Acoma PRO NEXT+iüiIM V1.02E) 20140407

TABLE OF CONTENTS
Chapter 1 Ensuring safe operation·········································1-1-14

Chapter 2 Accessories························································2-1
Chapter 3 Part names and functions
[1] Left side view ·································································· 3-1-4
[2] Front view ······································································ 3-5-7
[3] Respiratory circuit upper view ············································· 3-8-9
[4] Right side view ································································ 3-9-10
[5] Rear view ······································································· 3-11-14
[6] Operating panel ······························································· 3-14-18
[7] Control panel ·································································· 3-18-20
Chapter 4 Pre-usage Preparation
[1] Connecting the power cable················································ 4-1-2
[2] Connecting the gas supply pipes
& excess anesthesia gas suction tube ································ 4-2-4
[3] Attach O2 sensor unit and connect the cable ··························· 4-4-5
[4] Connect the respiratory circuit set & respiratory bag, etc. ··········· 4-5-7
[5] Filling the CO2 absorbent ··················································· 4-7-8
[6] Mount the bottle adapters ··················································· 4-8
[7] Install the vaporizer··························································· 4-9
Chapter 5 Control panel operating
[1] Turning on power to the device ············································ 5-1-3
[2] Standard screen display····················································· 5-4-5
[3] Setting the ventilator ························································· 5-5-7
[4] Setting the alarm and checking the history ····························· 5-8-10
[5] Operating from the MENU ·················································· 5-10-15
Chapter 6 Operating Checks and Inspections
[1] Check the supply of gas····················································· 6-1-2
[2] Checks when turning power on ············································ 6-2-3
[3] Check the flow rate meter··················································· 6-3-4
[4] Check device safety·························································· 6-4-5
[5] Check the O2 flush ··························································· 6-5
[6] Make a respiratory circuit check ··········································· 6-6-7
[7] Checking the O2 concentration meter and calibrating
the O2 sensor ································································ 6-7-8
[8] Checking the vaporizer unit ················································ 6-8-10
[9] Check the alarm functions ·················································· 6-11-17
[10] Calibrating the flow rate sensors ········································ 6-17
[11] Checking the ventilator ····················································· 6-18
[12] Check the vaporizer ························································ 6-19
Chapter 7 Usage Methods
[1] BAG mode ····································································· 7-1-4
[2] VENT mode ···································································· 7-5
[3] O2 concentration meter ······················································ 7-5
[4] Injection vaporizer usage methods ······································· 7-6-9
[5] Setting the ventilator ························································· 7-9
[6] Respiratory mode····························································· 7-9-10
[7] Alarm description ····························································· 7-10-16
[8] How to measure usage quantities ········································ 7-16
[9] Using the support cylinder ·················································· 7-17
Chapter 8 HANDLING AFTER USE
[1] Ending operation······························································ 8-1-4
[2] Cleaning parts after use ····················································· 8-5-10
[3]Checking the usage time and other items ······························· 8-11
[4] If not using equipment for extended periods···························· 8-11-12
Chapter 9 Consumable Parts & Replacement Parts
[1] Consumable parts ···························································· 9-1
[2] Replacement parts ··························································· 9-1
Chapter10 Periodic Inspections
[1] Periodic inspections ·························································· 10-1
[2] Overhaul ········································································ 10-2
[3] Service contracts ····························································· 10-3
Chapter11 Troubleshooting ···················································11-1-6
Chapter12 After-Sales Service
[1] Warranty ········································································ 12-1
[2] Repairs·········································································· 12-1
Chapter13 Specifications ······················································13-1-7
Chapter14 Piping-tubing system diagram
[1] VENT(Automatic ventilation)mode ········································ 14-1
[2] BAG(hand-operated breathing)mode ···································· 14-2
Chapter15 Inspection items for before-during-after usage ············15-1-10
【Symbols & abbreviations used in this manual】
O2 Oxygen
N2O Nitrous oxide
AIR Air
DISS Diameter index safety system (system for standardized connections)
mL Milliliter(unit of volume)
L Liter(unit of volume)
L/min Liters per minute
g Gram(unit of mass)
kg Kilogram(unit of mass)
hPa Hectopascal(unit of pressure)
kPa Kilopascal(unit of pressure)
mm Millimeter(unit of length)
m Meter(unit of length)
bpm Beats per minute (VE:expiratory minute volume)
VCV Volume controlled ventilation
PCV Pressure controlled ventilation
PSV Pressure support ventilation
PEEP Positive end, expiratory ventilation
Hz Hertz(unit of frequency or vibration)
VA Volt-ampere(unit of electrical power)
Compulsory and/or command item
Prohibited item
・Display shown to express lethal or extremely serious and irreversible

harmful phenomenon even if appropriately used, or results where
WARNING problems were found, or possibly leading to extremely serious
hazardous phenomenon.
・Display shown when handling errors might possibly lead to death of the
user or create a hazardous state involving extreme injury.
・Shown to indicate a state where errors in handling might cause a

CAUTION
hazardous situation involving light injury to the user or just material
damage.
・Shown to indicate patients where usage is not allowed due to patient
PROHIBITED symptoms, underlying illness, complications, past illness, family health
history, and patient condition.
・ Shown to indicate usage methods and items exceeding the
manufacturer’s range of responsibility such as improper usage or limits
on the applicable medical treatment device.
・ Shown to indicate notable items handy to know about, such as

NOTE measures to prevent failures (breakdowns) from occurring in the
applicable medical treatment equipment. This display does not involve
hazardous phenomenon.
I Power switch ON
O Power switch OFF
IEC symbol expressing standby state
IEC symbol expressing B type mounting
～ IEC symbol expressing alternating current
IEC symbol urging caution to follow usage instructions
Symbol indicating alarm volume is continuously adjustable (non-stepped)
Symbol indicating stop or muting of alarm sound
Symbol indicating starting or restoring alarm sound
Symbol for “BAG” indicating “hand-operated” breathing by respiratory bag
Symbol for “VENT” indicating “automatic breathing” by artificial respirator
Symbol indicating AC power is being supplied
Symbol indicating battery is being charged

Chapter 1 Ensuring safe operation
This device in designed to supply inhalant anesthesia to the patient during surgical operations.
The following instructions are essential for ensuring safe usage of this device. This device should
therefore only be used by a qualified person after fully understanding the contents of this manual.
[Display shows extent of injury and loss-damage]

-Display shown to express lethal or extremely serious and irreversible harmful
WARNING
phenomenon even if correctly used, or results where problems were found,
or items possibly leading to extremely serious hazardous phenomenon.
-Display shown when handling errors might possibly lead to death of the user
or create a hazardous state involving extreme injury.
-Shown to indicate patients where usage is not allowed due to patient

PROHIBITED symptoms, underlying illness, complications, past illness, family health
history, and patient condition.
-Shown to indicate usage methods and items exceeding the manufacture’s
range of responsibility such as improper usage or limits on the applicable
medical treatment device.
CAUTION
-Show to indicate a state where errors in handling might cause a hazardous
situation involving light injury to the user or just material damage.
NOTE
-Shown to indicate notable items handy to know about such as measures to
prevent failures (breakdowns) from occurring in the applicable medical
treatment equipment. This display does not involve hazardous phenomenon.
[Description of symbols]
Indicates a "Prohibited" item so never attempt this action.
Indicates a "compulsory" or "command" item so always perform this action.
<Terms used in this manual>

(1) Failure/malfunction: State where condition of medical device itself is becoming worse.
Breakdown status
(2) Hazardous event/phenomenon: Situation or phenomenon harming the health of the patient or
health care provider.
１－1
WARNING
<Qualifications required>
This device is for use by “qualified personnel”
<Carefully read the attached text>

Carefully read the instruction manuals and dedicated appended
materials for this device and related equipment such as vaporizers
and start use only after fully understanding those materials
<Electromagnetic noise>
Do not use devices such as cell phones and radios in the
same room where this device is used
(Electromagnetic interference could cause faulty operation affecting the life of the
patient.)
Data output cable must be shorter than 3 meters

(Connecting a data output cable longer than the specified length to external equipment
may cause problems such as external noise or unexpected malfunctions to occur.)
<Making connections & attachments>

Confirm that the power cable is clamped with cable lock
hardware
(If not clamped with a cable lock, the power to the main unit will be cut off if the cable
comes loose or is disconnected.)
Check that the joint cap is connected

(Check that the joint cap is securely connected to the gas outlet. If no junction cap was
connected then fresh gas is not being supplied to the respiratory circuit. Use caution
since this could lead to accidents involving the life of the patient.)
<Monitor installation>
Joint usage with monitor
(Use monitors jointly with pulse oximeters alarms, capnometer alarms, or anesthesia
gas monitors capable of independently warning of patient abnormalities such as when
the ventilator has stopped or the respiratory circuit is disconnected, etc.)
Be sure to use an O2 concentration meter

(If the O2 sensor has poor performance or is defective and a substitute O2 sensor is
not available, then use another O2 concentration meter as specified in JIS T 7203.)
* Using the anesthesia apparatus as is, without an O2 concentration meter will cause
problems with monitoring the patient.
Fasten devices on the monitor shelf with straps to prevent

them from falling
(Dropped equipment could cause major problems with patient observation.)
１－2
<Gas cylinders>
Shut the support cylinder valve if using gas from the in-
hospital gas supply pipe
(If the support cylinder valve is left open, the gas will be used up and no longer
available for emergencies.)
Take adequate precautions against “residual gas” in the

support cylinder
Close the valve after using the support cylinder

(If the valves on the support cylinders are left open then the gas will be used up and
no longer available for emergency use!)
<Usage environment & conditions>

Check the output waveform when using a power supply device
(If using an uninterruptible power supply device such UPS 、 DC/AC inverter or
generator and so on check that its output is a sine wave output.)
<Caution items involving usage methods>

If the concentration adjuster dial on the vaporizer mounted
in the unit rotated during use of the injection vaporizer then
immediately stop usage
(Safety device built into the vaporizer mounting stand is defective. Promptly request a
repair from the manufacturer.)
If the injection vaporizer “operates” during vaporizer use

then stop operation immediately
(The safety device in the main unit is defective. Promptly request a repair from the
manufacturer.)
Check that the vaporizer is securely clamped

(Anesthesia gas leaks might occur if not fully clamped in place.)
During use keep the power plug connected and leave the
power switch “ON” all the time
(“Turning off” the power switch during device use will cut off the power without
switching to battery operation. This is hazardous since all functions such as monitor
display, ventilator, injection vaporizer, O2 concentration meter, alarm devices and
safety device will cease to operate. Charging the battery is also impossible.)
* Also leave the power switch “ON” for both “BAG mode” and “VENT mode”.
Handle gently and carefully

(Be careful not to warp or deform the bellow when inserting it inside the bellows unit. If
the bellows is warped, the unit will not deliver the preset vent volume. A warped
bellow might also lead to accidents.)
１－3
Do not pull on the O2 sensor cable
(Do not pull forcefully on the unit cable when calibrating the O 2 sensor unit. This may
cause wire breakage or disconnections within the cable or connector wiring. Broken
or disconnected wiring will prevent correct measurement.)
Keep water or chemicals away from the unit

(This device is not water-proof or drip-proof so fluid or liquids might penetrate into the
unit and stop operation.)
Set both the low inspiratory pressure alarm level and excess
pressure alarm level to a value near the maximum inspiratory
pressure
●Setting the low intake pressure too low will prevent the alarms from operating even if
there is a leak from the respiratory circuit.
●Setting the excess pressure too high might cause pressure damage to the lungs.
The alarm volume involves patient safety so set loud

enough to easily hear
(At a low setting the alarm might not be heard due to ambient noise.)
Be aware of the N2O flow rate (non-attached interlocking

gear：option when shipped from factory)
(This device does not have an interlock mechanism for mechanically regulating the
N2O flow. Therefore, when O2 flows at “0.1Ｌ/minute” or more, then N2O can also be
supplied. However the flow rate alarm will activate when the O 2 flow is higher than a
specified ratio.)
Be aware of flow rate ratio setting errors when using O2 and

air
(This device has no interlock function to mechanically control the air flow rate. So the
wrong flow ratio could cause hypoexemia.)
<Measures to take during breakdowns and abnormalities>

When the overcurrent safety breaker trips, don’t try to
“reset” it. Instead ask for a repair and inspection
(If the overcurrent safety breaker trips, then some type of problem may have occurred
in the main unit. Don’t reset it but instead ask your dealer or ACOMA customer
support representative for a repair and inspection.)
Turn off the power switch and remove the power plug when
disconnecting the AC power supply (commercial) due to an
abnormal state
(Immediately stop use if high temperatures, smoke, abnormal odors/sounds or faulty
operation occur and set the power switch to “OFF” and remove the plug from the
socket. Continuing to use as is may cause fires, electrical shocks and breakdowns.
Do not place devices such as ME in locations that might interfere with operation.)
１－4
PROHIBITED
Do not use in areas near flammable gas
(This unit is not an explosion-proof design so sparks may create a hazardous situation
near inflammable gas.)
To prevent fires and so on in sections in contact with O2 do

not allow near oil, flames and inflammable objects
Leaving open and unsealed CO2 absorbent and leaving

fresh gas (mainly O2) supplied to the recirculating respirator
circuit will prevent the CO2 absorbent from drying
(Jointly using inhalant anesthetic along with CO2 absorbent that has lost its moisture
may cause fires, abnormal heat emission, CO emission or a possible loss of CO2
absorbance capability).
Do not use in a state where there is a problem or

malfunction
Do not dismantle or modify

(This might cause fires, electrical shocks and equipment breakdowns.)
Do not scratch or damage the power cable

(Don’t forcibly pull, bend, or tramp on the cable. Using a damaged cable could cause
fire or electrical shocks.)
Do not use benzene or thinner, etc.

(Don’t use benzene or thinner for cleaning the intake or exhaust valves or main unit
(operation unit, monitors, etc.) This might cause damage.)
Don’t let the cable of an electrical scalpel or similar item

come in contact with the main unit
(External noise could cause malfunctions (unit running out of control, etc.))
Do not attach unauthorized parts to the side rail

(Attaching unplanned items might cause it to topple over.)
<Interactive effects>
Don’t use other than our company-supplied products with
the Jackson Rees
(Combined use with other company’s products might cause connection problems
possibly resulting in inadequate ventilation.)
１－5
Don’t use other than our company products along with the
supply gas pressure tube
(Using other than our company-supplied products might prevent normal operation of
the device.)
<Electromagnetic noise>
Avoid jointly using with an MRI

Do not attempt to reuse products that were discarded
(Doing so might cause infection or gas leaks due to cracks, holes, and disconnections
from couplings that have become loose.)
* Dispose of safely and correctly to prevent contamination and infection.
Avoid joint use with items that cannot maintain a secure

connection
Avoid joint use that might cause blockages connections,

etc.
Avoid joint use with items that cannot be easily

disconnected
Do not directly touch CO2 absorbent material

(This is an alkaline material so if mistakenly touched, wash thoroughly with large
quantities of “tap water”.)
Do not fill above a fixed quantity

(When replacing or refilling the CO2 absorbent do not fill higher than the “no higher
than this line” mark seen inside the chamber. Overfilling may cause problems such
as uneven gas exchange or prevent a proper fit in the container.)
<Operation & adjustments>

Do not continue operation using incorrect alarm settings
(This prevents obtaining a correct Vti and rate, etc.)
Don’t change the flow rates during “calibration”

(Changing the applicable flow rates of a gas during flow rate sensor calibration will
make it impossible to perform correct calibration. It will cause errors in injection
vaporization unit concentrations and prevent the flow rate ratio alarm from operating
correctly.)
Do not remove just the anesthesia bottle

(Do not remove just the anesthesia bottle with the bottle adapter still attached to the
main unit, Doing this will cause air to enter the device piping and activate the empty
bottle alarm.)
１－6
Do not use if calibration of the flow rate sensor failed
(An incorrectly calibrated flow rate sensor will cause errors in the injection
vaporizer concentration and the flow rate ratio alarm will not function correctly.)
Do not pull on the control cable

(Don’t apply heavy force when pulling or bending the control cable. This could damage
the cable and cause problems with ventilator control or vent flow display.)
Don’t calibrate the flow rate sensors while using this device
(The alarms, flow gauges, and injection vaporizer cannot be used in calibration mode.)
Don’t take your eyes off the circuit pressure gauge

(If the circuit is normal no leaks will appear in the respiratory circuit leak test so the
internal pressure gauge will break if the test is left to run on its own.)
CAUTION
Maintain each gas at a rated supply range between “350 to
500kPa”

Connect the power plug to a 3-pin medical outlet (socket)
(Connect to a 3-pin medical treatment outlet (socket) to prevent electrical shocks.)
Connect securely
●Securely connect the canister chamber, drain cap, and respiratory bag, etc. No alarm
is given if any of these are poorly connected. If not fully connected then anesthesia
gas might contaminate the room interior.
●Measurements and control of the ventilator might be impossible if the cable
connector is not attached or installation is incomplete.
Attach correctly
(Check for any CO2 absorbent caught between one chamber and another, the
chamber and top lid (or bottom lid). Poor attachment might cause gas leaks.)
Insert plugs securely into unused gas pocket ports

