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Anaesthesia Machine

Baljit Singh
Director Professor Anaesthesia
G B Pant Hospital New Delhi
drbaljitsingh@gmail.com

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Inventor

Henry Edmund Gaskin Boyle

(1875-1941)

Founder member of AAGBI

Examiner for first DA exam

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History ?

First Boyle’s machine: Nov 1917

modification of the machine manufactured by

James Tayloe Gwathmy (1853-1943)

Original Boyle’s machine; 1917

Sight-feed water bottle and controls mounted
on a vertical rod

4 N2O cylinders

Reducing valves with spirit lamps

1 O2 cylinder

Rebreathing bag

3-way stop cock

Face piece/mask

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1920

Addition of ether bottle

1926

Addition of chloroform bottle

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1927

3 bottles, CO2 sight feed tube added

Back bar added

1930

Addition of plungers and cowls in ether

and chloroform bottles

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1933

Dry bobbin flow meters replaced water

sight-feed bottles

1937

Rotameter displaced dry bobbin

flowmeters

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1979

American National Standards Institute

Standards for Anaesthesia machines

Models available in India

Porta Boyle

King Porta Boyle

Boyle Cadet

Boyle F

Boyle mark III (Boyle Basic)

Boyle major

Boyle mark IIIS

Boyle mark IV

Anaesthesia work stations
Baljit Singh 2013

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Anaesthesia work station

Integrates most of the components necessary
for administration of anaesthesia into single unit

The current standards for anaesthesia

workstation:

American society for testing and materials (ASTM) is

F1850.

European standard is EN740

Anaesthesia machine

electrical
System
components
pneumatic

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Electrical Components
 Master Switch
 Power Failure Indicator
 Reserve Power
 Electrical Outlets
 Circuit Breakers
 Data Communication
Ports

Pneumatic component
Based on the pneumatics, the machine
is divided into three parts:

High pressure division

Intermediate pressure division

Low pressure division

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HIGH PRESSURE LOW PRESSURE

INTERMEDIATE PRESSURE

High pressure

Part of the machine that receives gases
at cylinder pressure

O2

N2O

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High pressure division, components

Yoke hanger

Yoke block / cylinder outlet yoke

Cylinder pressure gauge

Pressure regulator

Yoke hanger

Supports the cylinder

Provides gas tight seal

Ensures unidirectional flow of gases

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Yoke hanger, parts

Body

Retaining screw

Nipple

Index pins

Washer (Bodok seal)

Filter

Check valve assembly

Body; Yoke hanger

Support for the cylinder

Threaded into the frame of the machine

May be one-piece

Swinging gate (toggle handle, swivel gate type)

Retaining screw

New standards require that yokes should be so constructed that

cylinder can not be clamped unless the valve is securely fitted over
the index pins and nipple.

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Body

Baljit Singh 2013

Yoke hanger (assembly)

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Yoke hanger; retaining screw

Threaded into the middle of gate

Fits into ‘conical depression’

Angle 100 - 120°

Not less than 90°

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Yoke hanger; nipple

Gas enters through it to machine

Projects from proximal side of yoke

Fits into the gas outlet port of cylinder

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Nipple

Baljit Singh 2013

Pin index safety system

Proposal in 1952

Accepted in UK in 1954

Accepted in US in 1965

“System of gas specific pin and hole positions

arranged in an arc under the nipple or gas
outlet from cylinder”

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Index Pins

Two pins just below the nipple

7 Gas specific positions

Prevent wrong gas connection

Pins diameter 4 mm, 5.5-6 mm long

7th pin larger; 5 mm diameter

Baljit Singh 2013

Index Pins

Arranged in an arc; radius 9/16 inch
centered at the gas outlet port.

Pin positions arranged at an angle 60°

Angle between any two pins 12°

Index coding with gap of 1 position

Baljit Singh 2013

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Hole positions

Hole positions

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Hole positions

60°

Hole positions

12°

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Pin positions

1, 3 ethylene

1, 4 nitrogen

1, 5 air

1, 6 CO2 or O2 (CO2 >7%)

2, 4 helium & O2 (He <80%)

2, 5 oxygen

2, 6 CO2 or O2 (CO2 <7%)

3, 5 nitrous oxide

3, 6 cyclopropane

4, 6 He & O2 (He >80%)

7 entonox

Pin positions

1, 3 ethylene

1, 4 nitrogen

1, 5 air

1, 6 CO2 or O2 (CO2 >7%)

2, 4 helium & O2 (He <80%)

2, 5 oxygen

2, 6 CO2 or O2 (CO2 <7%)

3, 5 nitrous oxide

3, 6 cyclopropane

4, 6 He & O2 (He >80%)

7 entonox

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Failure in pin index system ?

