume loops (Fig. 5).
Lung and chest wall compliance can be calculated.
Parameters of patient and apparatus can be monitored
using the IAE system or an external monitor [7, 1827].
The system software can be updated as new versions
of ventilation and monitoring algorithms become avail
able.

Conclusion
A modern multifunctional inhalation anesthesia
apparatus has been developed. The apparatus meets all
requirements for apparatuses of this class. The apparatus

is commercially available from the Urals Optical and

Mechanical Plant. It was developed in collaboration with
leading specialists in medicine and engineering. The
monitoring equipment for the apparatus was developed in
collaboration with the Biomedical Engineering Depart
ment of the Bauman Moscow State Technical University
(Head, Prof. S. I. Schookin).
The apparatus was successfully tested by leading
domestic experts in resuscitation: Prof. Dr. V. V. Subbotin
and Academician Dr. A. A. Bunatyan. This work was pos
itively reviewed by Academician Yu. A. Vladimirov. The
IAE system developed in this work was positively evaluat
ed by medical specialists. The apparatus structure and
design are protected by Russian Federation patents.
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