(If not plugged then anesthesia gas might contaminate the room interior.)
１－7
If the yoke plug was removed, then store it to prevent losing
or misplacing it
Discharge the gas before installing the Aux. cylinder

(Before installing the support cylinder, discharge the gas “once or twice” at intervals to
remove grit and debris. Debris or grit that adheres to the port openings/couplings can
be the cause of breakdowns.)
Don’t lose the cap or other parts

(Losing the joint cap will prevent use of this device. Be cautious when handling during
use with open circuits, etc.)
Replace the bacteria filters with new ones

(To prevent cross-infection, use new bacteria filters at the intake and exhaust ports for
patient.)
* Read the attached specialist materials to find appropriate usage methods.
Store any removed wiring hole caps to prevent losing them
<Inspections & checks>

Make the operating check while following the “Before-
During-After-Use inspection items”
(Make each prep check & pre-use operating check, in-use operating check, and after-
use operating check according to the inspection tables. This is extremely important
for ensuring correct machine operation and safety the next time the equipment is
used.)
* See Chapter 15.
If the power failure alarm activates, check the remaining

power on the internal battery
(Always check the power outage alarm and the remaining internal battery power
before using the battery.)
Check alarm operation conditions

(The ALARM OFF function does not automatically cancel alarms. Turning off an alarm
requires operation according to cancel methods in the manual.)
Be aware of the anesthesia gas level

(The bottle adapter cannot be removed to replace the anesthesia bottle unless a
series of actions are completed. A maximum of about “1 minute” is required.)
* Make sure the anesthesia bottle is full before using it.
Connect the respiratory circuit to the patent AFTER first

making the “leak test”
１－8
<Operation & adjustments>
Injection vaporizer automatically stops in “1 hour” if there is
no O2 flow (“0.1 L/minute” or less)
* If using only air in the injection vaporizer then the injection vaporizer will “stop” after
“1 hour”.
* Holding down the injection vaporizer start/stop button for “3 seconds” or more sets it
to “start” again.
Backup time with a fully charged internal battery is “30

minutes”
* Battery charging requires at least “20 hours” or more.
Wait a while before turning on the power again

(In unusual cases, the equipment might not start up normally if the power is turned on
again immediately, It might also lead to equipment breakdowns. After turning “OFF”
the power, wait at least 5 seconds or more before turning the power back “ON”
again.)
“Recalibrate” after replacing a sensor unit

(After dismantling the O2 sensor unit into the main section and sensor unit, replace the
sensor unit. After reassembling it into the O2 sensor unit, leave for “1 minute” or more
in the outside air, and shake gently “2 or 3 times”.)
Place the O2 sensor unit in the outside air and after shaking
gently “2 or 3 times”, recalibrate
(Leave the O2 sensor unit in the outside air for “1 minute” or longer and after gently
shaking “2 or 3 times”, calibrate it.)
* Calibrating without shaking and in other than the outside air will cause display of the
wrong O2 concentration.
When shaking the O2 sensor, pick a wide space free of

surrounding obstructions
(Dropping it or apply strong impacts from striking it on something might damage the O2
sensor unit.)
Be aware of “flow rate setting” errors

(The flow rate setting affects injection vaporizer performance. Make periodic checks and
calibrate as needed.)
The injection vaporizer cannot “start” if the vaporizer

concentration dial is “OFF”
Turn the handle firmly

(Check that the chamber is fully clamped by the chamber attach-release handle. Gas
leakage might occur if it is not completely turned.)
１－9
Support the canister securely when pressing the release
button
(Securely support the canister when pressing the release button for raising-lowering the
canister. If not fully supported, it might pinch the fingers when the button is pressed.)
Carefully switch the BAG-VENT selector

(On the operation status display of the monitor, the background color is light blue when
switched to BAG and light green when switched to VENT.)
Always discharge water accumulated within the respiratory circuit

(Water that continues to accumulate might affect the PEEP. Pooled water can be
checked from the small window in the canister so always be sure to get rid of
accumulated water.)
Use caution to prevent accumulated “trace gases”

(In closed circulating anesthesia circuits & extremely low flow rate anesthesia (fresh
gas flow less than 1.0L/minute) carbon monoxide, acetone, ethanol, nitrogen, and
anesthesia metabolic products might accumulate within the circuit used by the
patient.)
* Wash away gas accumulated in the patient’s circuit at regular intervals by “O2
flushing” or other methods to “increase the fresh gas flow”.
Use caution to prevent accumulated water or fluids

(Large amounts of water or fluid might accumulate within the patient circuit due to low
“fresh gas flow” or “anesthesia at low flow rates for long periods”. So depending on the
extent of the accumulation remove the circuit and empty the water or fluids.)
Scavenging surplus anesthetic gas to be in a range “from 15

to 30 L/min”
If using an anesthesia gas monitor then connect it with a

tube, etc
(Connect a tube between the anesthesia gas monitor being used and this monitor
excess gas suction inlet. If the connection is faulty or incomplete then anesthesia gas
might leak and contaminate the room interior.)
In the case of anesthesia at a low flow rate, be aware of the

sampling gas flow on the monitor device (it is equivalent to
a circuit leak)
Check the setting values if the anesthesia gas concentration

was changed
(The setting value might not always change even if the anesthesia gas concentration
dial was turned. If the setting was changed then check that the value shown on the
anesthesia gas conc. indicator is the required value.)
Take correct action as needed

(If an operational message appears on the control panel, check the message on the
display, and make an accurate and correct response.)
１－10
<Caution items involving usage methods>
Check the “vent conditions” for the ventilator before
shifting to “VENT mode”
(Before shifting to “VENT mode”, check the “vent conditions” of the ventilator and the
flip the BAG-VENT selector.)
Replace the CO2 absorbent promptly

(Replace CO2 absorbent at an early stage since it is rapidly consumed in closed
circulating anesthesia circuits, and by low flow rate anesthesia.)
Always “stop” the injection vaporizer after use

(Allowing the “operating” state to continue as is for long periods will cause bubbles in
the unit internal piping and might affect operation the next time used!)
<Action in response to breakdowns and abnormal conditions>

During an “abnormality” quickly stop operation and replace
with properly working anesthetic equipment
(Remove the power plug of the broken unit from the power socket.)
If a breakdown occurs, clearly display that information, and

quickly ask for a repair
If the power failure alarm does not operate then have the
system promptly repaired or overhauled
<Replacement>
Replace with a new battery if the battery operating time
drops sharply or otherwise replace every “2 years”
（The battery wears down over the passage of time so periodically replace it with a
new battery.）
* Battery life is approximately “2 years”.
Contact the manufacturer if replacement is required.
Use parts supplied from the manufacture during parts

replacement
(Using a substitute items will cause breakdowns.)
<Handling after use>

Dispose of properly
●Properly dispose of consumables, residual items, and accessories as medical waste
products.
●When disposing the main unit of this device, comply with the regulations and
ordinances of regional civic bodies. Consult the regional civic bodies for detailed
information on pertinent legal regulations and ordinances.
* Disposing by illegal means will not only cause serious societal effects such as
environmental pollution and infection but also carries penalties so consider carefully
what action to take.
１－11
Empty water from the drain cup each time it accumulates
ATTACH THE YOKE PLUG

(Attach the yoke plug after removing the aux cylinder.
Unless the yoke plug is attached, dirt and dust will adhere to the cylinder port and
cause breakdowns.)
Mounting the caps

(After removing the other company’s vaporizer, mount the wiring hole caps. These will
prevent breakdowns due to penetration of moisture, etc.)
Dismantle in order to sterilize & disinfect

(Remove the intake valve, exhaust valve, canister drain cup, and bellows unit, etc.
Remove at all possible locations and carry out sterilizing and disinfection.)
Securely mount the dome caps O-rings into the “O-ring

grooves” on the intake & exhaust valves
(A non-attached or incompletely attached dome cap O-ring can be the cause of gas
leaks.)
If not using for extended periods of time then remove the

power plug cable from the socket
Grip by the plug when removing the power cable

(Pulling it out by gripping the cable will damage the cable and cause trouble such as
fire or electrical shocks.)
During cleaning and inspections, always “turn off” the

power supply and remove the power plug from the socket
Use a soft cloth or similar item during cleaning

(Using chemicals such as benzene or thinner on the main operation panel may cause
warping or damage.)
<Periodic inspections & overhauls>

Make sure the device receives periodic inspections and
overhauls
(To maintain performance make sure the device receives periodic inspections “once a
year” or every “1,000 hours”.)
* Have an overhaul performed “once every 5 years” or every “5,000 hours”.
１－12
Precautions for Medical Electrical Equipment
The “Precautions for Medical Electrical Equipment” (for safety and hazard prevention) are
reported in conformance with Notification No.495 from the Director of the Pharmaceutical Affairs
Bureau of the Ministry of Health and Welfare (dated June 1, 1972).
Make sure to fully read these precautions to ensure this system is operated safely and correctly.
1. Do not use the equipment if you are unfamiliar with how to operate it.
2. Take the following precautions when installing the equipment.
(1) Avoid installing in places where any liquid may fall or splash on the equipment.
(2) Avoid installing in locations where atmospheric pressure, temperature, humidity, air flow,
sunshine, dust, or air containing salt or sulfur might adversely affect the equipment.
(3) Keep the equipment stable (even during transportation) by avoiding tilting, vibration, and
shock.
(4) Avoid installing in locations where chemicals are stored or gas may be generated.
(5) Pay attention to the frequency, voltage, and allowable current (or power consumption) of
the power supply.
(6) Correctly ground the equipment.
3. Take the following precautions before using the equipment.
(1) Inspect the switch contacts, polarity, dial setting, and meters to confirm that the
equipment operates accurately.
(2) Confirm that the equipment is completely grounded.
(3) Confirm that all the cables are accurately and fully connected.
(4) Use caution if the equipment is combined with other devices since that might lead to
errors in diagnosis or create hazards
(5) Recheck the external circuits that are directly connected to the patient.
4. Take the following precautions when using the equipment.
(1) Do not exceed the time or amount required for diagnosis or treatment.
(2) Continuously monitor the equipment and patient for any abnormality.
(3) If any abnormality is observed in the equipment or patient, take appropriate measures
such as stopping the equipment while maintaining patient safety.
(4) Prevent the patient from touching the equipment.
5. Take the following precautions after using the equipment.
(1) Return the operation switch and dial to the condition before use according to the
specified procedure and turn off the power.
(2) Be sure to grip by the plug when removing the cord from a socket/outlet.
(3) Store under the same conditions as installation items (1) to (4) in 2. Equipment
installation.
(4) After washing accessories, cables, and conductors and so on, arrange them together in
order.
(5) Always clean the equipment to prevent problems during the next usage.
6. Do not try to repair a failure by yourself. Put an appropriate tag on the equipment and ask a
designated technician to make repairs.
7. Do not attempt to modify the equipment
１－13
8. Maintenance and inspections
(1) Make sure that the equipment and parts are inspected periodically.
(2) Confirm that the equipment operates normally and safely before use if it has been left
unused for a long period.
9. Other essentials
Check the instruction manual for that product to find the particular caution items.
１－14
Chapter 2 Accessories
(1) (2)
(3) (4)
(5)
[Fig.2-1]
Check that the following accessories are included.

●Accessory component names
(1) Bottle adapter (for sevoflurane / Isofluane)
(2) Excess anesthesia gas discharge tube
(3) O2 sensor unit (mounted in canister)
(4) Handle for aux cylinder
(5) Instruction manual
* We ask that the customer provide fittings and couplings such as Pressure tubes to connect to the
gas source pipes used within the clinical facility.
２－1
MEMO
Chapter 3
Part names and functions
[1] Left side view
A01
A12
A11
A10 A02
A03
A04
A09 A05
A08 A06
A07
[Fig.3-1]
A01: APL valve (pop-off valve)

This valve adjusts the flow of gas discharged within the circuit. Turning the knob fully
“clockwise” closes the valve, and gas cannot be discharged from within the circuit.
However, turning “counterclockwise” opens the valve and gas within the circuit can be easily
discharged. APL valves manufactured by other companies and available as an option prior to
shipment can also be installed.
３－1
A02: Breathing bag coupling
Connect the respiratory bag (3 liters).
Connect it securely
CAUTION (If it should come loose no alarm is given to announce the problem. If the
connection is faulty or incomplete then anesthesia gas might leak and
contaminate the room interior.)
A03: CO2 absorbent device (canister)

This contains CO2 absorbent inside a chamber that absorbs the CO2 discharging from the
patient.
It contains a total of 1,340mL (1,200 g) of CO2 absorbent.
PROHIBITED Leaving open and unsealed CO2 absorbent and leaving

fresh gas (mainly O2) supplied to the recirculating
respirator circuit will prevent the CO2 absorbent from
drying
(Jointly using inhalant anesthetic along with CO2 absorbent that has lost its
moisture may cause fires, abnormal heat emission, CO emission or a
possible loss of CO2 absorbance capability.)
PROHIBITED
(When replacing or refilling the CO2 absorbent do not fill higher than the “no
higher than this line” mark seen inside the chamber. Overfilling may cause
problems such as uneven gas exchange or prevent a proper fit in the
container.)
Connect it securely
Attach correctly
CAUTION (Check for any CO2 absorbent caught between one chamber and another, the
The amount of time the CO2 absorbent is usable varies with usage conditions
NOTE
(“fresh gas flow” and “vent flow”). So we recommend replacement with new
absorbent after a “10 hours” usage time as a general guide.
３－2
A04: Chamber attach-release handle
Turn this handle when attaching or detaching the chamber to fill or replace the CO2 absorbent.
A fold-up type knob is attached to the handle. To release the lock, pull the knob upward and
turn 180 degrees “counterclockwise”, and you can now attach or release the chamber.
To lock the knob, turn 180 degrees “clockwise”.
After locking, fold the knob down to its original position to prevent it hanging up on other
objects.

CAUTION (Check that the chamber is fully clamped by the chamber attach-release
handle. Gas leakage might occur if it is not completely turned.)
A05: Canister drain cup

This cup is for accumulating moisture from the patient and CO2 absorbent.
Empty water from the drain cup each time it

CAUTION accumulates
Connect it securely
A06: Gas pocket port (open circuit usage)

This port is utilized to discharge excess anesthesia gas from the circuit during usage of infant
circles or pain circuits.
Insert plugs securely into unused gas pocket ports

CAUTION (If not plugged then anesthesia gas might contaminate the room interior.)
A07: Gas pocket port (for respiratory circuit)

An excess anesthesia gas discharge tube (19F) can be connected to the canister gas port
when using the device internal ventilator.
Connect it securely
３－3
A08: Ventilator gas-out
An artificial respirator tube (22F) can be connected to the canister ventilator port when using
the device internal ventilator.
A09: Ventilator control cable-flow sensor tube connector
The ventilator control cable and flow sensor tube are integrated into 1 connector. Just flipping
the BAG-VENT selector on the canister controls the “operation” and “standby” of the ventilator
housed in the equipment.
This supplies fresh gas and measures the vent flow and pressure, etc.
Do not pull on the control cable

PROHIBITED (Don’t apply heavy force when pulling or bending the control cable. This could
damage the cable and cause problems with ventilator control or vent flow
display.)
Connect it securely
CAUTION (Measurements and control of the ventilator might be impossible if the cable
connector is not attached or installation is incomplete.)
Connect it securely
connection is faulty or incomplete then anesthesia gas might leak out and
A10: Cable hook

Pressure tubes and power cables are hung from this hook installed at 2 points on left and right.
A11: Side rail
This rail is for installing optional parts.
PROHIBITED
Only install standard optional parts on the side rail
(Installing unplanned items might cause the unit to topple over.)
A12: Flow rate meter backlight switch

This switch turns the backlight attached to the rear side of the flow rate meter glass tubes ON
and OFF.
３－4
[2] Front view
B01
B02
B03
B09
B10
B11
B12
B13
B04
B14
B05
B15
B06 B07
B08
B16
[Fig.3-2]
B01: O2 extra flow meter (option prior to shipping)

Flow rate display range : 0 to 10.0L/minute
B02: O2 extra flow gas outlet (option prior to shipping)
This is a gas outlet for the O2 extra flow. A tube connected here supplies gas to the patient by
way of a mask, etc.
B03: Release button
Press this to “raise or lower” the telescoping pole (respirator circuit unit).
Keep holding down the button to “lower” it. Lower after having lightly raised the pole upward.
３－5
Support the canister securely when pressing the
CAUTION release button
(Securely support the canister when pressing the release button for raising-
lowering the canister. If not fully supported, it might pinch the fingers when
the button is pressed.)
B04: Respiratory circuit drain

Pressing the discharge button to the right of the small window (for checking if water has
accumulated) ejects water discharged from within the respiratory circuit.
Always discharge water accumulated within the

CAUTION respiratory circuit
(Water that continues to accumulate might affect the PEEP. Pooled water can
be checked from the small window in the canister so always be sure to get rid
of accumulated water.)
B05: Canister clamp knob

This knob prevents the canister from rotating. After facing the canister where desired, clamp it
in place with this knob.
B06: Clamp ring
This ring clamps the “height” and “direction” of the telescoping pole (respiratory circuit unit). To
change the position, loosen this ring by turning it “counterclockwise”. When set at the correct
position, turn the ring clockwise to tighten it.
B07: Gas outlet
This is the fresh gas outlet. It is connect by a joint cap.
When using an open circuit (Jackson Rees bag valve mask, etc.) remove the joint cap and
supply the gas from there.
Check that the joint cap is connected

WARNING
(Check that the joint cap is securely connected to the gas outlet. If no junction
cap was connected then fresh gas is not being supplied to the respiratory
circuit. Use caution since this could lead to accidents involving the life of the
patient.)
Don’t lose the cap or other parts

CAUTION (Losing the joint cap will prevent use of this device. Be cautious when handling
during use with open circuits, etc.)
３－6
B08: O2 flush button
Supplies “35 to 75L/minute” without passing through the flow rate meter adjuster valve.
B09: Air supply pipe pressure gauge
Pressure display range : 0 to 10×100kPa
B10: N2O supply pipe pressure gauge
Pressure display range : 0 to10×100kPa
B11: O2 supply pipe pressure gauge
Pressure display range:0 to 10×100kPa
B12: N2O auxiliary cylinder pressure gauge (Air support cylinder pressure gauge: option prior to
shipment)
Pressure display range : 0 to 200×100 kPa (same as for air)
B13: O2 auxiliary cylinder pressure gauge
Pressure display range : 0 to 200×100 kPa
B14: Handle grip
Use this handle grip to move the device when shifting the device main unit or changing its
direction.
B15: Drawer
B16: Bellows unit
This feeds gas according to preset conditions during use of the internal ventilator (vent mode).
It can be removed and disinfected.
３－7
[3] Respiratory circuit upper view
C01
C08
C07 C02
C06
C03
C05 C04
[Fig.3-3]
C01: BAG-VENT selector

Allows switching with just one-touch to: “BAG (hand-operated breathing) mode” when using a
respiratory bag; and to “VENT (auto-respiration) mode” when using the internal ventilator.

