CO-ORDINATED BY : DR PARUL PRESENTED BY : DR GURNEET

ANAESTHETIC MACHINE

Supply compressed gases Measure flow of gases Add vapours in known concentrations

Deliver vapours and gases to patient via a

breathing system

Scavenge waste Monitor machine and patient

ANAESTHETIC MACHINES
Pressurized gases are supplied by cylinders or

pipelines to the anaesthetic machine which

controls the flow of gases before passing

them through a vaporizer and delivering the

resulting mixture to the patient via the breathing circuit

History

Original Continuous-flow Anaesthetic Machine designed by Boyle in 1917

Most current anaesthetic machines derived from Boyles Machine

Simpler anaesthetic machines draw over used

by Armed Forces (no need for fresh gas supply)

Boyles Anaesthetic Machine

Components of the Anaesthetic Machine

Gas supplies Pressure gauges Pressure reducing valves Rota meters Vaporizers Common gas outlet High flow oxygen flush Pressure relief valve Oxygen supply failure alarm

Breathing system Ventilator Scavenging Monitoring devices

Basic Components of Anaesthetic Machine

Anaesthetic machine framework

Box shaped sections of welded steel or aluminium provide a rigid metal framework mounted on wheels with antistatic tyres and brakes.

Antistatic

measures

improve

flowmeter

performance and, where flammable vapours are used, reduce the risk of ignition.

Gas Supply - Pipelines

Central supply point O2, N2O, air, medical vacuum supplied Pipelines throughout hospital Outlets colour and shape coded Flexible colour coded pipelines run to anaesthetic machine Pipelines permanently fixed to machine (NonInterchangable Screw Thread NIST) Pressure 400kPa (4 bar)

Flexible pipelines have three components:

Schrader probe. To prevent misconnection to the wrong gas service, the probe for each gas supply has a protruding indexing collar with a

unique diameter, which only fits the Schrader socket assembly for the
same gas.

Flexible hosepipe. Originally the hoses were made of black reinforced

rubber with short lengths of coloured sheaths at each end. Modern

hoses are colour-coded for each gas (oxygen is white; nitrous oxide, French blue; medical air hose, black/white).

Non-Interchangeable Screw Thread (NIST) connection to the anaesthetic machine. This ensures a hose connection specific to each gas service. It comprises a nut and probe. The probe has a unique profile for each gas, which fits only the union on the machine for that

gas. The nut has the same diameter and thread for all gas services, but
can only be attached to the machine when the probe is engaged.

PIPELINE INLET

FILTER
CHECK VALVE Diameter index safety system (DISS) some machines have an oxygen power outlet that may be used to drive the ventilator or provide an

auxillary oxygen flowmeter

DISS fittings for oxygen inlet and oxygen power outlet are identical and not be mistakenly interchanged

Gas Supply - Cylinders

Molybdenum steel or aluminium Cylinders are subjected to mechanical testing before marketing for use. The test is done with one in 100 furnished cylinders.
a. b.

Tensile test Flattening test

c.
d. e.

Impact test
Bend test Hydrolic test or pressure test

There are different sizes of cylinders A, B, C, D,E and others. D and E

cylinders of N2O and O2 are in common use.

O2, Nitrogen, Air and He are kept in cylinder as compressed gases, but N2O, cyclopropane and CO2 are stored in liquid form.

Oxygen -- Black & white shoulder 2000 PSI (138 Bar) Nitrous oxide Blue Carbon Dioxide Grey Cyclopropane Orange -- 750 PSI (52 Bar) -- 720 PSI (50 Bar) -- 75 PSI (5 Bar)

N2O + O2 (entonox) 2000 PSI (138 Bar) The colour coding is also used on the hoses. Safety relief valve Pin Index System The pins are below the nipple Each particular cylinder has a fixed pin code Oxygen 2and 5 N2O 3 and 5 CO2 1 and 6 Air 1 and 5 Cyclopropane 3 and 6 N2 1 and 4 Entonox 7 Bodok seal

Pressure Gauges
Pressure gauges to measure pipeline and cylinder pressures O2, N2O and air gauges on front of machine Gas colour coded and calibrated

Bourdon Gauge

Pressure Regulators
Function: Reduce pressure to protect machine Maintain constant supply to compensate for changing cylinder pressures + demand Reduce high and variable pressure found in a cylinder to a lower (40 48 PSI, 272 336 Kpa) and more constant pressure.

.Compression spring
acting on diaphragm coupled to inlet valve

ADAMS VALVE : - It reduces the pressure to between 5 cm 10 PSI. It consists of a chamber enclosed to one side by a diaphragm. High pressure gas enters into the chamber

from the lower end of the valve, the Diaphragm is

distended against the recoil of its own and of a strong spring. The gas passes through the tube on the side of valve. The pressure may be regulated by adjusting the screw at the top of valve.

