Anesthesia Machines

Give me to drink mandragora

That I might sleep out this great gap of time
my Anthony is away.
[excerpt from Anthony and Cleopatra]

Mandrake (Mandragora officinarum) is a

plant related to the potato family.
 Purpose

Anesthesia units
dispense a mixture of
gases and vapors and
vary the proportions to
control a patients level
of consciousness
and/or analgesia during
surgical procedures.
 Functions

Provide oxygen (O2) to the patient.

Blend gas mixtures that can include (besides
O2) an anesthetic vapor, nitrous oxide (N2O),
other medical gases, and air.
Facilitate spontaneous, controlled, or assisted
ventilation with these gas mixtures.
Reduce, if not eliminate, anesthesia-related
risks to the patient and clinical staff.
 Anesthesia delivery
The patient is anesthetized by inspiring a
mixture of O2, the vapor of a volatile liquid
halogenated hydrocarbon anesthetic, and, if
necessary, N2O and other gases.

Because normal breathing is routinely

depressed by anesthetic agents and by muscle
relaxants administered in conjunction with them,
respiratory assistance either with an
automatic ventilator or by manual compression
of the reservoir bag is usually necessary to
deliver the breathing gas to the patient.
 Principles of operation

An anesthesia system comprises four

basic subsystems:
a gas supply and control circuit;
a breathing and ventilation circuit;
a scavenging system;
a set of system function and breathing circuit
monitors (e.g., inspired O2 concentration,
breathing circuit integrity).
Safe practice of anesthesia

Anesthesia machines incorporate a

number of alarms that indicate:
levels and variations of several physiologic
variables and parameters associated with
cardiopulmonary function; and/or
gas and agent concentrations in breathed-gas
mixtures.
Safe practice of anesthesia
Anesthesia machines must monitor:
O2 concentration;
airway pressure; and either
the volume of expired gas (Vexp); or
the concentration of expired CO2 (capnography).

Stand-alone monitors may be used to track other

essential variables:
electrocardiogram;
SpO2;
blood pressure (invasive / non-invasive);
temperature.
MAJOR COMPONENTS

Gas Supply
Pressure Regulators
Flowmeters
Vaporizers
Safety Devices
Breathing System
Continuous-flow anesthesia system

Reproduced from Health Care Product Comparison System, ECRI. 2003 Anesthesia Units
 Breathing circuits used in
continuous-flow systems

Reproduced from Health Care Product Comparison System, ECRI. 2003 Anesthesia Units
 Circle systems advantages:
conserve a greater proportion of the anesthetic
gases: cost;
conserve body heat and moisture from the patient.

T-piece systems advantages:

lower circuit compliance;
easier circuit sterilization;
less complex design requiring fewer valves and no
CO2 absorber (although one can be used with it).
Note: T-piece systems are used most often in pediatric
anesthesia.
Gas Supply

Vaporizers
Flowmeters

To purge the breathing circuit of

AIR 6 anesthetic vapors.

6 O2 Flush
Common
N2O 6 Gas
Outlet

6 O2 Pressure Alarm
O2 supply pressure < 25- 30 psi: unit

O2 6 decreases or shuts off the flow of the other

gases and activates an alarm
Ventilator
6 Power
Outlet
 Lack of O2 delivered to the patient
(Hypoxia):
can result in brain damage or death.

Administration of O2 in a concentration of
100%, even for a short duration, may be
toxic:
resorption atelectasis;
particularly acute in neonatal anesthesia; can
cause retrolental fibroplasia and
bronchopulmonary dysplasia.
Gas Supply

Pipeline Inlet
(between 45 and 55 psig)

6
Pressure reduced
to 50 psig
 Pressure Regulators

Closed Open

Outlet
50psig

Inlet Inlet
Flowmeters

To Vaporizers

Link assures 25%

oxygen

N2O and O2 flow controls are interlocked

so that the proportion of O2 to N2O can
never fall below a minimum value
(nominal 0.25) to produce a hypoxic
breathing mixture.