CAUTION (On the operation status display of the monitor, the background color is light
blue when switched to BAG and light green when switched to VENT.)
C02: Expiratory valve

C03: Circuit internal pressure gauge
Displays the internal circuit pressure (with zero adjuster)
Pressure display range : -10 to 70hPa
C04: Expiratory port
C05: Inspiratory port
C06: O2 sensor installation section
The O2 sensor unit connects to the respiratory circuit. Opening the lid allows installing or
replacing the sensor unit. Shut the lid when these tasks are complete.
* Installing the O2 sensor unit
Open the lid and connect the cable from the O2 sensor unit to the connector in the canister.
Next, install the O2 sensor unit on the respiratory circuit and lock in place with the internal
stopper.
３－8
* Replacing the sensor
Open the lid and release the lock on the internal stopper. Remove the O2 sensor unit from
the respiratory circuit, loosen the clamping screw on the main unit, and dismantle the main
unit and sensor section.
Replace the old sensor with a new one, and reassemble in the opposite order of the above
procedure. Reinstall the O2 sensor unit in the respiratory circuit.
C07: Inspiratory valve
C08: Relief valve
This valve discharges excess pressure within the respiratory circuit. The upper section of the
relief valve is a test adapter. Insert a Y-piece tip in it when making a leak test of the respiratory
circuit.
[4] Right side view
D01
D03
D02
D04
[Fig.3-4]
３－9
D01: Sound volume knob
Turn the knob “clockwise” to increase the alarm volume.

WARNING
enough to easily hear
D02: Speaker
Speaker sounds an alarm when an alarm has occurred.
D03: Working place
D04: Side rail
This is a rail for installing optional parts.
Only install standard optional parts on the side rail

PROHIBITED
(Installing unplanned items might cause the unit to topple over.)
３－10
[5] Rear view
E01
E02
E03
E04
E05
E06
E07
E17
E14
E08
E15
E09
E13
E10
E12
E11
E16
[Fig.3-5]
E01: Monitor shelf

This is a rack for mounting various types of monitoring equipment. (Maximum weight: up to
10kg)
Fasten devices on the monitor shelf with straps to

WARNING prevent them from falling
(Dropped equipment could cause major problems with patient observation.)
E02: Elapsed time counter

Counter displays the total device usage time up to “999999.9 hours”.
３－11
E03: External data output terminal (RS-232C): Option prior to shipment
Outputs data to different types of remotely installed patient monitors.
Includes a cover for standard specifications and no output terminals are installed.
Data output cable must be shorter than 3 meters

WARNING (Connecting a data output cable longer than the specified length to external
equipment may cause problems such as external noise or unexpected
malfunctions to occur.)
E04: Main unit power socket (with cable lock clamp)

This socket is for supplying power to the main unit.
When shipping with the power cable connected, clamp it in place with a cable lock.
* Connect to a 5A or larger capacity power supply.
WARNING Confirm that the power cable is clamped with cable

lock hardware
(If not clamped with a cable lock, the power to the main unit will be cut off if the
cable comes loose or is disconnected.)
E05: Power switch

Press this switch when supplying power to the main unit.
A transparent switch cover is installed to protect the power switch.
WARNING During use keep the power plug connected and leave
the power switch “ON” all the time
switching to battery operation. This is hazardous since all functions such as
monitor display, ventilator, injection vaporizer, O2 concentration meter, alarm
devices and safety device will cease to operate. Charging the battery is also
impossible.)
Wait a while before turning on the power again

CAUTION (In unusual cases, the equipment might not start up normally if the power is
turned on again immediately, It might also lead to equipment breakdowns.
After turning “OFF” the power, wait at least 5 seconds or more before turning
the power back “ON” again.)
３－12
E06: Overcurrent safety breaker : 3A
A current of 3A or higher triggers the breaker to cutoff power to the main unit.
If the breaker triggers, immediately request a repair and equipment inspection.
When the overcurrent safety breaker trips, don’t try to

WARNING
“reset” it. Instead ask for a repair and inspection
(If the overcurrent safety breaker trips, then some type of problem may have
occurred in the main unit. Don’t reset it but instead ask your dealer or
ACOMA customer support representative for a repair and inspection.)
E07: Aux. O2 cylinder yoke

Attach the O2 support cylinder yoke.
E08: Aux. N2O cylinder yoke (or air support cylinder yoke : option prior to shipment.)
Attach the N2O support cylinder yoke (or air support cylinder).

CAUTION (Attach the yoke plug after removing the support cylinder. Unless the yoke plug
is attached, dirt and dust will adhere to the cylinder port and cause
breakdowns.)
E09: O2 gas inlet

This is a port or inlet for supplying O2.
The inlet (port) coupling supports DISS standards. Connect the pressure-resistant pipe (green)
securely with a 19mm wrench.
E10: Surplus anesthesia gas suction inlet (for monitor)
This is a port or inlet for suctioning anesthesia gas discharged from the anesthesia gas
monitor (outside the system). Connect a tube (sold separately) between the anesthesia gas
monitor and this suction inlet.
If using an anesthesia gas monitor then connect it with

CAUTION a tube, etc
(Connect a tube between the anesthesia gas monitor being used and this
monitor excess gas suction inlet. If the connection is faulty or incomplete then
anesthesia gas might leak and contaminate the room interior.)
E11: N2O gas inlet

This is a port or inlet for supplying N2O.
This inlet (port) coupling supports DISS standards. Connect the pressure-resistant pipe (blue)
E12: Surplus anesthesia gas suction port

This is an exhaust (suction) port for discharging excess anesthesia gas in the respiratory
circuit to outside the room. Connect the anesthesia gas discharge system to this connection
port with a tube (sold separately) etc.
３－13
Excess anesthesia gas is suctioned in a range from
CAUTION “15 to 30 L/minute”
E13: Air gas outlet

This is a port or inlet for supplying air.
This inlet (port) coupling supports DISS standards. Connect the pressure-resistant pipe (yellow
E14: Gas pocket port
This port discharges excess anesthesia gas from the respiratory circuit.
Connect to the gas pocket port (A07) on the main unit with an excess anesthesia gas
discharge tube.
E15: Canister protective guard
This is hardware (guard) for protecting the ventilator control cable-flow sensor tube connector
(A09) on the rear lower side of the canister.
E16: Aux. cylinder holder
This is a holder for the support cylinder and an impact-cushioning rubber guard.
E17: Ventilator port
If using the internal ventilator in this device, then connect a respirator tube (22F) from this port
to the ventilator gas outlet on the left side of the main unit.
[6] Operating panel

F02 F03 F04 F13 F14 F15 F16 F18
F01
F05
F06
F07
F08
F09
F10 F11 F12 F17 F19

[Fig.3-6]
３－14
F01: AIR selector indicator
This indicator lights up when AIR was selected.
F02: N2O/AIR flow rate indicator
Flow rate display range: Both N2O and AIR are 0 to 10.0L/minute
F03: N2O selector indicatory
Indicator lights up when N2O is selected.
F04: O2 flow rate indicator
Flow rate display range: 0 to 10.0L/minute
F05: AIR selector button
Pressing this button for 3 seconds selects AIR.
Selecting AIR shuts off the N2O.
F06: N2O selector button
Pressing this button for 3 seconds selects N2O.
Selecting N2O shuts off the AIR.
F07: AIR flowmeter
F08: N2O flowmeter
F09: O2 flowmeter
F10: AIR flow adjuster knob
Adjusts the AIR flow from 0 to 10.0L/minute.
Be aware of flow rate ratio setting errors when using

WARNING
O2 and air
(This device has no interlock function to mechanically control the air flow rate.
So the wrong flow ratio could cause hypoexemia.)
Injection vaporizer automatically “stops” in “1 hour” if

CAUTION there is no O2 flow (“0.1 L/minute” or less)
* If using only air in the injection vaporizer then the injection vaporizer will
“stop” after “1 hour”.
* Holding down the injection vaporizer start/stop button for “3 seconds” or more
sets it to “start” again.
F11: N2O flow adjuster knob

Adjusts the N2O flow from 0 to 10.0 L/minute.
３－15
Be aware of the N2O flow rate (non-attached
WARNING
interlocking gear: option when shipped from factory)
(This device does not have an interlock mechanism for mechanically
regulating the N2O flow. Therefore, when O2 flows at “0.1L/minute” or more,
then N2O can also be supplied. However the flow rate alarm will activate
when the O2 flow is higher than a specified ratio.)
F12: O2 flow adjuster knob

Adjusts the O2 flow from 0 to 10.0 L/minute.

PROHIBITED
drying
moisture may cause fires, abnormal heat emission, CO emission or a
possible loss of CO2 absorbance capability.)
F13: Injection vaporizer start-stop button

Holding down this button for “3 seconds”, “starts” or “stops” the injection vaporizer.
If the injection vaporizer “STARTS” up while using the

WARNING
internal vaporizer then stop use immediately
(The internal safety device inside the main unit is broken. Promptly request a
repair from the manufacturer.)

CAUTION (Allowing the operating state to continue as is for long periods will cause
bubbles in the unit internal piping and might affect operation the next time
used!)
F14: Anesthesia sensor indicator

The sensor inside the device lights up the indicator when liquid passes it during suction of
anesthesia from the anesthesia bottle into the main unit.
F15: Anesthesia gas conc. indicator
Display range settable between: 0 to 8.0%
３－16
F16: Anesthesia gas conc. dial
Turning the dial “clockwise” allows setting the vaporizer device anesthetic gas concentration in
the following range.
Sevoflurane: 0 to 8.0%
Isoflurane: 0 to 6.0%
* To set the sevoflurane to “5.0%” or more and the isoflurane to “4.0%” or more, press in on
the anesthetic gas concentration dial while turning it.
F17: Bottle adapter mounting port
Connect a bottle adapter with an anesthesia bottle (sevoflurane or isoflurane) attached, to the
bottle adapter mounting port.
* The isoflurane bottle adapter is sold separately.

PROHIBITED (Do not remove just the anesthesia bottle with the bottle adapter still attached
to the main unit. Doing this will cause air to enter the device piping and
activate the empty bottle alarm.)

CAUTION (The bottle adapter cannot be removed to replace the anesthesia bottle unless
a series of actions are completed. A maximum of about “1 minute” is required.)
F18: Vaporizer mounting stand

One selected Acoma vaporizer MK-5i/s or another company’s vaporizer unit: (both sold
separately) can be attached here.
An anesthesia anti-contamination device automatically locks the conc. dial of the mounted
vaporizer while the injection vaporizer is being used.
If the concentration adjuster dial on the vaporizer

WARNING mounted in the unit rotated during use of the injection
vaporizer then immediately stop usage
(Safety device built into the vaporizer mounting stand is defective. Promptly
request a repair from the manufacturer.)
Before attempting to use the vaporizer always read the

WARNING
instruction manual and special attached materials to
fully understand this device
F19: Wiring hole caps

This is a cap for concealing the hole through which the wiring passes. If mounting another
company’s vaporizer, then removing this cap will allow routing the power cable from the
vaporizer to outside the unit (rear side).
* Caps are located at front and back.
３－17
Mounting the caps
CAUTIOM (After removing the other company’s vaporizer, mount the wiring hole caps.
These will prevent breakdowns due to penetration of moisture, etc.)
[7] Control panel

G01 G18 G17 G16
G02
G15
G03
G19
G14
G04
G05
G06
G07 G08 G09 G10 G11 G12 G13 G20 G21
[Fig.3-7]
G01: Monitor
The monitor displays device information such as ventilator settings, alarm display-settings-
history, and pressure waveform displays.
G02: Multi-item selector button A (from the top)
Press this button to select a respiratory mode shown on the monitor to the right of the button.
G03: Multi-item selector button B
Press this button to select a Menu item during the respiratory mode or Vent mode (auto
respiration) shown on the monitor to the right of the button.
G04: Multi-item selector button C
Press this button to select a Menu item or respiratory mode shown on the monitor to the right
of this button.
G05: Multi-item selector button D
Press this button to select an Alarm status or Menu item during BAG mode (hand-operated
breathing ) show on the monitor to the right of this button.
G06: STBY/ON indicator
This indicator lights up “green” when the device is “ON (operating)” and lights up “orange”
during “STBY(standby)”.
３－18
G07: STBY/ON switch
Press this button to switch the device to “ON (operation)” or “STBY(standby)”.
G08: Item Set-Enter button A (from left)
Press this button to select and/or enter settings shown on the monitor above this button.
G09: Item Set-Enter button B
G10: Item Set-Enter button C
G11: Item Set-Enter button D
G12: Item Set-Enter button E
G13: Number Set-Enter dial
Turning this dial left or right changes the number of the selected item or item where the cursor
is positioned.
Pressing this dial enters the displayed setting or item.
G14: MENU button
Press this button to check device information or do sensor calibration, or check and set jointly
used device settings.
* The allowable operation and displays will vary according to whether in VENT (Auto) or BAG
(Manual).
G15: ALARM button
Press this button to check alarm settings or check the alarm history.
G16: SELECT button
Press this button to switch the circuit pressure measurement display.
* The display shown may vary during VENT (Auto) or BAG (Manual) and also according to
whether PEEP was set or not.
G17: Alarm indicator
Flashing display appears simultaneous with alarm. Alarm displays are in “RED” or “YELLOW”
depending on the alarm priority.
G18: Alarm pause button
Press this button to pause the alarm.
G19: AC power indicator
This indicator lights up when the power cable is connected to AC (commercial outlet) power
and the power switch is “ON”.
G20: Battery remaining power indicator
This indicator displays the remaining internal battery power via a 4-stage indicator display
during battery operation. (This is off while AC power is supplied.）
a) Indicators are all lit up when battery is fully charged
b) First stage indicator lights up when 50% of battery charge was used up
c) Second stage indicator lights up when 70% of battery charge was used up
d) Third stage indicator lights up when 90% of battery charge was used up
In a state where 90% of battery power was consumed, the power outage alarm activates again
to announce that remaining battery power is approaching “0”.
３－19
When remaining battery power reaches “0”, the anesthesia main unit shuts off and only the
alarm still sounds.
The internal battery operates for approximately “30 minutes” as a general guide. The battery
gradually deteriorates due to the battery charging state and to changes occurring over time so
in some cases might not be able to supply “30 minutes” of power.
Replace with a new battery if the battery operating

CAUTION time drops sharply or otherwise replace every “2
years”
(The battery wears down over the passage of time so periodically replace it
with a new battery.)
* Battery life is approximately “2 years”. Contact the manufacturer if
replacement is required.
G21: Battery charging indicator

This indicator lights up during charging of the internal battery. When charging is finished the
indicator turns off.
Battery charging starts when the power plug is inserted into a AC power (commercial outlet)
socket and the power switch is “turned on”.
If the remaining battery power is “0” then “20 hours” or more is required to reach a fully
charged state.
* If the battery is not used for a long periods then the voltage might drop due to natural
discharging. Periodically (about once every 3 months) check the remaining battery level and
if not in a fully charged state then charge it.
３－20
Chapter 4 Pre-usage Preparation
Connect securely
CAUTION
(Securely connect the canister chamber, drain cap, and respiratory bag, etc.
No alarm is given if any of these are poorly connected. If not fully connected
then anesthesia gas might contaminate the room interior.)
When using optional part and sections for optional use, connect and install
NOTE according to instructions in the respective appended material
[1] Connecting the power cable

(1) Insert the power cable into the socket on the main unit
and secure in place with a cable lock clamp.
Cable lock
Power cord
[Fig.4-1]
Confirm that the power cable is clamped with cable