HIGH PRESSURE RELIEF VALVE

Provided downstream of the regulator, opens

when pressure exceeds the machines maximum

safety limit (95 110 PSI) 700 Kpa.

OXYGEN SUPPLY FAILURE PROTECTION DEVICES

Oxygen & air can pass directly to its flow control valve
Other gases must first pass through safety devices before reaching the flow valve

These devices permit the flow of other gases only if there is

sufficient oxygen pressure in the safety device

Safety devices sense oxygen pressure via a small piloting pressure line

If piloting pressure line falls below a threshold (20 psig), shut off valves close preventing administration of gases

Most modern machines use a propotioning safety device instead of a threshold shut-off valve

Called oxygen failure protection device (draeger) or

a balance regulator (datex

ohmeda),proportionately reduce the pressure of nitrous oxide and other gases except for air

All machines also have a oxygen supply low

pressure sensor that activates a gas whistle,when

inlet gas pressure drops below a threshold value

(20-35 psig)

Ritchie Whistle (1960)

Rotameters
Measure flow rate of gas passing through them Calibration (accuracy +/- 2.5%)

Components: flow control (needle) valve, tapered tube, bobbin (slits + dot)

Low flow rates: flow laminar + function of gas viscosity (Poiseuilles Law) High flow rates: flow turbulent + function of gas density

Causes of flow meter malfunctioning include

a) Dirt in the flow meter. b) Vertical tube mis alignment c) Striking or concealment of float at the top of tube. Safety mechanisms in rotameters

a) O2 flow meter is always positioned down stream to all other flow meter.
b) Minimum oxygen flow The oxygen flow valves are usually designed to deliver a minimum flow of 150 ml/min. The method involved the use of a minimum flow resister.

This safety feature helps ensure that some oxygen enters the

breathing circuit even if the operator forgets to turn on the

oxygen flow.

c) constant rotation of the floats

d) coating the tubes interior with conducting substance

e) Oxygen knob
f)OXYGEN NITROUS OXIDE RATIO CONTROLLER Links the two flow valves

either mechanically, Pneumatically ,Electronically .

MECHANICALLY LINKAGE : -

There is a 14 tooth sprocket on the N2O flow control valve and a 29 tooth sprocket on the O2 flow control

valve. A pin on the O2 sprocket engages a pin on the O2

flow control knob if the flow control valves are adjusted so that 25% conc of O2 is reached. This minimum oxygen ratio device (proportioning system) permits independent control of each gas as long as percentage of O2 is above minimum.

PNEUMATIC LINKAGE : - A movable horizontal shaft

connects the diaphragm of the N2O and O2 chambers and

the N2O slave control valve. The slave control valve is a ball check valve. ELECTRONICALLY MEASURED : An electronic

proportioning valve controls the O2 conc in the fresh gas. A computer calculates the max allowable N2O flow given the O2 flow. If the N2O flow control valve opened to cause a

flow higher than maximum allowable, the proportioning

valve reduces the N2O flow to supply a minimum of 25% O 2.

AUXILLARY OXYGEN FLOW INDICATOR

Allows delivery of O2 to a patient without turning on the

main switch. This can be used to supply O2 directly to

patients or can be connected to a resuscitator bag. If there is problem with the anesthesia machine. This can also act as a source of high pressure O2 for transtracheal jet ventilation. UNIDIRECTIONAL (CHECK) VALVE : - Present b/w the vaporizer and common gas outlet. To prevent retrograde

flow of gases.

Back Bar

Horizontal part of machine between rotameters and common gas outlet

Vaporizers mounted here so volatiles can be added to fresh gases

Pressure ranges 0-30 kPa (1 kPa at outlet end) Non-return pressure relief valve downstream of vaporizers set at 35 kPa prevents barotrauma to rotameters, vaporizers and patient

Vaporizers

Add controlled amount inhalational agent, after changing it from

liquid to gas, to fresh gas flow

Accurate delivery of anaesthetic agent regardless of time, gas flow

and temperature
Safety mechanisms include

temperature compensation

Non-corrosive property
Colour coded dials & bodies Antispill mechanism Colour coded keyed filling devices Safety interlock device

Common Gas Outlet

Fresh gas mixture supplied to patient or ventilator Hose of breathing circuits attaches to it Often mounted on swivel Supply gas to the breathing circuit. An anti disconnect device is used to prevent accidental detachment of the gas outlet hose

that connects the machine to the breathing circuit.