Air Nitrous Oxide Oxygen

Vaporizers

Inhaled anesthetic agents, with the exception of

N2O, exist as liquids at room temperature and
sea-level ambient pressure.
Vaporizers add a controlled amount of
anesthetic vapor to the gas mixture.
Types of vaporizers:
variable bypass (conventional);
heated blender;
Measured flow;
draw-over.
Vaporizers

1/2

OFF
FULL
Vaporizers
5

Dial Settings

5
4

4
Anesthetic 3
Agent [%]

1 1

.5

0 2 4 6 8 10

Flow [Liters Per Minute]

Safety Devices
Diameter Index Safety System

Body Nipple Nut

Bore
Nose

Shoulder
Safety Devices Gas Index Pins
Oxygen 2-5
Pin Index Safety System Nitrous Oxide 3-5
Air 3-6
Cyclopropane 3-6

Front View Side View

Machine
Left Right
Cylinder

1
6 2
5 3
4 7
 Safety Devices
Oxygen Pressure
Failure Devices
Inlet Controlling Gas
(O2)

Vent to Atmosphere

Outlet to Flowmeter

Inlet Anesthetic Gas

Safety Devices
Vaporizer Interlock

OFF OFF

OFF OFF

OFF OFF
Bain System a common configuration of the T-
piece system

Patient
Fresh Gas

Reservoir

Patient Patient

Inhalation Exhalation
To Patient
Inhalation-Assisted Manual Ventilation

To Ventilator

To Scavenger
Fresh Gas

,
From Patient
Exhalation-Assisted Manual Ventilation

To Ventilator

To Scavenger
Fresh Gas
To Patient
Inhalation-Ventilator Controlled Ventilation

From Vent ilat or

To Scavenger

Fresh Gas
From Patient
Exhalation-Ventilator Controlled Ventilation
To Vent ilat or

To Scavenger

Fresh Gas
CO2 Absorbers

soda lime

barium hydroxide lime

O2 Monitor

An O2 monitor located on the inspiratory

side of the breathing circuit analyzes gas
sampled from the Y-piece of the patients
breathing circuit and displays O2
concentration in volume percent.

O2 monitors sound an alarm if the O2

concentration falls below the preset limit.
 Adjustable Pressure Limiter (APL) Valve

Pressure imposed on the patients lungs can cause serious

lung damage.
Either an APL valve or a valve in the ventilator allows
excess gas to escape when a preset pressure is exceeded.
Types:
spring-loaded;
needle.
Many APL valves do not have calibrated markings: The
anesthetist must adjust them empirically to give a desired
peak inspired pressure.
Circle systems and T-piece systems also include a pressure
gauge for monitoring circuit pressure and setting the APL
valve.
 Adjustable Pressure Limiter (APL) Valve

Adjusting Knob

To
Scavenger

Needle Valve Check Valve

Scavenging System - Rationale

Captures and exhausts waste gases to minimize the

exposure of the operating room staff to occupational risks.

Exposure to trace levels of anesthetic gases continually

present in the operating room can cause adverse health
effects in operating room personnel:
increased incidence of spontaneous abortion;
congenital anomalies in babies.

Trace gas levels in the air may have a slight anesthetizing

effect on the anesthetist and surgeon.
 Scavenging System

Scavenging systems remove gas by a

vacuum, a passive exhaust system, or
both.

Note: Inadequate evacuation of some

scavenging systems can cause pressure to
build up in the breathing circuit, with the
potential for pneumothorax (air in the
pleural cavity).
 Scavenging System

Vacuum (active):
Vacuum scavengers use the suction from an operating
room vacuum wall outlet or a dedicated vacuum
system.
To prevent positive or negative pressure in the vacuum
system from affecting the pressure in the patient
circuit, manifold-type vacuum scavengers use one or
more positive or negative pressure-relief valves in an
interface with the anesthesia system.
Open-type vacuum scavengers have vacuum ports
that are open to the atmosphere through some type of
reservoir; such units do not require valves for pressure
relief.
 Scavenging System

Passive exhaust system:

Passive-exhaust scavengers can vent into a
hospital ventilation system (if the system is the
non-recirculating type) or, preferably, into a
dedicated exhaust system.