WARNING lock hardware
(If not clamped with a cable lock, the power to the main unit will be cut off if
the cable comes loose or is disconnected.)
(2) Insert the power cable plug AC (commercial) into the

socket. Power plug
Socket
[Fig.4-2]
４－1
Do not damage the power cable
PROHIBITED
(Don’t forcibly pull, bend, or tramp on the cable. Using a damaged cable could
cause fire or electrical shocks.)
Connect the power plug to a 3-pin medical outlet (socket)

CAUTION (Connect to a 3-pin medical treatment outlet (socket) to prevent electrical
shocks.)
Turn off the power switch and remove the power plug
WARNING when disconnecting the AC power supply
(commercial) due to an abnormal state that occurred.
(Immediately stop use if high temperatures, smoke, abnormal odors/sounds or
faulty operation occur and set the power switch to “OFF” and remove the plug
from the socket. Continuing to use as is may cause fires, electrical shocks
and breakdowns. Do not place devices such as ME in locations that might
interfere with operation.)
[2] Connecting the gas supply pipes & surplus anesthesia gas suction
tube
Connecting to gas supply source
(1) Turn each of the O2, N2O (or AIR) Aux. cylinder
yoke clamp handles on the rear side of the main
Yoke plug
unit "counterclockwise”.
*AIR: Option ordered prior to shipping Clamp handle
[Fig.4-3]
If removing the yoke plug, then store it to prevent

CAUTION
losing or misplacing it
Discharge the gas before installing the Aux. cylinder

CAUTION (Before installing the Aux. cylinder, discharge the gas “once or twice” at
intervals to remove grit and debris. Debris or grit that adheres to the port
openings/couplings can cause breakdowns.)
４－2
[Gas discharge method]
a) Insert the hole notch on the support
handle onto the valve head at the
Gas inlet
upper edge of the Aux. cylinder.
b) Gently open the valve by turning the
Aux. cylinder handle
Clamp handle
“counterclockwise”.
c) When finished, don’t forget to turn the
Aux. cylinder handle “clockwise” to
[Fig.4-4]
close the valve.
(2) Insert the 2 bottles (O２, N２O, or AIR: Option ordered prior to shipping) on each yoke connection
port to match the bottle index mark on each Aux. cylinder
(3) Turn the clamp handle “clockwise”, and tighten securely so there are no leaks from the connection
port.
[When using the Aux. cylinder]

*Do not open the Aux. cylinder valve except during emergencies and when needed.
a) Insert the hole notch on the support handle onto the valve head at the upper edge of the Aux.
cylinder.
b) Keep turning the Aux. cylinder handle fully “counterclockwise” until it stops so that the cylinder
valve is fully open.
Shut the Aux. cylinder valve if using gas from the in-
WARNING hospital gas supply pipe
(If the Aux. cylinder valve is left open, the gas will be used up and no longer
(4) Connect the Pressure tube to the gas inlet on the

rear of the main unit.
※Use an available item as the Pressure tube or
purchase if necessary.
A connector nut is attached to each O2, N2O and AIR
Pressure tube. Tighten the connector nut onto each
inlet.
Then securely tighten it with an available wrench
[Fig.4-5]
O2:19mm, N2O & AIR:22mm）.
(5)Insert the other end of each Pressure tube into the in-hospital gas supply pipe
Maintain each gas at a rated supply range between

CAUTION “350 to 500 kPa”
４－3
Connect the surplus anesthesia gas suction tube
(1) Using a tube or hose, connect the excess anesthesia gas suction
inlet on the rear of the main unit to the excess anesthesia gas
discharge system within the clinical facility.
*Use an available item as the tube or hose, or purchase if
necessary.
(2) On the anesthesia gas monitor, check for gas discharging from
the monitor. If found, connect a tube to the surplus anesthesia gas
suction (inlet) on the rear side of the main unit.
[Fig.4-6]
S anesthesia gas is suctioned in a range from “15 to

CAUTION
30 L/minute”
If using an "anesthesia gas monitor then connect it

CAUTION
with a tube, etc.
(Connect a tube between the anesthesia gas monitor being used and this
monitor excess gas suction inlet. If the connection is faulty or incomplete then
anesthesia gas might leak and contaminate the room interior.)
In the case of “anesthesia at a low flow rate”, be aware

CAUTION
of the sampling gas flow on the monitor device (it is
equivalent to a circuit leak)
[3] Attach O2 sensor unit and connect the cable

* An O2 sensor unit is built into the canister prior to shipment from the factory.
(1) Open the O2 sensor cover on the upper side of the
canister.
[Fig.4-7]
４－4
(2) The O2 sensor unit is comprised of 2 sections. One is
a sensor unit (outer end section) and the other is the
main piece (converter section). When replacing the
sensor, align the guide pin and hole positions as shown
in the photo and tighten with the setscrew on the main
piece.
Pin Hole
Setscrew
[Fig.4-8]
(3) Raise the internal stopper in the O2 sensor

[Fig.4-9]
hole groove and insert the O2 sensor unit into Internal stopper
the installation hole. Connect the cable connector

coming out of the unit main piece section, to the
connector within the canister.
Connector
(4) Close the O2 sensor cover. Press the O2 sensor unit

cable into the canister while preventing it from being
pinched or crushed by the cover.
[4] Connect the respiratory circuit set & Breathing bag, etc.
(1) Connect the respiratory circuit set (tube set) you will
use, to the inspiratory port and exp port on the canister.
Insiratoly port
*Use an available item as the respiratory circuit set Expiratory oirt
(tube set) or purchase if necessary.
*To prevent cross-infection, we recommend attaching a
bacteria filter (sold separately)
[Fig.4-11]
４－5
Replace the bacteria filter with a new one
CAUTION (To prevent cross-infection, use new bacteria filters at the intake and s for the
patient.) exB02kkport
* Read the attached specialist materials to find appropriate usage methods.
(2) Connect a breathing bag (3L) to the breathig bag connection port
protruding from the canister.
* Use an available item as the breathing bag or purchase if necessary.
Breathing
bag port
Breathing
bag
[Fig.4-12]
(3) Connect the accessory surplus anesthesia gas

[Fig.4-13]
removal tube to the gas pocket connection port on the Gas pocket
port
bottom rear side of the canister. Also connect the Ventilator port
artificial respiratory tube to the ventilator port.
* Use an available item as the Ventirator corrugated
tube tube (diameter 22F)or purchase if necessary.
Surplus Ventilator
anesthesia corrugated
gas tube
discharge
Gas pocket
(4) Couple the opposite side of the tubes connected above Ventilator gas- port
out
in (3) to each port on the left side of the main unit..
Couple the surplus anesthesia gas removal tube to the
gas pocket port (respiratory circuit); also connect the
ventilator corrugated tube to the ventilator gas-out.
Excess anest
Ventilator gas
Corrugated discharge
tube [Fig.4-14]
４－6
Connect securely
CAUTION
(No alarm is given if any of these are poorly connected. If not fully connected
then anesthesia gas might leak and contaminate the room interior.)
[5] Filling the CO2 absorbent

(1) Raise the knob on the chamber release fold-up handle
located on the lower side of the canister toward you. Then
grip that handle and turn 180° ”counterclockwise” to
release the chamber lock.
(2) Remove the 2 chambers from the canister. Fill these
Fixed level
with CO2 absorbent up the fixed level mark as seen in the mark height
photo.
* Use an available item as the CO2 absorbent or purchase
if necessary. Chamber
(3) Stack the chambers now filled with CO2 absorbent onto
Foldup handle
the lower lid of the canister. Next grip the chamber
[Fig.4-15]
release fold-up handle and turn 180° “clockwise” to lock
the chamber. Lastly, fold the handle knob back and down rearward.

PROHIBITED
drying
moisture may cause fires, abnormal heat emission, carbon monoxide
emission or a possible loss of CO2 absorbance capability.)

PROHIBITED
(This is an alkaline material so if mistakenly touched, wash thoroughly with
large quantities of “tap water”.)

PROHIBITED (When replacing or refilling the CO absorbent do not fill higher than the “no
2
higher than this line” mark seen inside the chamber. Overfilling may cause
problems such as uneven gas exchange or prevent a proper fit in the
container.)
Attach correctly
CAUTION (Check for any CO2 absorbent caught between one chamber and another, the
４－7
CAUTION
(Check that the chamber is fully clamped by the chamber attach-release

CAUTION
accumulates
NOTE The amount of time the CO2 absorbent is usable varies with usage conditions
(“fresh gas flow” and “vent flow”). So we recommend replacement with new
absorbent after a “10 hours” usage time as a general guide.
[6] Mount the bottle adapters

(1) Mount the anesthesia bottle onto the accessory bottle
adapter (sevoflurane).
* The accessory bottle adapter is only for sevofurane. If
using isoflurane, then prepare an isoflurane bottle
adapter (sold separately).
[Fig.4-16]
(2) Connect the bottle adapter and attached anesthesia bottle to the
Bottle adapter
bottle adapter mounting section of the operating panel.
* Push the bottle adapter in firmly until a latching sound is heard.
Anesthesia
bottle
[Fig.4-17]

to the main unit, Doing this will cause air to enter the device piping and

a series of actions are completed. A maximum of about “1 minute” is
required.)
４－8
[7] Install the vaporizer
*The vaporizer is sold separately.
*The Acoma vaporizer MK-5i/s or another company’s vaporizer selected during purchase can also be
installed.

WARNING
instruction manual and special attached materials to fully
understand this device
Check that the vaporizer is securely clamped

WARNING (Anesthesia gas leaks might occur if not fully clamped in place.)
●When installing the Acoma vaporizer MK-5i/s:

Conc adjuster dial
(1) Check that the conc adjuster dial on the vaporizer
is “OFF”, and the lock-lever is set straight to the
Lock-lever
right side.
(2) Align the connecting hole on the upper side of the
vaporizer mounting stand with the connecting pin
on the vaporizer and slowly lower it vertically.
(3) Turn 90° “clockwise” while pressing on the lock
lever and tighten securely.
(4) After fastening the vaporizer in place, hold down
the lock-lever to prevent it from moving and clamp
Acoma vaporize
even tighter.
* To find more vaporizer information, check the
“Acoma vaporizer MK-5i/s Instruction Manual.” [Fig.4-18]
●When installing another company’s vaporizer selected
during purchase:
* If installing another company’s vaporizer, then the Acoma “Vaporizer Mount” is required. Please
note that this vaporizer mount is an option product selected during purchase of this device.
* To find operating methods and other detailed information please see the special instruction
manual that is provided.
４－9
MEMO
Chapter 5
Control panel operating methods
The control panel provides pressure waveform displays, alarm setup-displays, operational messages,
and setup screens as well as displays-operating functions, including sensor calibration.
The liquid crystal display screen incorporates highly
NOTE sophisticated technology. An extremely small number of pixel
defects or constantly lit pixels might be seen but this is not an
equipment fault.
The liquid crystal screen is a unique component so please
keep this in mind during operation.
[1] Turning on power to the device
Startup
(1) Set the power switch on the unit rear panel to “ON”. The STBY/ON indicator first flashes (orange) and then stays
fully lit (orange).
[Fig.5-1]
Power switch
STBY/ON
indicator
STBY/ON
switch
[Fig.5-2]
WARNING During use keep the power plug connected and leave
impossible.)
*Also leave the power switch “ON” for both “BAG mode” and “VENT mode”.
* In this state (STBY:standby), switching the BAG-VENT selector to VENT makes a beep-beep-beep-
beep alarm sound.

CAUTION
(Before shifting to “VENT mode”, check the “vent conditions” of the ventilator
and the flip the BAG-VENT selector.)
５－1
(2)Press the STBY/ON switch on the control
Operation
panel. status display
The STBY/ON indicator then turns green

and the equipment makes a self-diagnosis.
STBY/ON
After checking the device status, a self- indicator
diagnostics screen appears, the display

switches to the standard screen (BAG
[Fig.5-3]
mode) and the device is now in the
“ON(operating)” state.
The self-diagnostics screen displays the date, production No., main program version, and LCD
program version. It also shows the driver gas pressure and BAG-VENT selector position.
* During self-diagnostics, and “NG” appears if the driver gas pressure is not within the correct
range and a message, “Cannot detect driver gas pressure. Check the connection to gas supply
pressure. If you wish to operate as is under current conditions, then press the dial” appears on
the monitor. Following these monitor instructions, turns the device “ON (start)”. This allows the
user to check the alarm history or software version and so on even when operating in an
environment with no gas pressures.
If at this time, the BAG-VENT selector is on the “VENT” side, then operation is “NG” and the
message, “Set BAG-VENT selector to BAG” appears on the monitor. Following these instructions
sets the device to “ON (start)”.
Cannot detect driver gas pressure. Check the

connection to gas supply pressure. If you wish to
operate as is under current conditions, then press the
dial
[Fig.5-4] [Fig.5-5]
Ending operation
Press the STBY/ON switch on the control [Fig.5-6]
panel.
A popup message “Quitting, Press push the
encoder when ending” appears. Pressing
the dial sets the device to "STBY (standby)”,
and the STBY/ON indicator lights up
(orange).
５－2
[Fig.5-7]
*If at this time the fresh gas still continues to
flow or the ventilator is operating (VENT
mode) then an operation message appears
and the device does not set to STBY
(standby) state.
If the injection vaporizer is operating then

[Fig.5-8]
operation automatically ends.
Even in the unlikely event for example that a

[Fig.5-9]
switch is broken and a fresh gas OFF state
cannot be detected, in BAG mode, the device
can be set to “STBY (standby)” state by
holding down the STBY/ON switch for “5
seconds”.
５－3
[2] Standard screen display
When the device starts up, a standard screen appears as shown in the figure below.
At this time, the pressure waveform, major settings (ventilator & alarm, etc.) and measurements,
respiratory mode and so on appear on the monitor.
Pressure
Operation waveform O2 Conc.
status display display display
Alarm
setup
display
Alarm-
message
display
Measurement
Trigger display
display
Setting
display
[Fig.5-10]
(1) Operation status display

This wide slot section of the screen displays BAG mode and Alarm OFF, Alarm ON/pause, and
Alarm pause timer(120 seconds).
(2) Pressure waveform display
This displays waveforms of the circuit pressure.
(3) O2 Conc. display
This displays the measured O2 concentration within the respiratory circuit.
(4) Alarm setup display
This displays alarm settings for O2 concentration, (upper/lower limit), circuit pressure (excess
pressure/low respiratory pressure), and Minutes volume (MV) :upper/lower limit,
(5) Measurement display
This displays the measured respiratory circuit pressure, Vti, rate, Minutes volume (MV), selected
gas consumption flow, connected anesthesia consumption flow, and device usage time, etc.
* After device startup, the previous measured value is displayed in a state where injection
vaporizing has not started and manual measurement has not started.
(6) Setting display
This displays the Vti, plateau (EIP), rate, I/E ratio (inspiratory vs. expiratory), PEEP, inspiratory
pressure, flow rate, support pressure, and trigger values that were set.
* Display information will change according to the selected respiratory mode.
５－4
(7) Alarm-message display
This section located between the measurement display and setting display, shows operational
messages indicating currently issued alarms, device breakdowns, improved usage methods and
status.
*When an alarm occurs, a message appears following the alarm display.
[3] Setting the ventilator

* Settings can be changed during both BAG-VENT mode.
To set the ventilator, perform the following procedure.
(1) Setting procedure in BAG mode
(1-1) Select a desired respiratory mode (VCV, PCV, PSV) displayed on the left side of the monitor
screen, and press a multi-item selector button (A to C) on the left side of the control panel.
*PSV mode is an option set prior to shipment. It is not displayed unless selected.
(1-2) The required setting parameters for the desired respiratory mode appear at the lower section of
the monitor.
(1-3) Press the Item Set-Enter button (A to E) for the parameter you want to set or change.
(1-4) The selected parameter changes to a red display. Set the numeric value you want on the
Number Set-Enter dial.
(1-5) When finished changing or setting the desired parameter, press the Item Set-Enter button or
Number Set-Enter dial to enter and store the numeric value or setting that was set.
*Waiting longer than 10 seconds without pressing the button or dial will cancel your setting and
return to the previous setting.
Multi-item selector button
(from top A to D)
[Fig.5-11]
Item Set-Enter button Number Set-

(from left Ａ to Ｅ) Enter dial
[Fig.5-12]
PSV mode Display screen when no option is selected
５－5
◎ VCV mode
Here, “Vti”, “Plateau”, “Rate”, “I/E ratio” [Fig.5-13]
and “PEEP” are displayed as the setting
parameters.
◎ PCV mode
Here, the “insp. Press.”, “Flow rate”, [Fig.5-14]
“Rate”, “I/E RATIO”, and “PEEP” are
displayed as the setting parameters.
◎ PSV mode(option prior to shipping) [Fig.5-15]

Here, “HOS”, “Trigger”, and “Peep” are
displayed as the setting parameters.
[Fig.5-15]
(2) Setting procedure in VENT(ventilator)mode

The respiratory mode & parameters required for the selected respiratory mode can be directly set or
changed even while an artificial respirator is operating.
(2-1) Select a desired respiratory mode (VCV, PCV, PSV) displayed on the left side of the monitor
and press the multi-item selector button (A to C) on the left side of the control panel.
*PSV mode is an option set prior to shipment. It is not displayed unless selected.
(2-2)A popup screen appears, and easily set parameters for the desired respiratory mode appear on
the monitor.
(Easily changeable parameters VCV: Vti, PCV: inspiratory pressure, PSV: support pressure)
５－6
[Fig.5-16] [Fig.5-17]
[Fig.5-18]
(2-3) To change a desired numeric value, set the desired number on the Number Set-Enter dial. If not
changing a numeric value, then just press “ENTER”. To quit the selected respiratory mode, select
“CANCEL”.
(2-4) When operation starts in the desired respiratory mode you want to change, the required setting
parameters appear at the bottom of the monitor.
(2-5) Press the Item Set-Enter button (A to E) for the parameter you want to set or change.
(2-6) The selected parameter changes to a red display. Set the numeric value you want on the
Number Set-Enter dial.
(2-7) When finished changing or setting the desired parameter, press the Set-Enter button or Number
Set-Enter dial to enter and store the numeric value you set.
*Waiting longer than 10 seconds without pressing the button or dial will cancel your setting and
return to the previous setting.