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Failure in pin index system

Breakage of pins

Yoke block fitted upside down

Double washer

Pushing in of the pin

Yoke assembly; washer

Seal between cylinder valve & yoke

Fits over the nipple

Metal rim at the periphery, 1 mm

2.4 mm in the middle

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Metal rim Fits over the nipple

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Check valve assembly

To prevent retrograde flow of gas

Can change the empty cylinder

Some leak may occur

Close the cylinder valve when empty

Use yoke plug when cylinder removed

Reduction in pressure

Two types of valves

Plunger type

Spring loaded type

Check Valve

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Check valve assembly

Not designed to act as seals

Gas can leak

Place yoke plug if no cylinder

If cylinder, keep valve closed

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Yoke block

Piece of metal like cylinder outlet valve

Pin indexed

Several hazards

Cross connection between gases

Short top- can bypass pin index

Use should be discouraged

Cylinder pressure gauge

One pressure gauge for each gas inlet

Bourdon tube linked to clock like system

With pressure tube straightens

Movement moves the lever

Gas specific, should be identified by gas
name

Has in-built safety features

Should have scale, 33%> gas pressure

Span angle 180-280°

Lowest indication between 6 and 9 on face

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Pressure regulators

Pressure in gas cylinder varies on use

Pressure regulators – constant pressure

High variable to low constant pressure

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Pressure regulators
Pa = pA

A
a

p
P

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Pressure Reducing Device

Reduces the high and variable pressures to a
lower and more constant pressure (45-55
psig)

Reducing devices are preset so that the

machine uses gas only from the pipeline
when the pipeline inlet pressure is 50 psig.

This prevents gas use from the cylinder even

if the cylinder is left open

Intermediate pressure system

Receives gases at reduced pressure

Pipe line inlet connections

Pipe line pressure gauges

Ventilator power outlet

Oxygen pressure failure device

Flowmeter assembly

Oxygen flush

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Intermediate pressure system

Pipe line inlet connections

Non-interchangeable quick-connect

Diameter index safety system (DISS)

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Auxillary outlets

Usually two to supply O2

Between pipeline & flow control valve

Shrader quick coupler/ DISS fitting

Has many applications

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Auxillary oxygen outlets, uses

To run pneumatic driven ventilators

Manley Servovent

Additional oxygen outlet

Spray

Blood pressure cuff inflation

Suction

High frequency ventilation

Safety Devices for Oxygen Supply

Pressure Failure
Machine standards require that an
anaesthesia machine be so designed that
whenever the oxygen supply pressure is
reduced below normal, the oxygen
concentration at the common gas outlet
does not fall below 19%

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Gas loaded regulator

Another type of oxygen failure safety
device

Spring in regulator is replaced by O2

If pressure of O2 drops, N2O is cut-off

Master (O2) slave (N2O) mechanism

Oxygen failure safety device

“located in the intermediate pressure
system upstream of the flow control
valves of all gases except O2”

Thus O2 pressure acts as the control for

all other gases

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Oxygen failure safety device

Set to close N2O line – O2 ↓ 15-30 psi

Oxygen failure safety device

O2 50 psig O2 0 psig

N2O, 50 psig N2O, 50 psig

Valve open Valve closed

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Alarms

Low pressure alarms sensitive to pressure
drop

Usually activated when pressure ↓ 50%

Various types

Spring loaded

Electronic

Whistle

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Oxygen supply failure alarm

If O2 supply pressure falls below
manufacturer- specified threshold (~ 30
psig), an alarm is activated within 5 sec.

May be silenced for ≤ 120 sec.

Cannot be disabled

Oxygen supply failure alarm

Electronic alarms: use pressure operated
electric switch to activate the alarm.
In Ohmeda machine – 28 psig
In Drager machine – 30 to 37 psig

Pneumatic alarms: when pressure falls, alarm

directs a stream of oxygen through a whistle.
Sound will continue till the reservoir is depleted.
So, end of sound does not indicate that the
low pressure condition has been corrected.