The slight pressure of the waste-gas discharge

from the anesthesia machine forces gas
through large bore tubing and into the disposal
system or directly into the atmosphere.
 Scavenging System
Adjustable
Pressure Positive Negative
Limiter Valve Pressure Pressure Relief
Relief Valve Valve
Flow Controller

Waste
Gas

Expired Gas
from Patient
 Preventive Maintenance

Test apparatus and supplies:

Lung simulator with adjustable compliance or
ventilator tester
Pressure gauge or meter with 2 cm H2O resolution,
from -20 to +120 cm H2O
Various breathing circuit adapters
Leakage current meter or electrical safety analyzer
Ground resistance ohmmeter
Additional items as required for specific
manufacturers procedures
 Preventive Maintenance

Qualitative tests:
Fittings/Connectors
Chassis/Housing
Filters
Mount/Fasteners
Controls/Switches
Casters/Brakes
Fan
AC Plug
Battery/Charger
Line Cord
Indicators/Displays
Strain Reliefs
Alarms/Interlocks
Circuit Breaker/
Labeling
Tubes/Hoses
Accessories
Cables
Bellows
 Preventive Maintenance

Quantitative tests:
Grounding resistance [0.5 ]
Leakage current [300 A chassis]
Modes and settings [10% accuracy]
Monitors and Alarms [10% accuracy]
Alarms tested:
Airway pressure
Tidal volume
FIO2
Others
 Preventive Maintenance
Others:

Gas Supply
Pneumatic lines (including air filters)
Gas cylinders (and gauges and regulators, if so equipped)

Patient Circuit

Breathing circuit (including filters)
Humidifiers
Pressure-relief mechanism
Absorber
 IEC Standards
International Electrotechnical Commission. Medical electrical equipment part
1: general requirements for safety [standard]. IEC 60601-1 (1988-12). 1988.
Medical electrical equipment part 1: general requirements for safety.
Amendment 1 [standard]. IEC 60601-1-am1 (1991-11). 1991.
Medical electrical equipment part 1: general requirements for safety.
Amendment 2 [standard]. IEC 60601-1-am2 (1995-03). 1995.
Medical electrical equipment part 1: general requirements for safety. Section
1. Collateral standard: safety requirements for medical electrical systems. IEC
60601-1-1 (1992-06). 1992.
Medical electrical equipment part 1: general requirements for safety. Section
1. Collateral standard: safety requirements for medical electrical systems.
Amendment 1. IEC 60601-1-1-am1 (1995-11). 1995.
Medical electrical equipment part 1: general requirements for safety. Section
2. Collateral standard: electromagnetic compatibility requirements and tests.
IEC 60601-1-2 (2001-09). 2001.
Medical electrical equipment part 2-13: particular requirements for the safety
of anesthetic workstations [standard]. IEC 60601-2-13 (1998-05). 1998.
 ISO Standards
International Organization for Standardization. Anaesthesia and respiratory care
alarm signals part 1: visual alarm signals [standard]. 1st ed. ISO 9703: Part
1:1992. 1992.
Anaesthesia and respiratory care alarm signals part 2: auditory alarm signals
[standard]. 1st ed. ISO 9703-2:1994. 1994.
Anaesthetic and respiratory equipment conical connectors part 1: cones
and sockets [standard]. 2nd ed. ISO 5356:1-1996. 1987 (revised 1996).
Anaesthetic and respiratory equipment conical connectors part 2: screw-
threaded weight-bearing connectors [standard]. 1st ed. ISO 5356-2:1987. 1987.
Anaesthetic and respiratory equipment heat and moisture exchangers
(HMEs) for humidifying respired gases in humans [standard]. ISO 9360:2001.
2001.
Anaesthetic machines for use with humans [standard]. 2nd ed. ISO 5358:1992.
1992.