CAUTION
and the flip the BAG-VENT selector.)
５－7
[4] Setting the alarm and checking the history
* Settings can be changed and displayed during both BAG-VENT mode.
Pressing the “ALARM” button on the right side of the control panel displays the 2 History/Setting
items on the left side of the monitor.
At first always start from the display screen for the setting (each alarm item). When necessary
press the multi-item selector button C/D on the left side of the monitor and switch the monitor
display.
(1)How to set the alarm
ALARM button⇒ Setting (each alarm item)
(1-1) The following setting items are common to each respiratory mode: pressure (excess
pressure/low respiratory pressure), and Minutes volume (MV): upper/lower limit, O2
concentration: upper/lower limit.
Alarm “OFF” can be selected for Minutes volume (MV): upper/lower limit; and O2
concentration: upper limit
(1-2) Turn the Number Set-Enter dial (hereafter: dial), shift the cursor to the desired alarm item (blue
band), and press the dial to enter and store the desired change item.
(1-3) Then turn the dial either left or right, and after setting the new alarm value press the dial again
to set and enter the new value.
(1-4) When finished setting the required alarm items, align the cursor onto “RETURN” and press the
dial or press the “MENU” button on the right side of the control panel to return to the BAG-
VENT mode screen.
* A “2 minute” or “Continuous” alarm sound pause time selection is for alarm operation in BAG mode.
ALARM button [Fig.5-19]
MENU
button
Number Set-
Enter dial
◎ Setting ALARM OFF(BAG mode)

Separate from the above settings, the alarms (Low inspiratory pressure alarm, APNEA, Minutes
volume (MV): upper/lower limit alarm) can themselves be turned off during BAG mode.
５－8
In BAG mode, pressing the “multi-item selector button D” on the left side of the control panel
displays the “ALARM OFF (BAG mode) set screen” as shown in the following figure, and individual
alarms to turn off can be selected.
Choosing “Select All” allows placing a check mark in all items.
When finished selecting alarms to turn off, align the cursor with “ENTER” and press the dial.
Alarms that were turned off appear in the “ALARM OFF display box” and the “Alarm setup display”
changes to an “OFF display” (orange).
[Fig.5-20]
To cancel, press the “multi-item selector BAG mode

ALARM OFF
button D” or switch to VENT mode. set screen
Alarm setup
ALARM OFF display box display
WARNING Check alarm operation conditions

(The ALARM OFF function does not automatically cancel alarms. Turning off
an alarm requires operation according to cancel methods in the manual.)
◎Alarm standby
In BAG mode, holding down the “Alarm Sound Pause button” for 3 seconds or longer sets the
“ALARM STANDBY mode” and the alarms (Low inspiratory pressure alarm(Low), APNEA, Minutes
volume (MV): upper/lower limit alarm ) are no longer issued.
Moreover, no operations other than #ALARM OFF in BAG mode” and “switching to VENT mode” will
function.
[Fig.5-21]
The “Alarm standby mode” is cancelled under the following conditions.

-Circuit pressure rises to 3hPa or higher
-When set to VENT mode
-When the alarm sound pause button is held for 3 seconds or more
-When a vent flow of 30mLor more was detected
５－9
(2)Alarm history
[Fig.5-22]
ALARM button ⇒Multi-item selector button C
⇒ History
Up to 10 alarm occurrence dates and their
information can be shown on 1 page. A
maximum of 300 alarm history cases can be
stored.
(2-1) Turn the dial and shift the cursor (blue
band) to the alarm date and info that you
want to check, and press the dial to enter it.
[Fig.5-23]
(2-2) Pressing the dial displays the detailed

status of the selected alarm date and info.
*Turning the dial with the detailed status still
shown, allows checking the alarm history for
that display.
(2-3) After checking the information, press the “MENU” button on the right side of the control panel to
return to the BAG-VENT mode screen.
NOTE If the history exceeds over 300 cases then cases are automatically deleted in
the order of oldest first.
[5] Operating from the MENU

* Setting changes and displays will vary depending on BAG-VENT mode.
Pressing the MENU button on the right side of the control panel will display the 4 Consumption
/Info/Calib/Setup items on the left side of the monitor.
Always first start from the display screen information. If necessary, press the Multi-item selector
buttons A to D on the left side of the control panel, and switch to the monitor display.
(1) Consumption quantity
[Fig.5-24]
* Displayable in both BAG-VENT mode.
MENU button ⇒ Consumption flow
The gas consumption, anesthesia
consumption and device usage time are
displayed and can each be checked here.
* After device startup, the previous measured
value is displayed in a state where
injection vaporizing has not started and
manual measurement has not started.
５－10
(1-1) Starting the injection vaporizer, also automatically starts measurement of “Gas”, “Anesthesia”,
Consumption, and “Usage time” at this same time. (Measurement continues until set to Standby.)
Consumption quantity for each gas (O2, N2O, AIR is displayed and the consumption quantity for
either the Sevo or Iso anesthesia is displayed.
(1-2) If starting measurement in manual then hold down the “SELECT” button or select
“RESET/START” on the Consumption screen to set all measurements to “0” and then restart
measurement.
(1-3) After checking, align the cursor on “RETURN” and press the dial or press the “MENU” button on
the right side of the control panel to return to the BAG-VENT mode screen.
(2) Information
[Fig.5-25]
* Displayable in both BAG-VENT mode.
MENU button ⇒ Information
(2-1)The Current date, device production No.,
software version, last maintenance date are
displayed and can each be checked.
(2-2)After checking, press the MENU button on
the right side of the control panel to return to
the BAG-VENT mode screen.
WARNING Make sure the device receives periodic inspections

and overhauls
(To maintain performance make sure the device receives periodic inspections
“once a year” or every “1,000 hours”.)
[Fig.5-26]
(3)Calibration
* Only operable in BAG mode.
“MENU button” ⇒ Multi-item selector button
C ⇒ Calibration
(3-1) O2 sensor
*Check that the O2 sensor unit is installed
within the canister.
a) Remove the O2 sensor unit from the O2
sensor installation unit in the canister, and
gently shake “2 or 3 times” in the outside
air. [Fig.5-27]
５－11
CAUTION
(Do not pull forcefully on the unit cable when calibrating the O2 sensor unit.
This may cause wire breakage or disconnections within the cable or
connector wiring. Broken or disconnected wiring will prevent correct
measurement.)
“Calibrate” when replacing the sensor unit

WARNING
(Dismantle the O2 sensor unit into the main piece and the sensor unit and then
replace the sensor unit. After reassembling the O2 sensor unit, place in the
outside air for “1 minute” or more and then shake gently “2 or 3 times”.)
WARNING Place the O2 sensor unit in the outside air and after
shaking gently “2 or 3 times”, recalibrate
(Leave the O2 sensor unit in the outside air for “1 minute” or longer and after
gently shaking “2 or 3 times”, calibrate it.)
* Calibrating without shaking and in other than the outside air will cause
display of the wrong O2 concentration.
When shaking the O2 sensor, pick a wide space free of

WARNING
surrounding obstructions
(Dropping it or apply strong impacts from striking it on something might
damage the O2 sensor unit.)
To remove the O2 sensor unit, grip by entire unit and pull out.
NOTE
b) Press the dial after checking that the cursor(blue band)is on“21% calibration”on the display.
The cursor automatically moves to “START”, pressing the dial again displays “Calibration In-
progress” (blue) and calibration starts.
After a while an “OK” (blue) is displayed and calibration ends. Return the O2 sensor to the
original location (canister).
c) After finished calibrating, align the cursor on “RETURN” and press the dial or press the “MENU”
button on the right side of the control panel to return to BAG (Hand-operated breathing ) mode.
(3-2) Vent flow zero point calibration
a) Turning the dial moves the cursor to “START”. Pressing the dial switches the display to
“Calibration In-progress” (blue) and calibration starts.
After a while an “OK” (blue) is displayed and calibration ends.
b) After finished calibrating, align the cursor on “RETURN” and press the dial or press the “MENU”
button on the right side of the control panel to return to BAG (Hand-operated breathing ) mode.
５－12
(3-3) Calibrate the flow rate sensor
* If an “F.F.F” or “L.L.L” appears on the
[Fig.5-28]
flow rate indicator then perform flow
rate calibration.(”Not-
calibrated”appears on the applicable
section)
* Flow rate sensor calibration is
impossible unless the concentration
setting on the injection vaporizer after
startup is “0%”.
a) Align the cursor on the gas (O2 /Ｎ2O /AIR)you want to calibrate and on High-Low and press the
dial.
b) To calibrate the Low side(Low flow rate region 0 to 1 L/minute)align the float for a gas flow of 1
L/minute and press the dial. The “START” (white)or “Not calibrated” (red) display then switches
to “Calibration In-progress” (blue). After a while an OK (blue) is displayed and calibration ends.
c) To calibrate the High side (High flow rate region 1 to 1 0L/minute)align the float for a gas flow of
6L/minute and press the dial. The START (white) or “Not calibrated” (red) display then switches
to “Calibration In-progress” (blue). After a while an OK (blue) is displayed and calibration ends.
d) When finished calibrating the required sensor, align the cursor on RETURN and press the dial or
press the MENU button on the right side of the control panel to return to the BAG mode screen.
Don’t calibrate the flow rate sensors while using this

PROHIBITED
device
(The alarms, flow gauges, and injection vaporizer cannot be used in calibration
mode.)
Don’t change the flow rates during calibration

PROHIBITED
(Changing the applicable flow rates of a gas during flow rate sensor calibration
will make it impossible to perform correct calibration. It will cause errors in
injection vaporization unit concentrations and prevent the flow rate ratio alarm
from operating correctly.)
Do not use if calibration of the flow rate sensor failed

PROHIBITED
Be aware of flow rate setting errors

WARNING
(The flow rate setting affects injection vaporizer performance. Make periodic
checks and calibrate as needed.)
５－13
(4) Settings
[Fig.5-29]
* Operable in both BAG and VENT modes.
The KEY-sound, LCD Backlight, Date,
Initial value, Language, Backup
ventilation, Hospital defaults settings
can now be made.
“MENU” button ⇒Multi-item selector
button D ⇒Set
(4-1) KEY-sound
The operation and the check tones heard when turning the dial or pushing buttons can be turned
on/off.
a) Align the cursor on “KEY-sound”, press the dial. Turn the dial to select ON or OFF and press the
dial again.
b) When finished, align the cursor on “RETURN” and press the dial or press the MENU button on
(4-2) LCD Backlight
The monitor brightness is adjustable in 8 levels(bar graph)display.
a) Align the cursor on LCD Backlight and press the dial. The bar graph switches from white to
yellow and turning the dial increases or decreases the bar graph to change the brightness of the
monitor. After setting the desired brightness, press the dial again. This time the bar graph returns
to a white display.
b) When finished, align the cursor on “RETURN” and press the dial or press the “MENU” button on
(4-3) Date
The 5 items: Yr. Mo. Dy. Hr. Mn. can be changed here.
a) Align the cursor on “Date” and press the dial. Turn the dial to select the item you want to set (Yr.
Mo. Dy. Hr. Mn.) and then press the dial.
b) Turn the dial, to change to the numeric value you want, and then press the dial again.
c) When finished setting the desired items, align the cursor on “SET” and press the dial.
d) When finished, align the cursor on “RETURN” and press the dial or press the “MENU” button on
(4-4) Initial value
Select the setting you want at machine startup here.
a) Align the cursor on “Initial value” and press the dial. Turn the dial and select “Hospital defaults”
or“Last end values”and press the dial again.
*To find information on Hospital defaults, see the setting method described later.
５－14
(4-5) Language
Here you can set the display language to show on the monitor.
a) Align the cursor on “Language” and press the dial. Turn the dial and select “Japanese” or
“English” and press the dial again.
(4-6) Backup ventilation
Here, you can set the APNEA Backup ventilation (“Insp. press”, “Rate”, “Insp. time”, “standby time”).
a) Align the cursor on any one of the “Insp. press”, “rate”, “Insp. time”, “standby time” and press the
dial. Turn the dial, set the desired numeric value and press the dial again.
(4-7) Set the hospital defaults
At device startup, selecting Hospital defaults [Fig.5-30]
settings allows setting and saving the
following items for each respiratory mode.
However these items can only be set and
saved during BAG mode.
a) Align the cursor on “Hospital defaults
settings” and press the dial.
b) The cursor shifts to “START” and
pressing the dial once again switches the screen display to show the respiratory mode and the
settings and alarm settings for each respiratory sub-mode.
c) Turn the dial and change the desired respiratory mode, and the setting and alarm setting for
each respiratory mode to the desired new numeric value and press the dial again.
*To change each setting, turn the dial, align the cursor on the desired item, press the dial to
make that setting, turn the dial to change the numeric value, and press the dial to set a new
numeric value. Repeatedly enter the numeric values as needed.
*Align the cursor on ”Copy current setting” and press the dial to copy the currently set respiratory
mode and the settings and alarm settings for that respiratory mode.
d) After setting or checking the required item, align the cursor on “Save” and press the dial. When
the message “Saved” appears (blue), the settings changed up till then are now saved.
e) When finished, align the cursor on “RETURN” and press the dial or press the “MENU” button on
the right side of the control panel to return to the BAG mode screen.
５－15
MEMO
Chapter 6 Operating Checks and Inspections
Make the operating check while following the

CAUTION
"Before—During—After-Use inspection items”
(Make each prep check & pre-use operating check, in-use operating check,
and after-use operating check according to the inspection tables. This is
extremely important for ensuring correct machine operation and safety the
next time the equipment is used.)
* See Chapter 15.
[1] Check the supply of gas

In-hospital gas supply pipe pressure
Check that the respective supply pipe pressures for the O2, N2O and air to the anesthetic unit are
within “350 to 500kPa”. The chemical term for oxygen, namely O2 and the chemical term for nitrous
oxide, namely N2O are used from here onwards for simplicity and to match the nomenclature on the
device controls, etc.
Cylinder pressure
Check the O2 and N2O (and air: option prior to factory shipment) on each cylinder pressure gauge.
(1) Aux. O2 cylinder
Fully open the valve on the Aux. O2 cylinder and check that the pressure is “50×100kPa” or more.
After checking, securely tighten the Aux. O2 cylinder valve.
(2) Aux. N2O cylinder
Fully open the valve on the Aux. N2O cylinder and check that the pressure is “40×100kPa” or more.
After checking, securely tighten the Aux. N2O cylinder valve.
(3) Aux. Air cylinder (option prior to factory shipment)
Fully open the valve on the Aux. Air cylinder and check that the pressure is “50×100kPa” or more.
After checking, securely tighten the Aux. Air cylinder valve.
In-hospital gas supply pipe Cylinder pressure
AIR N2O O2 N2O O2

[Fig.6-1]
Shut the Aux. cylinder valve if using gas from the in-
WARNING
hospital gas supply pipe
(If the Aux. cylinder valve is left open, the gas will be used up and no longer
6－1
【Replacement periods for Aux. cylinders】
a) Aux. O2 cylinder
Prepare a replacement Aux. O2 cylinder when the needle on the O2 cylinder pressure gauge
falls to “50×100kPa” or below.
b) Aux. N2O cylinder
When the needle starts to fall below the first value shown on the gauge (needle is below
“40×100kPa”) then there is almost no gas remaining in the cylinder. Immediately prepare a
replacement cylinder.
c) Aux. Air cylinder
Prepare a replacement Aux. Air cylinder when the needle on the air cylinder pressure gauge
falls to “50×100kPa” or below.
Take adequate precautions against “residual gas” in

WARNING the Aux. cylinder
[2] Checks when turning power on

(1) “Turn on” the Power switch, and if the STBY/ON indicator on the control panel switches from
flashing orange to fully on then press the STBY/ON switch.
[Fig.6-2] Power switch
STBY/ON
indicator
STBY/ON
switch
[Fig.6-3]
(2) The STBY/ON indicator changes to

green, and a self-diagnostic screen Operating status
display
(including the date/time, production
No., each program version, Driving
STBY/ON
gas pressure status and switching indicator
valve position) appears on the monitor.