22mm male outlets external diameter 15mm female outlets internal diameter

OXYGEN FLUSH VALVE (O2 by pass, emergency O2 receives

O2 from the pipeline inlet or cylinder reducing device

and directs a high un metered flow directly to the common gas outlet. The flow is between 35 75 litres/min.

In most anesthesia machines the oxygen flush can be

activated regardless of whether the master switch is

turned ON or OFF. DISADVANTAGES : 1. Internal leakage

2. Sticking in the ON position

3. Barotrauma.

OXYGEN ANALYZERS

G.A should never be administered without it in breathing circuit 3 types are polarograpgic,galvanic,paramagnetic They utilize electrochemical sensors that contain cathode and anode electrodes embedded in a electrolyte gel separated from

the sample gas by a oxygen permeable membrane

Should have alow level alarm Sensor placed in inspiratory or expiratory limb of circle systemnot in fresh gas line

Spirometers

Used to measure exhaled tidal volume in the breathing circuit on all the anaesthesia machines ,typically near the exhalation valve

Some also

measure the inspiratory tidal volume

just past the inspiratory valve

Changes in exhaled tidal volume represent changes in ventilatory settings Also may represent circuit laeks,disconnections or ventilatory malfunction

Circuit pressure

A pressure gauge or electronic sensor is used to

measure breathing circuit pressure somewhere

between the expiratory and inspiratory unidirectional valves

Rise in airway pressure signal worsening lung

compliance, increase in tidal volume, obstruction in breathing circuit & ET tube

Drop may indicate improvement in compliance, leak

in circuit

Adjustable pressure limiting valve

APL valves are used in both types of breathing circuit. It allows excess gas to escape when a preset pressure is exceeded, thus minimizing the risk of barotrauma to the patient.

Many APL valves do not have calibrations and are

adjusted empirically to give a desired peak inspired

pressure

Scavenging system

Modern scavenging has four components for collecting, transferring, receiving and disposal of waste gases from the breathing circuit:

The collecting system comprises a gas-tight shroud enclosing the APL valve of the breathing circuit (or expiratory port of the ventilator) utilizing 30 mm conical connections. Some systems (Ohmeda AGS) have an over-pressure relief valve which blows at 1 kPa.

The transfer system comprises wide bore tubing leading from the collecting systems to the receiving system.

The receiving system comprises a reservoir, air brake, flow indicator and filter. A closed system requires a dumping

valve to prevent excessive negative pressure developing

(0.5 cm water at 30 litre min1 gas flow) and a pressure relief valve to prevent excessive positive pressure (5 cm

H2O at 30 litre min1 gas flow).

Disposal systems are active and high flow . The subatmospheric pressure required is generated by an

exhauster unit, which uses a fan to generate a low

pressure, high volume system capable of removing 75 litre min1 at a peak flow of 130 litre min1.

Safety Features of Anaesthetic Machines

1. Non inter changeable gas specific

connections to pipeline inlet (DISS) with

pressure gauges, filter and check valve.

Prevent incorrect pipeline attachments, detect failure, depletion, or fluctuation.

2. Pin index safety system for cylinders with pressure gauges. One O2 cylinder Prevent incorrect cylinder attachments, provide back up gas supply detect depletion.

3. Low oxygen pressure alarm at the common gas inlet.

Detect O2 supply failure

4. Minimum oxygen/N2O ratio controller device (hypoxic guard) Prevent delivery of less than 21% O2.
5. Oxygen failure safety device (shut off or proportioning device Prevent adm of N2O or other gases when the O2 supply fails.

6. O2 must enter the common down stream to other gases Prevent hypoxia in event of proximal gas leak. 7. O2 conc monitor and alarm precisely regulate O2 conc. 8. Automatically enabled essential alarms and monitors Prevents use of the machine without essential monitors. Prevent adm of hypoxic

gas mixture in event of a low pressure system leak,

9. Vaporizer interlock device

Prevent simultaneous

adm of more than one volatile agent.

10.Capnography and anesthesia gas measurement

guide ventilation, prevent anesthesia over dose, help in

reduced an awair ness.

11.Oxygen flush mechanism

breathing circuit.

Rapidly refill or flush the

12.Breathing circuit pressure monitor and alarm and negative airway pressures. 13.Exhaled vol monitor hypo or hyper ventilation.

Prevent

pulm barotrauma, detect sustained positive, high peak,

Assess ventilation and prevent

14.Pulse oximetry, BP, ECG monitoring

Provide

minimal standard monitoring.

15.Mechanical ventilator prolonged periods. 16.Back up battery Provide temporary electrical power (> 30 mt) to monitors and alarms in event of power failure. Control alveolar ventilation

more accurately and during muscle paralysis for

17.Scavenging system Prevent contamination of OT with waste anesthetic gases.