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The oxygen failure protection

device (OFPD)
OFPD responds proportionally to changes in oxygen supply pressure

Oxygen flush valve

Can deliver unmetered O2 @ 30-65 L/m

Independent of Master switch

Self closing type

Minimize possibility of inadvertent change

Should not be kept on for long time

Can lead to barotrauma

Awareness

Accidental activation

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Oxygen flush
 The button is recessed or placed in a collar to
prevent accidental activation.
 Activation of oxygen flush produces pressure
change in the machine circuitry. It may
change
- vaporizer output
- flow indicator readings
 Activation should not change the pressure at
the vaporizer outlet by >10 kPa or increase
the vapour output by >20%.

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Flow meter assembly

Thorpe type tube

Transparent tapered tube with float

Smallest diameter at bottom

Gas enters from below

Float moves with the flow of gas

Rests at seat when no flow

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Flow meter tube

Rate of gas flow through the tube:

Pressure drop across the constriction

Size of the annular opening

Physical properties of the gas

Flow meter tube

Pressure drop: why?

Frictional resistance float and tube

Flow less laminar, more turbulent

Loss of energy, drop in pressure

Pressure drop constant for all positions

Equal to the weight/cross sectional area

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Gas flow
Physical characteristics of the gas

Longer and narrow constriction, tubular

Flow is low

Poiseuille law

Flow is a function of the viscosity of the gas

Short and wide constriction, annular

High flow

Graham’s law

Flow is a function of the density of the gas

Flow meter tube

Temperature and pressure effects

Temp, pressure affect viscosity & density

Accuracy of flow can be affected

Temperature changes are minor

Insignificant change in flow

Low barometric pressure, high altitude

Low setting, laminar flow, depends of viscosity

Independent of altitude

High flow setting, turbulent flow, depends on density

↓ density due to high altitude – flow more than
indicated

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Flow meter, components

Flow control valve (needle/pin/fine

adjustment valve)

Body

Stem and seat

Flow control knob

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Flow meter; control knob

Knob joined to the stem,

Gas specific

Color coded

Touch coded

O2 knob should stand out from the rest

Minimum interknob distance 25 mm

Should be high from working surface

Bar, guard protected or recessed

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Flow meter; control knob

Delicate part of the assembly

Counterclock opens, clockwise closes

90° rotation to move float in upper 90%

End of the day:

Keep open after closing cylinder till no flow

Then close

Start of the day:

Check flow control valve is closed

Open cylinder first

Open valve slowly

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Flow meter assembly

Components:

Knob

Tube

Indicator, float

Base rest

Top stop

Scale

Fluorescent back

Flow meter assembly

TUBE:

Usually made of PYREX

Single or double tapered

Gas specific

Tubes with ball floats may be ribbed

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Flow; where to read?

Type Read at
________________________________

Ball waist

Plumb bob top

Non-rotating top

Rotating top

Skirted top

H/I-type (spool) top

Bobbin rotation

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Shape of Bobbins

Flow meter assembly, STOP

Base rest for the bobbin

Allows bobbin to rest at base when not in use

Spring TOP

Prevents bobbin to get stuck at the top

Prevents the bobbin to disappear at the top

Prevents plugging of the outlet of flowmeter

Keeps the bobbin upright

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Flowmeters, arrangement
Series and parallel

Series arrangement:

Two tubes, first up to 1 lit, second up to 10

One flow control valve for two flow meters

Total flow measured at the higher flowmeter

Parallel arrangement:

Two complete flow meter assemblies

Two flow control valves

Total flow is sum total of the two
ANSI only one flow control valve

Flow meter assembly, float

Indictor/ float

Rotating bobbin, made of aluminium

Rim diameter > the height

Slanted grooves/ cuts

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Problems with Flowmeter

 Inaccuracy
 Improper assembly or connection
 failure to rotate
 Back pressure
 Float damage
 Float unnoticed at top of tube
 Blockage of tube outlet
 Using the wrong flowmeter
 Reading of wrong flow indicator
 Changes in float position
 Leaks

Flowmeter arrangement

The O2 flowmeter is positioned downstream
from the other flowmeters and closest to
the common gas outlet

In the event of a leak in one of the other

flowmeter tubes, this position is the one least
likely to result in a hypoxic mixture

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The flow meter sequence

A & B, Flowmeter leak dangerous if N2O is downstream
C & D, The safest configuration if O2 is downstream