Check that the startup screen (BAG
mode) appears after a few seconds.
[Fig.6-4]
6－2
(3) Check the device power status shown on the right side of the monitor [Fig.6-5]
panel is displaying a battery charging (CHARGE) state.
* The battery charging indicator turns off when the battery is fully
charged.
CAUTION Replace with a new battery if the battery operating

time drops sharply or otherwise replace every “2
years”
(4) Check the total accumulated device usage time on the

elapsed time counter on the rear of the unit. The reading at this
Elapsed time indicator
time should be within “5,000 hours”.
[Fig.6-6]
Periodic inspections and overhauls

CAUTION (To maintain performance schedule the device for periodic inspections “once a
year” or every “1,000 hours”.)
* Schedule an overhaul for the device “once every 5 years” or every “5,000
hours”.
[3] Check the flowmeter

(1) Select the gas
(1-1) Check that you can switch to N2O or air by
pressing the select button on the flow rate
meter display panel.
(1-2) Check that O2 and air flows but that there is
no flow of N2O when the power is “off” (it is
shutoff). Select the gas
* O2 always flows regardless of whether power [Fig.6-7]

is “on or not”.
6－3
(2) When fully open
Turn each of the O2, N2O, and air Flow rate control knobs
fully “counterclockwise” to fully open the flow rate adjuster
valve. Check that the float on the flow rate meter rises to
10L/minute or more.
* Select either N2O or air.
Flow rate meter
[Fig.6-8]
(3) When fully closed

Turn each of the O2, N2O, and air Flow rate
control knobs fully “clockwise” to fully close
the flow rate adjuster knob. Check that the
flow returns to the lowest position at this time Flow rate adjuster
knob
and the gas is fully shutoff.
* Select either N2O or air.
[Fig.6-9]
PROHIBITED
drying
[4] Check device safety

(1) O2 and N2O interlocking gear
(1-1) Press the N2O select button to select N2O.
(1-2) Start an O2 flow at a rate of “1.5L/minute”, and a N2O flow at a rate of “3.5L/minute”.
(1-3) Turn the N2O flow rate adjuster knob “counterclockwise” to increase the flow rate. Check that
the interlocked O2 flow rate adjuster knob also automatically turns to increase the flow rate.
(1-4) Turn the O2 flow rate adjuster knob “clockwise” to decrease the flow rate. Check that the
interlinked N2O flow adjuster knob also automatically turns to decrease the flow rate of N2O.
6－4
(2) Low O2 supply pressure alarm and N2O shutoff device
(2-1) Make the O2 and N2O flow at about “3L/minute”.
(2-2) Remove the O2 Pressure tube from the in-hospital gas supply pipe.
(2-3) Check that the alarm (whistle: Low O2 supply pressure alarm) sounds and that the N2O is shut
off (the N2O shut off device operates).
(2-4) Check that the alarm (whistle) sounds when the O2 Pressure tube is attached and that the N2O
flows.
(3) N2O cutoff (when there is no interlock gear)
(3-1) Check that in a state where no O2 flows (“0.1L/minute” or less) there is also no N2O flow even if
the N2O flow adjustor knob is turned “counterclockwise”.
(3-2) Check that when the O2 is “0.1L/minute” or less that the flow of N2O is shut off.
a) Start the O2 flowing at “0.1L/minute” or more and the N2O flowing as well.
b) Check that when the O2 is set to less than “0.1L/minute”, the safety equipment activates: to
display a flow gas ratio alarm, to sound an alarm, and to shut the N2O shut off in sequence on
the monitor panel on the control box.
[5] Check the O2 flush

The O2 flush must function correctly.
* If an anesthesia mask is connected to the tip of the Y piece of the respirator circuit set (coil hose
set) then remove that mask and insert the Y piece tip into the test adapter in the upper part of the
relief valve on the upper section of the canister to seal it.
(1) Set the BAG-VENT Selector cock to “BAG”.
(2) Close the APL valve.
(3) Press the O2 flush button.
(4) Check that the breathing bag swells up and that O2 is supplied.
[Fig.6-10] [Fig.6-11]
APL valve
O2 flush button
BAG-VENT
Selector cock
Gas outlet
Breathing bag
6－5
[6] Make a respiratory circuit check
At a pressure level of “30 hPa”, the drop in pressure when the supply of gas was stopped
(flow rate of zero) for a “30 second period” shall be lower than “5 hPa”.
The following method complies with the “Anesthesia apparatus startup inspection” issued by the
Japanese Society of Anesthesiologists.
* This “Anesthesia apparatus startup inspection” can be viewed on the homepage of the Japanese
Society of Anesthesiologists (http://www.anesth.or.jp/safety/guideline.html)
(1) General method
a) Insert the tip of the Y piece attached to the Y piece
respiratory circuit into the test adapter of Relief valve
the relief valve on the upper section of the

Circuit pressure
canister to seal it. If an anesthesia mask is gauge
connected to the Y piece tip then remove it.
Inspiiratoru
b) Close the APL valve. port
APLvalve
c) Open the O2 flow adjuster knob and set the
O2 flow to “5L/minute”. Close the other Flow
rate control knobs.
d) Allow the breathing bag to swell up to a
pressure level of “30 hPa”.
e) Apply pressure to the breathing bag by expiratory port
hand, setting to a pressure of “40 to 50

hPa”.
Leaks and poor couplings can be detected
at this time if the following occurs.
・The pressure will drop at this time if there
is a large leak.
・The coupling will come off at this time if Breathing bag
[Fig.6-12]
loose.
f) Release your handhold on the breathing bag, returning the pressure to “30h Pa”.
g) Set the O2 flow rate to “0L/minute”, and let stand for about a “30 seconds” period. Check that the
pressure drop is less than “5hPa” or less,
* In some cases, the pressure may be higher than a specified figure or show no rise due to the
state of the breathing bag (drop in elasticity from deterioration, etc.).
(2) Testing for leakage with a low flow rate
a) Close the APL valve.
b) Connect the Y piece tip of the respiratory circuit to the connection port on the breathing bag
with a hose.
* No special hose is supplied with the unit so please utilize an available hose for the test.
c) Open the O2 flow rate adjuster knob and set the flow to “0.1 L/minute”. Close the other flow
adjuster knobs at this time.
d) Check that the needle on the Circuit pressure gauge is “30 hPa” or more.
6－6
Don’t take your eyes off the circuit internal pressure gauge
PROHIBITED
(If the circuit is normal no leaks will appear in the respiratory circuit leak test so
the internal pressure gauge will break if the test is left to run on its own.)
e) After confirming the status in d), quickly restore the O2 flow rate to “0Ｌ/minute”. This test allows
judging that at a pressure of “30hPa” any leaks from the flow rate adjuster valve throughout the
entire respiratory circuit are less than “0.1L/minute”.
* However, the method in (2) alone cannot detect leaks in the breathing bag itself or the resp bag
coupling so use it along with the method in (1).
f) When the test is finished, restore the connections to the state prior to the inspection.
* Large leakage can cause break or coupling defects in plastic portions of the respiratory circuit,
deterioration of the intake valves and canister chamber packing or constriction of the CO2
absorbent.
Connect the respiratory circuit to the patent AFTER

CAUTION first making “the leak test”
[7] Checking the O2 concentration meter and calibrating the O2 sensor

Checking the O2 concentration meter
Check that numerals are displayed on the O2 concentration display at the [Fig.6-13]
upper right on the monitor.
Calibrating the O2 sensor
The O2 sensor is calibrated from the control panel.
To find O2 sensor attachment (replacement) methods, see “[3] O2 sensor
attachment and cable connections in Chapter 4 Pre-usage Preparation”.
To find calibration methods, see “[5] Operating from the MENU in Chapter
5 Control panel operating methods”
* An “OK” might not always be displayed in the first calibration right after
replacing a portion of the sensor with a new component. If that happens
then repeat the calibration several times.
* If an“NG”appears
An NG may indicate that the sensor section is deteriorated or defective, the O2 sensor unit cable is
not connected or is broken, or the O2 sensor cable connection port (connector within canister) is
defective, etc.
Please repair or replace with a new component, or reconnect correctly and then recalibrate.
(Just to be certain, try recalibrating with the old component before replacing with a new one.)
* If the sensor section is deteriorated or defective but a new replacement sensor is not available then
use as is while in that state (still inserted into canister) with that sensor.
In such cases always use an eternal O2 concentration meter.
At this time, always remove the O2 sensor unit cable from the connector within the canister. Unless
this connector is removed, the O2 concentration will still remain displayed on the monitor. An “O2
sensor communication error alarm” is activated if the O2 sensor unit cable is removed from the
connector within the canister during use.
6－7
Be sure to use an O2 concentration meter
WARNING (If the O2 sensor has poor performance or is defective and a substitute O2
sensor is not available, then use another O2 concentration meter as
specified in “JIS T 7203”.)
* Using the Anesthesia apparatus as is, without an O2 concentration meter
will cause problems with monitoring the patient.

WARNING
(Do not pull forcefully on the unit cable when calibrating the O2 sensor unit.
This may cause wire breakage or disconnections within the cable or
connector wiring. Broken or disconnected wiring will prevent correct
measurement.)
Removing the O2 sensor from the respiratory circuit (O2 sensor connection port)
NOTE
will cause leaks in the respiratory circuit.
If the O2 sensor was replaced, enter the date that usage was started with a
NOTE
ballpoint pen or similar item.
[8] Checking the vaporizer unit

Check the injection start and stop operation
(1) Check that the bottle adapter for holding the anesthesia bottle: for
[Fig.6-14]
sevoflurane (or isoflurane: sold separately) is installed in the bottle
adapter mounting section of the operating panel.
6－8
(2) Holding down the injection vaporizer start-stop button for “3 seconds” or more displays a “INJ
START Preparation” on the alarm-message display in the monitor that flashes for a while and then
turns off. Check that the previous valve on the measurement section of the display is
simultaneously reset to “0” and the new consumption quantity is being measured.
Injection vaporizer [Fig.6-16]

start-stop button
[Fig.6-15]
(3) Turn the anesthesia gas concentration (Conc.)

dial and check that the numbers on the Anesthesia gas
Conc. indicator
indicator of the anesthesia gas conc. indicator
are changing.
Anesthesia gas
Conc. dial
[Fig.6-17]
(4) Hold down the injection vaporizer start-stop button for “3 seconds” or more. An “INJ END
Preparation” message starts flashing on the alarm-message display in the monitor of the control
panel, and orange line segments appear “ ” in a clockwise rotating display in the anesthesia
gas conc. indicator. This orange“ ”display disappears after a while and the ignition vaporizer
stops. The alarm-message display also turns off. Check that measurement of anesthesia gas
consumption in the measurement section of the display also stops at the same time.
Injection vaporizer [Fig.6-19]

start-stop button
[Fig.6-18]
Always stop the injection vaporizer after use

CAUTION (Allowing the operating state to continue as is for long periods will cause
used.)
6－9
Check the gas flow rate measurement
(1) Check that “0.00” is displayed on the N2O/air flow
rate indicator and on the O2 flow rate indicator,
and that air selection indicator (green) is lit up.
Select the gas

[Fig.6-20]
(2) Start both the O2 and air flowing and check that the values
shown on the glass tube flow rate meters match the values on
the flow rate indicators (O2, N2O/air) located above the glass
tube flow rate meters. After checking the air, switch to N2O and
carry out the same check. Flow rate indicators
If the glass tube and indicator values don’t match each other Check that values on flow rate indicators
and glass tube meters match each
then calibration (See “[10] Calibrating the flow rate sensor” other.
shown below) is required. Glass tube meters
* N2O and air cannot both flow at the same time so check both
these gases by switching as needed.
[Fig.6-21]
Be aware of “flow rate setting” errors

CAUTION (The flow rate setting affects injection vaporizer performance. Make periodic
checks and calibrate as needed.)
Check the safety equipment

(1) Be aware that the injection vaporizer will not “operate” under the following situations even in the
injection vaporizer start-stop button is pressed.
a) When no bottle adapter is attached
b) When the vaporizer concentration dial is “ON” while an Acoma vaporizer MK-5i/s or another
company’s vaporizer is attached.
* The bottle coupling alarm (when at: a) or the injection vaporizer malfunction alarm (when at: b)
activates at this time.
The injection vaporizer will not operate unless the

CAUTION concentration adjuster dial on the vaporizer is “OFF”
6－10
[9] Check the alarm functions
Check that each alarm functions correctly
The alarms are set from the control panel.
To find how to set the alarms, see “[4]Set the alarm, check the history in the Chapter 5 Control panel
operating methods”.
(1) Power failure alarm (mid-level priority:yellow)
Removing the power plug from a socket while this device is operating will make the alarm-message
display on the monitor in the control panel shift to a yellow “Power Failure” display, and a flashing
alarm mark (bell) appear on the operation status display and sound an alarm. Check that the
yellow alarm indicator is flashing at this same time.
Also check that the “AC power indicator” in the power status display on the right side of the control
panel is turned off, and the battery remaining power indicator (4-stage “ ”mark) lights up.
Check that pressing the Alarm pause button stops the alarm sound, and that an Alarm pause
mark(bell X) is flashing on the operation status display. Reinsert the power plug into the socket.
The “Power Failure” and the Alarm pause button will now turn off, check that the yellow alarm
indicators is off and that the power status display on the control panel returns to its original state.
If the power failure alarm does not operate then have

CAUTION the system promptly repaired or overhauled
CAUTION Replace with a new battery if the battery operating

time drops sharply or otherwise replace every “2
years”
(2) INJ Bottle connection alarm (mid-level priority:yellow)

Pressing the injection vaporizer start-stop button with no bottle adapter attached will make the
alarm-message display on the monitor in the control panel shift to a yellow “INJ Bottle connection”
display and a flashing alarm mark (bell) appear on the operation status display and sound an alarm.
Also check that the yellow alarm indicator is flashing at this same time.
Check that the “Bottle coupling” display turns off after “5 seconds”, that the alarm sound stops, and
that the yellow alarm indicator turns off.
(3) INJ vaporizer nonusable alarm (mid-level priority:yellow)
Check that setting the concentration adjuster dial on the vaporizer to “ON” and pressing the
injection vaporizer start-stop button make the alarm-message display on the monitor in the control
panel shift to a yellow “INJ vaporizer nonusable alarm” display, and a flashing warming mark (bell)
appear on the operation status display and sound an alarm. Also check that the yellow alarm
indicator is flashing at this same time.
Check that the “INJ vaporizer nonusable alarm” display turns off after “5 seconds”, that the alarm
sound stops, and that the yellow alarm indicator turns off.
6－11
(4) INJ bottle empty alarm (high level priority:red)
Connect a bottle adapter having no anesthesia bottle attached to it and press the injection
vaporizer start-stop button to make the alarm-message display on the monitor in the control panel
shift to a red “INJ bottle empty” display simultaneously with the ending of “INJ START Preparation”,
and show a flashing alarm mark (bell) on the operation status display and sound an alarm. Check
that the red alarm indicator is flashing at this same time.
Also check that even pressing the Alarm pause button does not stop the alarm sound.
Check that the pressing the injection vaporizer start-stop button starts the “INJ bottle empty”
display turns off simultaneously with the start of “INJ END Preparation”, “and that the alarm sound
stops and the red alarm indicator turns off.

