BREATHING SYSTEM SEMI-CLOSED FG — Freeh gee P — PatientReservoir tube m - Patient APL — Adjustable pressure Umiting valve FGF — Fresh gas tlow RB - Reservor bas “The Image shown above Is of Laek's etreult, wien modification or Mapleson’s @ eireuit. Coaxial crcults nave two tubings, one Inner anc one outer tubing (arranged co-axlaly) F Suter inepiracory tubing carries frech gas flow to the pation APL valve IT RRCRRERRCIRRORRESE «SIN StH aason 0 t Boe Nise. Babee: Far Patient 2u Reservoir bag APL valve Modification of Maploson A Inner tube - expiratory Fer —= -) 5 Lack’s cireuit au Patient Reservoir bag Bain's ve Lack's circuit ON circurt (mapteson A) designed by Sir Ivan May Maptewon A 2 Jackson and Rees cireult (Mapleson F) is a modincation of Ayre's T ploce. Gest uted for ehildren under 20 ka, 6. Identity the circuit shown below EXPIRATORY PAUSE ‘The clreuit shown above Is Mapleson's A or Magill clreult. Its the circuit of choice for spontaneous ventilation Modified co-axial variety of Type A- Lack’s eiroult SMAL - For Spontaneous, Magills circuit, Mapleson’s Type A, Lack’s co-axial circuitackson Ree: modification of Ayre T piece I= the circull of choice for veniiiating @ =pontaneousty Jackson Rees modification of Ayre's T piece Is classified az a Maplezon's F system, although was not included In the original description by Prof Mapleson, Type A aaagii's circulty ‘Cireutt of cnoiee for spomiancous ventilation nype 8 censor type © qwaters to and trey onsorte Cireutt oF choice for controtied ventiiation. Mont commonty used type © @ain's erreur, Susan DPE (Crroutt of 2nd chetce in enitaren, type F Gackson Ree= Meameation) - - Ciroutt of choice in children (20 kg) The emiciency of Mapieson circuits in spentancous ventilation I= A> DFE > CB, The emciency of Mapieson circuits in controlled ventiation I= DFE > BC > A. A> DFE > CB: A Dog Can Bite (Usually = spontaneous event) (Dead Gabler can't assist (contraied) Pearl #302: Mapleson Classitication CERT omername TITMITTTT Tn canon van vague 4 minute ventilation (MV)Le 80 Very nigh and aimncuit to mnlnerenin Presi 8 5 238M) 225 say © Waterstoand$e 2-3 «My 2as xa > Bain eweur 23x 25 omy 5 Ayres tptece: 23 xy axa F SSE 23x zea Yaekson Rees circutt (Mapioson F) Is not a co-axial eIrcult. It Is a modinication of Ayre’s T piece. (Co-axiat cireutts have two tubings, one Inner and one outer tubing (arranged co-axtally). Examples of co-axial circuits: = Lack’s eweuit: co-axial moattication of Mapieson A + Sains ceurt_ co-axial moarication of Mapleson D_ 2 Penton eireurt: co-axial modification of Mapieson D or medineation of Bain’s circutt The circle system is net associated with increased air pollution, “The Incidence of air pollution: Cpen=Mapieson=Circle system. Components of the circle system: G0; absorber, rresh gas inlet, unK-adirectional valves (Inspiratory and expiratory), breathing tubes (Inspiratory land expiratory), a Y-connector, APL valve. and reservowr bag, Circle system allows for a uni-directional flow of anesthetic gases, Carpon dioxice absorber (eg soda-time) allows rebreathing of anesthetic gases arter the removal o exhaled carbon dioxide. This conserves anesthetic gases and ius reduces ait pollution How green is my operation theatre? Almost all anesthetic gases (volatile agents and nitrous oxide) are aggressive greenhouse gases. With ‘S50 being metabolized by the body, the vast majonily ofthe anesthetic i routinely vented to the imosphere rom the operating room. The global warming potential of a halogenated anesthetic 1s up to 2.000 times greater tnan that or COzAbii to scavenge exhaled gases Is maximum with Girele system (Circie>Mapleson=Open) Scavenging 1s the process of removal of