An oxygen leak from the flow tube can

produce a hypoxic mixture, regardless
of the arrangement of the flow tubes

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Proportioning devices
Ensure min conc. of O2 relative to N2O

Mechanical

Chain linked

Electronic

Proportioning regulator

Can change the proportion of O2 relative to N2O

Chain linked system’ Link-25

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Flowmeters, problems

Static electricity

If bobbin rotates normally, no inaccuracy

Float damage

Float hitting the top when cylinder opened

Bobbin stuck at the top

Blocked outflow of the tube

Flow control knob loose

Inadvertent change of set flow

Low pressure system

From outlet of flowmeter assembly to CGO

Back bar

Vaporisers

Back pressure safety device

Common gas outlet

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Back bar

From flowmeter outlow to pop-off valve

Vaporiser heads are mounted

Selectatec arrangement

Common gas outflow

Ends in non-return pop-off valve

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Vaporisers

Various types:

Low Pressure System

Vaporizers- Classification:
A. Method of regulating output concentration
1. Concentration calibrated
2. Measured flow
B. Method of vaporization
1. Flow over
2. Bubble Through
3. Injection
C. Temperature compensation
1. Thermocompensation
2. Supplied heat
D. Specificity
1. Agent specific
2. Multiple agent
E. Resistance
1. Plenum
2. Low resistance

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CLASSIFICATION

• Variable bypass
Fresh gas flow from the flowmeters enters the
inlet of any vaporizer which is on. The
concentration control dial setting splits this stream
into bypass gas (which does not enter the
vaporizing chamber), and carrier gas (also called
chamber flow, which flows over the liquid agent)

CLASSIFICATION

• Flow over
Carrier gas flows over the surface of the liquid
volatile agent in the vaporizing chamber (as
opposed to bubbling up through it (as in the
copper kettle and Vernitrol)

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CLASSIFICATION

Temperature compensated
Equipped with automatic devices that ensure steady
vaporizer output over a wide range of ambient
temperatures
Agent-specific
Only calibrated for a single gas, usually with keyed
fillers that decrease the likelihood of filling the
vaporizer with the wrong agent
Out of circuit
As opposed to (much) older models such as the Ohio
#8 (Boyle's bottle) which were inserted within the
circle system.

Order of Vaporisers
Less potent – upstream
More potent – downstream

If equipotent
low VP – upstream
high VP – downstream

ALSO if explosive – downstream

trilene – downstream

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ORDER OF VAPORISERS

Vaporizer Interlock Mechanism

Allows ONLY one vaporizer at a time to be opened

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Vaporisers; safety features

Temperature controlled

Agent specific keyed filling devices - prevents

filling with wrong agent

Interlock system– prevents simultaneous

use of two vaporizers thereby preventing
administration of more than one inhaled
agent at the same time

Non-return pop-off valve

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Non-return pop-off valve

Common gas outlet

The exit point of all gases and vapours

Usually at level of working surface

May be recessed or guarded

Gas pressure at outlet 4-8 psi

15 mm female slip in

22 mm male connection

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Safety features

Safety features

Antistatic large castor wheels; 140 mm, 360° rotation

Front wheel locking bar

Small floor space 83 cm X 67 cm

Colour coded cylinders

Provision to accommodate 2, type E cylinders

High pressure gas conduit tubing

Pin index system

Pressure gauges

Pressure reducing valves

Oxygen fail safe device

Low pressure alarms

2 auxillary oxygen outlet quick couplers

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Safety features

Flow meters:

Flow control valves, colour and touch coded

Oxygen knob; large, stands out

Minimium distance between knobs 25 mm

Recessed, guarded, bar protected knobs

Minimum 90° rotation required to change setting

Base rest for the bobbin

Rotating bobbin (slanted grooves/cuts at the top)

Long tubes, easy and accurate setting of flow
(230 mm cf 150 mm Boyle F)

Safety features

Flow meters:

Gas specific colour coded bobbin

Flouroscent dot on the bobbin

Position of the tubing

Top stop spring loaded

Arrangement of flowmeters, O2 flowmeter downstream

Colour coded calibration
Oxygen: 100 cc/min to 8 lit/min
Nitrous oxide: 200 cc/min to 12 lit/min

Antistatic lumen of the tubes (tin oxide coating)

Back plate fluorescent

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Safety features

Non-return pop-off valve

Antistatic tubing, bag and mask

Oxygen flush device

Vaporiser arrangement

Colour coded vaporisers

Keyed filling ports of vaporisers

Check-list
Check that the anaesthetic machine is connected to the
electricity supply (if appropriate) and switched on.