WARNING (Do not remove just the anesthesia bottle with the bottle adapter still attached to
the main unit, Doing this will cause air to enter the device piping and activate the
empty bottle alarm.)
(5) INJ excessive setting alarm (mid-level priority:yellow)

Set the anesthesia gas concentration to “5%”, and set the fresh gas flow rate to “18L/minute”.
The alarm-message display on the monitor in the control panel shifts to a yellow “INJ excessive
setting”, and a flashing alarm mark (bell) appears on the operation status display and an alarm
sounds.
Also, check that the yellow alarm indicator is flashing at this same time.
Also check that the alarm sound does not stop even if the Alarm pause button is pressed.
Lower the anesthesia gas concentration or lower the fresh gas flow rate. Confirm that this action
turns off the “INJ excessive setting” display, the alarm sound stops, and the yellow alarm indicator
turns off.
(6) Fresh gas flow excessive alarm (mid-level priority:yellow)
Open the O2 flow rate adjuster knob to the maximum and set the O2 flow to “10 L/minute”.
The alarm-message display on the monitor in the control panel at this times shifts to a yellow “fresh
gas flow excessive” display, and “- - - L/min” flashes on the O2 flow rate indicator, and the alarm
sounds. Check that the yellow alarm indicator is flashing at this same time.
Also check that the alarm sound does not stop even if the Alarm pause button is pressed.
Now set the O2 to “10L/minute” or less. Check that this action turns off the “fresh gas flow
excessive” display; that the O2 setting appears on O2 flow rate indicator; that the alarm sound stops,
and that the yellow alarm indicator turns off.
(7) Fresh gas ratio alarm (high level priority:red)
Set the O2 flow to “0.4L/minute” and the air flow to “2.5L/minute”.
When this state continues for “2 seconds” or longer, the alarm-message display on the monitor in
the control panel at this time shifts to a red “fresh gas ratio” display, and a flashing alarm mark
(bell) appears on the operation status display and an alarm sounds. Also check that the red alarm
indicator is flashing. Also check that the alarm sound does not stop even if the Alarm pause button
is pressed.
Set the air to “1L/minute”. Check that this action turns off the “Fresh gas ratio”, stops the alarm
sound, and turns off the red alarm indicator.
6－12
Be aware of the nitrous oxide flow rate (non-attached
WARNING
interlocking gear:option when shipped from factory)
(This device does not have an interlock mechanism for mechanically regulating
the nitrous oxide (N2O) flow. Therefore, when O2 flows at “0.1Ｌ/minute” or
more, then nitrous oxide can also be supplied. However the flow rate alarm will
activate when the O2 flow is higher than a specified ratio.)
(8) O2 flow shortage alarm (mid-level priority:yellow)

Remove the O2 sensor unit and exhale onto it or use other means to reduce the O2 state to below
18%.
The O2 flow rate indicator and the alarm-message display on the monitor in the control panel at this
time shifts to a yellow “O2 flow shortage” display, a flashing alarm mark (bell) appears on the
operation status display and an alarm sounds. Check that the yellow alarm indicator is flashing at
this same time.
Check that pressing the Alarm pause button stops the alarm sound, and that the alarm mark shifts
to a flashing Alarm pause mark(bell X).
Afterwards, leave the O2 sensor unit in the outside air.
Check that the alarm stops and that the yellow alarm indicator turns off.
(9) O2 concentration lower limit alarm (high level priority:red)
Set the O2 concentration lower limit value to “25%”.
Start the O2 flowing and at the point in time that the “O2 concentration” on the O2 concentration
display exceeds “30%”, remove the O2 sensor from the respiratory circuit and let stand for a few
minutes in the outside air.
When the O2 concentration falls below “25%”, the alarm-message display on the monitor in the
control panel at this time shifts to a red “O2 conc. LOW”, and a flashing alarm mark (bell) appears
on the operation status display, and an alarm sounds. Check that the red alarm indicator is flashing
at this same time.
to a flashing Alarm pause mark (bell X).
(If the O2 concentration falls further below “18%”, then “O2 conc. LOW” again appears on the
alarm-message display and the alarm sounds. The alarm will not stop at this time even if the Alarm
pause button is pressed.)
Reattach the O2 sensor unit to the respiratory circuit. Check that the when the O2 concentration
exceeds “25%”, the “O2 concentration lower limit”, the Alarm pause mark and the red alarm
indicator turn off.
(10) O2 concentration upper limit alarm (mid-level priority:yellow)
Set the O2 concentration upper limit to “40%”.
Start the O2 flowing and when the “O2 concentration” on the O2 concentration display exceeds
“40%”, the alarm-message display on the monitor in the control panel at this time shifts to a yellow
“O2 conc. HIGH” display, and the alarm mark (bell) flashes on the operation status display, and the
alarm sounds. Check that the yellow alarm indicator is flashing at this same time.
Remove the O2 sensor from the respiratory circuit and when the O2 concentration falls below “40%”,
check that the “O2 conc. HIGH”, the Alarm pause mark, and the yellow alarm indicator turn off.
6－13
(11) O2 sensor Not connected alarm (mid-level priority:yellow)
Remove a segment of the sensor from the O2 sensor unit.
The alarm-message display on the monitor in the control panel at this time shifts to a yellow “O2
sensor Not connected” display, and the alarm mark (bell) flashes on the operation status display,
and the alarm sounds. Check that the yellow alarm indicator is flashing at this same time.
Also check that pressing the Alarm pause button stops the alarm sound, and that the alarm mark
shifts to a flashing Alarm pause mark (bell X).
Reattach the segment of the sensor to the O2 sensor unit.
Check that this action turns off the “O2 sensor Not connected” display, and Alarm pause mark, and
yellow alarm indicator.
(12) Drive gas pressure alarm (high level priority:red)
After checking that the ventilator Driving gas is either O2 or air, remove the applicable Pressure
tube connector from the in-hospital gas supply pipe.
The alarm-message display on the monitor in the control panel at this time shifts to a red “Drive gas
pressure” display, and the alarm mark (bell) flashes on the operation status display and the alarm
sounds. Check that red alarm indicator is flashing at this same time.
Check that alarm sound does not stop at this time even if the Alarm pause button is pressed.
Reconnect the Pressure tube connector you removed back onto the in-hospital gas supply pipe.
This action turns off the “Drive gas pressure”, the alarm mark, and the red alarm indicator. Also
check that the alarm sound turns off.
(13) O2 gas pressure alarm (high level priority:red)
Remove the O2 Pressure tube connector from the in-hospital gas supply pipe.
The alarm-message display on the monitor in the control panel at this time shifts to a red “O2 gas
pressure” display, and the alarm mark (bell) flashes on the operation status display and the alarm
sounds. Check that red alarm indicator is flashing at this same time.
Reconnect the Pressure tube connector you removed back onto the in-hospital gas supply pipe.
This action turns off the “O2 gas pressure”, the alarm mark, and the red alarm indicator. Also check
that the alarm sound turns off.
(14) Low inspiratory pressure alarm (high level priority:red)
Set the low intake pressure to a value higher than the Peak circuit pressure.
If the low intake setting value is not reached within a waiting time (15 seconds), then the alarm-
message display on the monitor in the control panel at this time shifts to a red “Pressure LOW”
inspiratory pressure alarm” display, and the alarm mark (bell) flashes on the operation status
display and the alarm sounds.
Check that the alarm indicator is flashing in red at this same time.
Set the low inspiratory Insp. Press. to a lower value than the Peak circuit pressure. Check that this
action turns off the “Pressure LOW” and Alarm pause mark, and the red alarm indicator during the
next air intake.
(15) Excess pressure alarm (high level priority:red)
Set the excess pressure to a value lower than the Peak circuit pressure.
When the excess Insp. Press. value is reached during air intake, the alarm-message display on the
monitor in the control panel at this time shifts to a red “Pressure HIGH” display, or the alarm mark
(bell) flashes on the operation status display and the alarm sounds.
Check that the alarm indicator is flashing in red at this same time.
6－14
After checking the above, set the excess pressure to a value higher than the Peak circuit pressure.
Check that this action turns off the “Pressure HIGH” and alarm mark, and the red alarm indicator
during the next air intake.
Set both the low intake pressure alarm level and excess
WARNING pressure alarm level to a value near the maximum intake
pressure
●Setting the low intake pressure too low will prevent the alarms from operating
even if there is a leak from the respiratory circuit.
●Setting the excess pressure too high might cause pressure damage to the
lungs.
(16) Inspiratory pressure alarm (mid-level priority:yellow)

In VENT mode set the PCV (settings: intake pressure : 15hPa intake flow rate : 5L/min, rate :
12bpm, I : E ratio : 1:2, PEEP:0hPa)
After several respiratory cycles (breaths), the alarm-message display on the monitor in the control
panel at this time shifts to show a yellow “Insp. pressure” display, and the alarm mark (bell) flashes
on the operation status display and the alarm sounds.
Check that the alarm indicator is flashing in yellow at this same time.
Set the intake flow rate to 15L/minute or more (AUTO also allowable) so that the pressure
waveform on the monitor reaches the Insp. Press. during intake. Check that this action turns off
the “Insp. pressure”, and alarm mark, and the yellow alarm indicator. Also check that the alarm
sound turns off.
(17) Setting error alarm (high level priority:red)
Set the flow rate to exceed “80L/minute”.
The alarm-message display on the monitor in the control panel at this time shifts to a red “Setting
error” display, and the alarm mark (bell) flashes on the operation status display and the alarm
sounds. Check that the alarm indicator is flashing in red at this same time.
Set the flow rate to reach “1 to 80L/minute”. Check that this action turns off the “Setting error”
display and alarm mark, and the red alarm indicator. Also check that the alarm sound turns off.
Do not continue operation using incorrect alarm
PROHIBITED
settings
(This prevents obtaining a correct tidal volume and I/E ratio, etc.)
(18) Apnea alarm (high level priority:red)

If the time until spontaneous respiration (trigger) is not reached within a preset time during PSV,
then the alarm-message display on the monitor in the control panel at this time shifts to a red “No
respiration” display and the alarm mark (bell) flashes on the operation status display and the alarm
sounds. Check that the alarm indicator is flashing in red at this same time.
Also check that the backup ventilation (initial settings are: intake pressure “10hPa”, rate “10bpm”,
inspiration time “1.5 seconds”) is carried out at this time.
Induce spontaneous respiration so as to reach the trigger level. Check that taking this action turns
off the “No respiration” display and Alarm pause mark, and the red alarm indicator.
6－15
(19) O2 sensor communication error alarm (high level priority:red)
Open the O2 sensor attachment section on the respiratory circuit (canister) and remove the
connector from the O2 sensor unit cable. (Wait approximately 1 minute after removing the O2
sensor unit cable.)
The alarm-message display on the monitor in the control panel at this time shifts to a red “O2
sensor communication error” display, and the alarm mark (bell) flashes on the operation status
display and the alarm sounds. Check that the alarm indicator is flashing in red at this same time.
Reattach the O2 sensor unit cable to the connector. Check that after approximately 10 seconds the
“O2 sensor communication error” display and Alarm pause mark and the red alarm indicator turn off.
(20) MV upper limit alarm (mid-level priority:yellow)
Check the actual measured MV, and set the MV upper limit to a figure lower than the actual
measured MV.
panel at this time shifts to show a yellow “MV HIGH” display, and the alarm mark (bell) flashes on
the operation status display and the alarm sounds. Check that the alarm indicator is flashing in
yellow at this same time.
Set the MV appear limit to a figure higher than the actual measured minute ventilation. Check that
taking this action turns off the “VE upper limit” and Alarm pause mark, and the yellow alarm
indicator.
(21) MV lower limit alarm (mid-level priority:yellow)
Check the actual measured MV, and set the MV lower limit to a figure higher than the actual
measured MV.
panel at this time shifts to show a yellow “MV LOW” display, and the alarm mark (bell) flashes on
the operation status display and the alarm sounds. Check that the alarm indicator is flashing in
yellow at this same time.
Set the MV lower limit to a figure lower than the actual measured minute ventilation. Check that
taking this action turns off the “MV LOW” and Alarm pause mark, and the yellow alarm indicator
(22) Alarm sound pause-restore (during “2-minute” period setting)
Activate the low inspiratory pressure alarm during VENT (auto respiration) mode. Check at this
time that the alarm mark (bell) flashes on the operation status display and the alarm sounds. Next
press the Alarm pause button and check that the alarm sound stops, the alarm indicator flashes,
and that the “120 seconds” display below the speaker mark counts downwards and that the alarm
sound is restored on reaching “0 seconds.”
Also check that pressing the Alarm pause button during counting down in the stop (pause) period,
returns to “120 seconds” again and starts counting down.
(23) Alarm volume level adjustment
Activate the low inspiratory pressure alarm during VENT (auto respiration) mode.
At this time, check that turning sound volume knob on the right side of the unit “clockwise”
increases the alarm sound. Also check that turning the knob “counterclockwise” decreases the
alarm sound but that the alarm sound can still be heard even if the knob is turned fully
counterclockwise.
6－16
WARNING enough to easily hear
[10] Calibrating the flow rate sensors

If the “float reading” does not match the “flow rate measurement” on the upper section of the flow rate
meter; or if E.E.E ”or “L.L.L” appear on the flow rate indicator, then the flow rate sensor requires
calibration.
The flow rate sensors are calibrated from the control panel.
To find calibration methods, see “[5] Operating from the MENU in Chapter 5 Control panel operating
methods”.
Don’t calibrate the flow rate sensors while using this

PROHIBITED
device
(The alarms, flow gauges, and injection vaporizer cannot be used in calibration
mode.)
Don’t change the flow rates during “calibration”

PROHIBITED (Changing the applicable flow rates of a gas during flow rate sensor calibration
will make it impossible to perform correct calibration. It will cause errors in
injection vaporization unit concentrations and prevent the flow rate ratio
alarm from operating correctly.)
Do not use if calibration of the flow rate

PROHIBITED
sensor failed
6－17
[11] Checking the ventilator
Confirm that each respiratory mode is operating correctly.
Make the ventilator settings from the control panel.
To find setting methods, see “[3] Ventilator settings in Chapter 5 Control panel operating methods”.
(1) After setting a arbitrary respiratory mode, set the BAG-VENT selector to “VENT”. Check
that the “intake operation” starts and the pressure waveform and measurements are displayed on
the monitor on the control panel.
At this time check that the“BAG” “ “ mark has changed to “VENT” “ “on the operation
status display.
[Fig.6-22]
[Fig.6-23]
BAG-VENT
selector
(2) Also check the other respiratory modes and set the required items.
(3) Check that actual measured values are shown for ventilation meter (ventilation/I/E ratio/minute
ventilation) and internal circuit pressure (MAX・EIP・AVE・PEEP).
* Items switchable in the circuit internal pressure will vary according to the respiratory mode and
PEEP setting.
* The circuit internal pressure (MAX) measurement is automatically displayed if an applicable item
cannot be displayed due to a setting change.
During VENT mode:
VCV mode PEEP setting: MAX / EIP / AVE / PEEP
PEEP no-setting: MAX / EIP / AVE
PCV / PSVmode PEEP setting: MAX / AVE / PEEP
PEEP no setting: MAX / AVE
During BAG mode: MAX / AVE
(4) Check that “Trigger” is displayed on the [Fig.6-24]
alarm-message display on the monitor and
respiratory operation starts when a preset
trigger level is reached during PSV (option
selected prior to shipment).
Trigger
6－18
[12] Check the vaporizer
Check that the vaporizer mounted in the unit operates correctly.
If using a vaporizer, check operation before attempting use.
* Always read the instruction manual and special attached materials when handling the vaporizer.
WARNING Before attempting to use the vaporizer always read the

instruction manual and special attached materials to fully
understand this device
6－19
MEMO
Chapter 7 Usage Methods
WARNING
During use keep the power plug connected and leave
impossible.)
Keep water or chemicals away from the unit

WARNING (This device is not water-proof or drip-proof so fluid or liquids might penetrate
into the unit and stop operation.)

PROHIBITED
fresh gas (mainly O2) still supplied to a recirculating
drying
moisture may cause fires, abnormal heat emissions, carbon monoxide
emission, or a possible loss of CO2 absorbance capability.)
Backup time with a fully charged internal battery is “30

CAUTION minutes”
* Battery charging requires at least “20 hours” or more.
[1] BAG mode

(1) Select either air or N2O. Holding down the gas select button
(air or N2O) for “3 seconds” or longer shifts the selection. The
injector of the selected gas (air or N2O) also lights up.
Gas select button
[Fig.7-1]
７－1
(2) Flow rate meter backlight
Set the flow rate meter backlight switch to “ON” if using the flow
[Fig.7-2]
rate meter backlight.
Flow rate meter

backlight
(3) Turn the gas flow rate adjuster knob of the O2 and the selected gas to set the required flow rate.
Set the flow rate according to the top (upper edge) of the float mark stamped on each flow rate
meter.
* If using an O2 extra flow rate meter (option prior to shipment) then set to float center on the
stamped line mark.
[Fig.7-3]
Adjust the
flow rate at
this position
Flow rate adjuster knobs
Float
[Fig.7-4]
Be aware of flow rate ratio setting errors when using

WARNING O2 and air
(This device has no interlock function to mechanically control the air flow rate.
So the wrong flow ratio could cause hypoexemia.)
NOTE When using the flow rate adjust knobs, start from O2 if increasing the flow
or start from N2O if decreasing the flow.
● If the pressure from the gas supply pipe falls (below “350kPa”) during use or the supply is cut off
then start using a support cylinder. To find methods for using the support cylinder, see “[9]
Support cylinder usage methods”
７－2
● Interlocking gear type flow rate meter
The design prevents N2O from flowing unless the O2 flows at “0.2L/minute” or more. A special
interlocking gear is used between the O2 and N2O flow rate adjuster valves to increase the fresh
gas O2 concentration as the total flow decreases.
(This links the O2 and N2O flow rates so that the intake O2 concentration does not fall below
“30%”. However this is at an O2 consumption of “0.2L/minute”, and N2O consumption of
“0.05L/minute”.)
The maximum flow rate of N2O that can be set depends on the O2 flow rate. This is because the
current O2 flow rate determines the maximum amount of N2O that can flow at that time.
When the O2 flow is “1L/minute”, the N2O can be made to flow at “2.2L/minute” and the fresh gas
O2 concentration will reach approximately “32%”.
In this state, lowering the O2 to “0.5L/minute” will prevent an N2O flow of more than “0.8L/minute”
but the fresh gas concentration will reach approximately “38%”.
So even if the fresh gas flow rate has lowered, the fresh gas O2 concentration can in this way be
raised to prevent hypoexemia in the low flow rate zone.
(4) Set the vaporizer to the required concentration
Select the injection vaporizer or vaporizer installed in the unit (sold separately).
To find methods for using the injection vaporizer see the following “[4] Using the injection
vaporizer.”
If the concentration adjuster dial on the vaporizer

WARNING mounted in the unit rotated during use of the injection
vaporizer then immediately stop usage
(Safety device built into the vaporizer mounting stand is defective. Promptly
request a repair from the manufacturer.)
If the injection vaporizer “operates” during vaporizer

WARNNG use then stop operation immediately
(The safety device in the main unit is defective. Promptly request a repair from
the manufacturer.)