waste anestnete gases trom both the anestnesia machine and ine anestnatizing loration (operation ineatra). Thus minimizing operating room pollutlon Halogenated gas, 2 ppm Soda time te the most commonly used carbon dioxide absorbent in circle breathing systems. Pearl #303: Composition of CO2 Absorbers in rebreathing system cacony, - 80% With Titene. soda-lime forms neurotoxin dichloroacetylone ana pulmonary irntant posaene gas: nence + exon, Des Causes less degradation of volatile anesthetics eg. Sevotturane to Compound A or Destlurane to Carson = cacorn, 80% 2 acorn; 20%, Destturane can be broken down to CO by ary barium nyaroxide lime. €02 absorbents contain hydroxide salts that are capable of neutralizing the carbonic acta Reaction end products include heat (the heat of neutralization), water. calcium carbonate, and sodium hyaroxide, 4. C03 + H20 — Hacos 2 HaCO3 + 2NaOH — NazCOs + 2Hz0 + Heat (a Tast reaction) 3. NasGO3 + Ca(OM); — Caco; + 2NacH + Heat (a slow reaction) Note that ine water and sodium hydroxide intially required are regenerated, Dry COz absorment (Baralyme = Sodalime) can produce carbon monexiae. ‘The magnitude of CO production from greatest to least: Desflurane >= Enflurane = Isoflurane >> Halothane: Sevomurane, ‘nen carpon dioxide absorbing capacty of soda lime using ethyl violet inaicator Is exnausted, tne color changes from white to purp! Pearl #518: Soda lime indicator dye Ethyl violet white Phenolphthatein white Clayton yellow Red Etny! orange orange Mimosa 2 ReaIn Amsor, polyvinyipyrroidone used as a hardening agent. NaOH and KOH serve az catalysts or activators to =peed up the reaction between calcium hydroxide and Ethyl viotet is tne most commonty used Ingleater aye in soaa ime. ‘The ideal granule size of the carbon dioxide absorbent Ia between 4 and & mesh (1.5-6 mm). Smaller granule size favors greater area for absorption of carben dioxide. But, it offers greater airflow resistance (eaking) Converse is true with larger granule size - ine absorptive area Is less but alrmow resistance Is minimal (hanneting) So, tne deal size is to be between 4 and 8 mesh as absorptive surface area and resistance to flow are opumizea, ‘The true statement concerning compound A Is that ts formation Is less commen with Amserp apsorsent, Compound is fluoro-methyl-2,2-diflucro-1-(tiflucromethy!) vinyl ether which is the degradation product of “The strong bases like NaH and KOH present in absorbents (soda lime) lead to its formation. Lack of ‘strong alkali in Amsorp makes its formation less common. Compouns A Is nephrotoxic, not neurotoxic Its seen predominantly with tow flow anestnesia techniques and high absorbent temperatures. Size J 1s commonyy used for cylinder manifold system for central supply. oc inte Sa en ont “The oxygen flowmeter is located downstream of the ather flowmeters. This is to aveld generation of @ hypoxic mixture in the event of any air leak. re Sr sae Ih the first two images. A and 8. the ntrous oxide flowmeter is located downstream and there is a leak in the airmow tube. Through ihis leak, most cf the Oxygen passes out and mainly nitrous Oxide Is provided at the Outlet leacing *6 the production of a nypowe mbeture But in the other two images, C and D, the oxygen flowmeter is located downstream. Through the leak in the, alrmow tube, some of the nitrous Oxide passes out and the remaining passes out Inrough the outlet wh the ‘Gxygen. Thus the production of a hypoxie mixture ia tesa likely if oxygen flowmeter is placed downstream,The Diameter index Safety System (B188) prevents incorrect pips DISS Is a safety toaturs in the modern anesthesia workstation. DISS connectors have unique alameters tor Sach type of gas to