Note: Some anaesthetic workstations may enter an integral

self-test programme when switched on; those

functions tested by such a programme need not be retested.

Take note of any information or labelling on the anaesthetic
machine referring to the current status of the machine.
Particular attention should be paid to recent servicing. Servicing
labels should be fixed in the service logbook.

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Check-list

Check that all monitoring devices, in particular
the pulse oximeter and capnograph, are
functioning and have appropriate alarm limits.

• Check that gas sampling lines are properly attached

and free of obstructions.
• Check that an appropriate frequency of recording non-
invasive blood pressure is selected.

(Some monitors need to be in stand-by mode to
avoid unnecessary alarms before being connected to
the patient)

Check-list
Check with a "tug test" that each pipeline is correctly
inserted into the appropriate gas supply terminal.

Note: A blanking plug should be fitted to any empty cylinder

yoke.
• Check that the anaesthetic machine is connected to a
supply of oxygen and that an adequate supply of oxygen is
available from a reserve oxygen cylinder.
• Check that adequate supplies of other gases (nitrous oxide,
air) are available and connected as appropriate.
• Check that all pipeline pressure gauges in use on the
anaesthetic machine indicate 400 - 500kPa.

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Check-list
Check the operation of flowmeters

• Check that each flow valve operates

smoothly and that the bobbin moves
freely throughout its range.
• Check the anti-hypoxia device is working
correctly.
• Check the operation of the emergency
oxygen bypass control.

Check-list

Check the vaporizer(s):

• Check that each vaporizer is adequately, but not

overfilled.
• Check that each vaporizer is correctly seated on
the back bar and not tilted.
• Check the vaporizer for leaks (with vaporizer on
and off) by temporarily occluding the common
gas outlet.
• Turn the vaporizer(s) off when checks are
completed.
• Repeat the leak test immediately after changing
any vaporizer.

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Check-list

Check the breathing system to be employed.

Note: A new single use bacterial/viral filter and angle-piece/catheter

mount must be used for each patient. Packaging should not be
removed until point of use.

• Inspect the system for correct configuration. All connections

should be secured by “push and twist”.
• Perform a pressure leak test on the breathing system by
occluding the patient-end and compressing the reservoir bag.
Bain-type co-axial systems should have the inner tube
compressed for the leak test.
• Check the correct operation of all valves, including unidirectional
valves within a circle, and all exhaust valves.
• Check for patency and flow of gas through the whole breathing
system including the filter and anglepiece/catheter mount.

Check-list

Check that the ventilator is configured
appropriately for its intended use.

• Check that the ventilator tubing is correctly configured

and securely attached.
• Set the controls for use and ensure that an adequate
pressure is generated during the inspiratory phase.
• Check the pressure relief valve functions.
• Check that the disconnect alarms function correctly.
• Ensure that an alternative means to ventilate the
patient’s lungs is available.

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Check-list

Check that the anaesthetic gas scavenging
system is switched on and is functioning
correctly.

• Check that the tubing is attached to the

appropriate exhaust port of the breathing
system, ventilator or workstation.

Check-list

Check that all ancillary equipment which may
be needed is present and working.

• This includes laryngoscopes, intubation aids,

intubation forceps, bougies etc. and
appropriately sized facemasks, airways, tracheal
tubes and connectors, which must be checked
for patency.
• Check that the suction apparatus is functioning
and that all connectors are secure.
• Check that the patient trolley, bed or operating
table can be rapidly tilted head down.

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Check-list

Check that an alternative means to
ventilate the patient is immediately
available. (e.g. self-inflating bag and
oxygen cylinder)

• Check that the self-inflating bag and cylinder of

oxygen are functioning correctly and the cylinder
contains an adequate supply of oxygen.

Check-list

Recording

• Sign and date the logbook kept with the

anaesthetic machine to confirm the machine has
been checked.
• Record on each patient's anaesthetic chart that the
anaesthetic machine, breathing system and monitoring
has been checked.

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Check-list

?

Spanner keys

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“You may be confident of coming out of any

trouble, just in case; but ……………...........

..….the wise option is stay out of trouble”

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awakesleeping[1].jpg

Thank you for your kind attention

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