prevent wrang pipeline attachment to the wrang Inlet Contamination of ine anestnetic environment by waste gases Is prevented by Seavenging system. Delivery of hypoxic gases Is prevented by Oxygen failure safety device (shutoft or proportienating device) Components of anaesthesia machine a ee { High Pressure { Intermediate Preseure) { Lo Ww Pressure System System System N,Q. Cytiner Eve To pipeune, sais Ie 5 ‘. — a Ta Pegulatse Sargon FO. Pipeline surely eer Sod oes eato2 | Oxygen placed downstream Key points on Flowmeter Flowmeters are part of the low-pressure anesthetic gas supply system, Rotameters are variable orifice (area) constant pressure flowmeter ‘Thorpe tubes are made of tapered glass tube, the bottom has 2 smaller diameter than tne top. ‘The indicator fe known a Bobbin or float. Rotating float indicates the flow of gas. Interior of the tube is coated with a conductive substance (gold or tin oxide) in order to reduce the ertect of static eleetncity. =s=e_ = Sas eS 541_ = <_— The flow rate of oxygen in the given image is L. ‘The indicator present in the Rotameter (Flow meter) is known as Bepbin or Float. The nows are read from tne top end or ne BeppIn, Some rotameters Nave ball incicator Here, ine reaaing Is taken trom the center of he Ball Tne Helaprink meter In Doyle's macnine indicates the tlow or gases. Heidbrink is a type of flew meter, which was used in the past.Entiurane vaponzers are orang! Pearl #2249: Color coding of Vaporisers Isonurane Purple Enfurane Orange: Pearl #305: Coding of gas cylinders Etyiene Purple Purpte Anesthetic gas with ine highes! vapor pressure Ie Deefuran Because of nigh vapor pressure (669 mmHg at 20°C) and low polling point (22.6°C ~ room temperature), Desflurane requires a specialized vaporizer such as Tee 6 for its delivery. High saturated vapor pressure whien ie 2-4 times the einer agents Low plooa-gas Solubility (0.42) resutting In rapid uptake and recovery High MAG vaue of 6, indicating tow potency Requires specialized vapouriser such a= Tec & Undergoes minimal metabolism Begraded into Co by the desiccated COz absorbent itt most commonly placed between the expiratory unidirectional valve ana the GOz absorber. Maximum safety limit for tne concentration of nitrous oxide in the operating room environment is 26 ppm and for ine halogenated anesthetic Is 2 ppm. National institute for occupational safety and health (NIOSH) guidel Halogenated agent aloneHeat and moisture excnanger (HME) Is a passive humidifier, not active. “The natural numiatiication and conservation of Neat by the upper respiratory tract is lost or bypassed after by Itz hygroscopic material, and thus conserves Neat and ade= Mmatsture fo the inhaled gaze= micropes ftom the patient Io ihe machine and hence to other patients: ‘The disadvantage with the humidifiers that excess saturation can lead to blockage of the circuit Placement of HME fiter in the breathing evreut. Laminar flow mainly depends on the viscosity of gas while turbulent flow is more dependent on density. "2 number. ‘The transition between laminar and turbulent flow Is given by Reyne! Res pypin (v- velocity of tne Mud, p- density of the fluid, O- diameter of the tube, n- viscosity.) A Reynole!'s number <2000 ~ laminar now, =4000 ~ turbutent rlow In cases of upper ainvay obstruction, there is turbulent flow which increases the work of breathing Administering Helium or Heliex (@ mixture 0f 79% hellum and 21% oxygen). which has very low densiiy Gecreases Reynola's number This changes the characteristies of flow from turbulent to laminar and thus Gecreases the respiratory work. This is the reason for using Heliox to reduce respiratory distress due to upper airway obstruction,