WARNING instruction manual and special attached materials to
fully understand this device
(5) Set the alarm

Set the alarm from the control pane.
To find how to set the alarms, see “[4] Set the alarm, check the history in the Chapter 5 Control
panel operating methods”.
７－3
(6) Operate the breathing bag
Turn the APL valve while monitoring the circuit internalCircuit
pressure
internal to make the bag swell
pressure
appropriately.
APL
Inspiratory port valve
Expiratoryt
port
Breathing bag
[Fig.7-5]
(7) O2 flush
Press the O2 flush button as needed if an O2
flush is required.
O2 flush button
[Fig.7-6]
Use caution to prevent accumulated “trace gases”

CAUTION (In closed circulating anesthesia circuits & extremely low flow rate anesthesia
(fresh gas flow less than 1.0L/minute) carbon monoxide, acetone, ethanol,
nitrogen, and anesthesia metabolic products might accumulate within the
circuit used by the patient.)
* Wash away gas accumulated in the patient’s circuit at regular intervals by “O2
flushing” or other methods to “increase the fresh gas flow”.
Use caution to prevent accumulated water or fluids

CAUTION (Large amounts of water or fluid might accumulate within the patient circuit due
to low “fresh gas flow” or “anesthesia at low flow rates for long periods”. So
depending on the extent of the accumulation remove the circuit and empty
the water or fluids.)
Replace the CO2 absorbent promptly

CAUTION (Replace CO2 absorbent at an early stage since it is rapidly consumed in
closed circulating anesthesia circuits, and by low flow rate anesthesia.)
７－4
[2] VENT mode
* After making the above settings in [1]. (1) to (5) shift to the following procedure.
(6) Set the ventilator
Set the ventilator from the control panel.
To find setting methods, see “[3] Ventilator settings in Chapter 5 Control panel operating methods”.
(7) After checking the settings, set the BAG-VENT selector to
[Fig.7-7]
“VENT”. The BAG-VENT selector is located on the rear right
side of the canister.
BAG/VENT
selector
Carefully switch the BAG/VENT selector

CAUTION
(On the operation status display of the monitor, the background color is light

CAUTION shifting to “VENT mode”
and the flip the BAG/VENT selector.)
[3] O2 concentration meter

If connected to an O2 sensor, then
measurement of the O2 concentration
starts automatically and is shown on the
O2 concentration display section.
(1) To calibrate the O2 sensor, see “(2-1)
O2 sensor in [5] MENU operation on
the Chapter 5 Control panel operating
methods”. [Fig.7-8]
(2) Setting the device to standby and
turning the power off automatically ends measurement of the O2 concentration.
(3) Alarm
To find information on O2 concentration meter alarms, see “[4] Set the alarm, check the history in
the Chapter 5 Control panel operating methods”.
７－5
[4] Injection vaporizer usage methods
(1) To use the injection vaporizer, hold down the injection vaporizer start-stop button for “3 seconds”
or more. The message “Startup-Prep” appears on the alarm-message display on the monitor of the
control panel, and the anesthesia gas concentration indicator lights up, and startup preparation
begins.
Measurement of internally consumed anesthesia starts automatically.
[Fig.7-10]
Injection vaporizer
start/stop button
[Fig.7-9]
Startup preparation
Holding down the injection vaporizer start-stop button for “3 seconds” or more starts suctioning of
the anesthetic from the anesthesia bottle. The message “Startup-Prep” appears on the alarm-
message display on the monitor of the control panel.
This operation ends when the device is filled with anesthesia gas.
Holding down the injection vaporizer start/stop button again for “3 seconds” or more during
“Startup-Prep” stops the feed of anesthetic into the device and feeds it back to the anesthesia
bottle.
The injection vaporizer will not “operate” unless the

CAUTION
concentration adjuster dial on the vaporizer is “OFF”
Injection vaporizer automatically “stops” in “1 hour” if

CAUTION there is no O2 flow (“0.1 L/minute” or less)
* If using only air in the injection vaporizer then the injection vaporizer will
“stop” after “1 hour”.
* Holding down the injection vaporizer start/stop button for “3 seconds” or more
sets it to “start” again.
(2) Turn the anesthesia gas concentration dial Anesthesia concentration

adjuster dial
and set the required concentration.
* If set to a sevoflurane concentration of “5%”
or more or isoflurane concentration of “4%”
or more, then turn the anesthesia gas conc.
dial while pressing in.
[Fig.7-11]
７－6
Check the setting values if the anesthesia gas
CAUTION concentration was changed
(The setting value might not always change even if the anesthesia gas
concentration dial was turned. If the setting was changed then check that the
value shown on the anesthesia gas conc. indicator is the required value.)
(3) If the anesthesia bottle is empty then operate as shown below. Replace the anesthesia bottle
using the following procedure.
a) When the anesthesia bottle is “empty”
a-1) The fluid shortage (low fluid) alarm activates. (alarm sound can be turned off.)
Operation will continue for a while with anesthesia remaining within the vaporizer circuit. Prepare
a new anesthesia bottle during that time.
a-2) Hold down the injection vaporizer start/stop button for “3 seconds” or more. An “INJ End
Preparation” message appears on the alarm-message display in the monitor of the control panel,
and orange line segments appear “ ” in a clockwise rotating display on the anesthesia gas
concentration indicator. This orange“ ”display disappears after a while and the Injection
vaporizer stops. Remove the bottle adapter and replace the anesthesia bottle with a new one.
[Fig.7-13]
Injection vaporizer
start/stop button
[Fig.7-12]
a-3) Again mount the bottle adapter attached a new Bottle adapter
anesthesia bottle onto the main unit (bottle adapter
mounting port).
a-4) Hold down the injection vaporizer start/stop button for “3
seconds” or more.
Anesthesia bottle
[Fig.7-14]
７－7
b) When the anesthesia bottle inside vapor unit is “empty”
b-1) The alarm sounds again. (This time the alarm cannot stop.)
b-2) Hold down the injection vaporizer start-stop button for “3 seconds” or more. An “INJ END
Prepration” message appears on the alarm-message display in the monitor of the control panel,
and orange line segments “ ” appear in a clockwise rotating display in the anesthesia gas
conc. indicator. This orange“ ”display disappears after a while and the injection vaporizer
stops.
Afterwards, remove the bottle adapter and replace the anesthesia bottle with a new one.
* The preset anesthesia gas concentration cannot now be obtained since there now nearly no
anesthesia within the vaporizer.
b-3) Mount a bottle adapter with a new anesthesia bottle attached, onto the main unit (bottle
adapter coupling).
b-4) Hold down the injection vaporizer start-stop button for “3 seconds” or more.


a series of actions are completed. A maximum of about “1 minute” is
required.)
(4) To stop the injection vaporizer, hold down the injection vaporizer start-stop button for “3 seconds”
or more.
An “INJ END Preparation” message appears on the alarm-message display in the monitor of the
control panel, and orange line segments “ ” appear in a clockwise rotating display in the
anesthesia gas conc. indicator. This orange“ ”display disappears after a while and the injection
vaporizer stops.
[Fig.7-16]
Injection vaporizer
start-stop button
[Fig.7-15]
７－8
End-preparation
When the injection vaporizer start-stop button is pressed for “3 seconds” or more while the injection
vaporizer is operating or in standby, an operation starts to return the anesthesia within the device to
the anesthesia bottle. This is the “INJ END Preparation” operation.
This operation ends when the anesthesia within the device has returned the anesthesia bottle.
However when the injection vaporizer start-stop button is pressed for “3 seconds” or more during
this “INJ END Preparation”, the feed of anesthesia into the anesthesia bottle stops and is returned
back to the device. (also called “start-up prep”.)
CAUTION
Always stop the injection vaporizer after use
(Allowing the operating state to continue as is for long periods will cause
used.)
[5] Setting the ventilator

(1) Set the ventilator
Set the ventilator from the control panel.
To find how to set the ventilator, see “[3] Ventilator settings in Chapter 5 Control panel operating
methods”.
(2) Setting the alarm
Set the alarm from the control panel.
To find how to set the alarms, see “[4] Set the alarm, check the history in the Chapter 5 Control
panel operating methods”.
[6] Respiratory mode

PRO-NEXT+I includes 3 respiratory modes (also called breath modes) called “VCV” “PCV” and “PSV”
(PSV is an option set prior to shipment.)
(1) VCV mode
VCV or volume control ventilation is a forced ventilating mode (patient usually has no
spontaneous breathing) that feeds gas from the device and delivers it a preset Vti at a set rate.
VCV feeds the gas at the required Vti (amount of air taken in and expired during a breath) and so
offers the advantage that it can maintain a good ventilation or breath volume provided there are
no leaks in the circuit, etc.
This device is allows setting the Vti, plateau, rate, I/E ratio (breath intake vs. breath expiry) and
PEEP.
(2) PCV mode
PCV or pressure controlled ventilation is a forced ventilating mode that feeds gas from the device
at a preset “pressure” and maintains the flow at a preset pressure over a preset inspiratory (breath
intake) time and rate.
PCV has the advantage that gas is fed at a preset intake or inspiratory pressure so the internal
lung pressure or bronchial pressure never exceeds a preset value so damage to the lungs is
effectively prevented.
This device allows setting the inspiratory pressure, Vti, rate, I/E ratio (breath intake: breath expiry)
and PEEP.
７－9
(3) PSV mode
PSV or pressure support ventilation is a respiratory mode to feed gas from the device
synchronously with the patient’s own breathing effort. Gas is feed at a rate that the patients
themselves require. The flow volume fed to the patient is set by pressure.
Breaths initiated by the patient are sensed by a preset trigger, and the device feeds the gas so as
to arrive at a preset support pressure to the patient. The device functions so that a pressure limit
stops the flow of gas at the time a certain pressure is reached. Basically, the patient initiates every
breath and the PSV mode provides breathing support at a preset pressure value.
This device allows setting the support pressure, trigger, and PEEP.
Support pressure
When the support pressure is set to “0”, the both the intake and expiratory pressure operate at the
same CPAP (continuous positive airway pressure).
[7] Alarm description

The alarms operate under the
Alarm indicator
following conditions to display an
alarm-message display on the
monitor of the control panel and
generate an alarm sound.
When an alarm occurs, troubleshoot
it as specified and cancel the alarm.
alarm-message display [Fig.7-17]

(1) Power failure alarm
Cause: Alarm occurs when power to main unit was cut off due to power plug disconnection, broken
wires in the power cord, and power failure during operation by the STBY/ON switch.
Action: Restoring power cancels the alarm.
(2) INJ Bottle connection alarm
Cause: Alarm occurs when injection vaporizer was operated with no bottle adapter attached.
Action: Alarm is displayed and alarm sounds only for “5 seconds”. After that the alarm automatically
cancels.
(3) INJ vaporizer nonusable alarm
Cause: Alarm occurs when injection vaporizer was operated while no O2 was supplied, or the conc.
adjuster dial on the vaporizer was “ON”.
Action: Alarm is displayed and alarm sounds only for “5 seconds”. After that the alarm automatically
cancels.
(4) Liquid shortage alarm
Cause: Anesthesia bottle became empty while injection vaporizer was in “operation”.
Action: Setting the injection vaporizer to “Stop” (switching to “INJ END Preparation”) cancels the
alarm.
* This alarm also occurs when air bubbles get into the internal pipes and tubing during
attaching/removing the bottle adapter while the power switch is “OFF”.
If there is still some remaining anesthesia, then temporarily set to “Stop” and once again set to
“Start.”
７－10
(5) INJ Bottle empty alarm
Cause: Alarm occurs when no anesthesia was detected (no anesthesia) even at a specified inflow
in “INJ START Preparation”, or when there is no longer any anesthesia within the main unit
while the injection vaporizer is “operating”.
Action: Setting the injection vaporizer to “Stop” (switching to “INJ END Preparation”) cancels the
alarm.
* This alarm also occurs when air bubbles get into the internal pipes and tubing during
attaching/removing the bottle adapter while the power switch is “OFF”.
If there is still some remaining anesthesia, then temporarily set to “Stop” and once
again set to “Start.”
(6) INJ excessive setting alarm
Cause: Alarm occurs when the fresh gas flow rate is too large versus the anesthesia gas
concentration (occurs when fluid feed pump setting within injection vaporizer exceeded
“5mL/minute”).
Action: Correcting the setting cancels the alarm.
(7) Fresh gas flow excessive alarm
Cause: Gas flow rate exceeded flow rate sensor measurement range (“10L/minute” or more).
Action: Reducing gas flow rate below “10.0L/minute” cancels the alarm.
(8) Fresh gas ratio alarm
Cause: Alarm occurs when flow rate ratio (O2:N2O, O2:air) falls below a specified value.
a) In the case of O2+N2O:
This alarm occurs when after a “0.2L/minute” (adding N2O consumption of
“0.05L/minute”) flow compensation for O2 consumption, a state occurs where the N2O
flow rate exceeded a flow rate ratio capable of an O2 content of “28%” for “2 seconds”
or more.
b) In the case of O2+air:
This alarm occurs when after a “0.2L/minute” compensation for O2 consumption, the air
flow rate exceeded a flow rate ratio capable of an O2 content of “28%” for “2 continuous
seconds” or more. However, the air flow rate in this case is “3L/minute” or less.
Action: Setting a correct flow rate ratio cancels the alarm.
(9) O2 flow shortage alarm
Cause: a) Alarm occurs when the O2 flow rate dropped below “0.1L/minute” for “8 seconds” or
more while the N2O flow rate was “0.1L/minute” or more.
b) It also occurs when the O2 concentration dropped below “18%”.
Action: a) Setting the O2 to “0.1L/minute” or more cancels the alarm.
b) Setting the O2 concentration to“19%” or higher cancels the alarm.
(10) Fresh gas pressure too high alarm
Cause: Alarm occurs when shutting the gas outlet caused an extremely high pressure (“200hPa” or
more) within the device gas circuit.
Action: Lowering the pressure (below “100hPa”) cancels the alarm.
* During normal use, the pressure level is not high enough to trigger this alarm.
(11) Fresh gas flow sensor alarm
Cause: Alarm occurs when flow rate sensor calibration is incorrect or there is an abnormality
Action: Recalibrating the flow rate sensor cancels the alarm.
* If this alarm occurs then the device cannot be used at the current applicable flow rate. Extreme
care is needed when using the device at this time. Please calibrate the flow sensor.
７－11
(12) Low O2 supply pressure alarm (This alarm message is not displayed.)
Cause: Alarm occurs when O2 supply pressure has dropped to “250kPa”.
Action: Restoring O2 supply pressure to” 260kPa” or more cancels the alarm.
(13) O2 concentration lower limit alarm
Cause: Alarm occurs when O2 concentration dropped below “18 to 95%”.
Action: Raising O2 concentration above the lower limit cancels the alarm.
(14) O2 concentration upper limit alarm
Cause: Alarm occurs when O2 concentration setting was “30 to 100%” or higher.
Action: Lowering O2 concentration below the upper limit cancels the alarm.
(15) O2 sensor calibration failure alarm
Cause: Alarm occurs when sensor element in O2 sensor unit is deteriorated or defective.
Action: Replacing with a new sensor element and recalibrating cancels the alarm.
(16) O2 sensor Not connected alarm
Cause: Alarm occurs when sensor element of O2 sensor unit is not connected or is improperly
connected.
Action: Connecting the sensor element of O2 sensor unit cancels the alarm.
(17) Drive gas pressure alarm
Cause: Alarm occurs when the O2 or air (option set prior to shipment) serving as the Driving gas
has fallen below 280kPa.
Action: Raising the Driving gas (O2 or air) above “280kPa” cancels the alarm.
(18) O2 gas pressure alarm
Cause: Alarm occurs when O2 has fallen below “200kPa”.
Action: Raising the O2 above “200kPa” cancels the alarm.
(19) Low inspiratory pressure alarm
Cause: Alarm occurs when there is no pressure applied greater than the preset alarm level within
the preset time (15 or 30 seconds) .
Action: Applying pressure greater than the preset alarm level during the preset time cancels the
alarm.
(20) Excess pressure alarm
During VENT
Cause: Alarm occurs when internal circuit pressure during inspiratory reached a preset excess
level.
Action: Setting the internal circuit pressure below the preset excess level cancels the alarm.
During BAG
Cause: Alarm occurs under any of the following conditions.
Condition(1): When instantaneous pressure value was higher than the preset excess level
for a continuous “3 seconds” or longer.
Condition(2): When instantaneous value is “5hPa” or more, and moreover the average value
was monitored continuously for “5 seconds”, and when the average value
consecutively rose “3 times” or more, the difference between the average and
instantaneous values was below “3hPa”.
Condition(3): When 25hPa was exceeded for a consecutive 3 seconds or more regardless
of the preset alarm value.
Action: Setting the internal circuit pressure below the preset excess level cancels the alarm.
(21) Inspiratory pressure alarm
Cause: Alarm occurs when intake flow rate is too low during inspiratory cycle and the circuit
internal pressure does not reach a preset pressure during the inspiratory cycle.
Action: Increasing the intake flow rate (okay even in AUTO) to reach the preset level will cancel the
alarm.
７－12
(22) Setting error alarm
Cause: Alarm occurs when intake flow rate was outside the “1 to 80L/minute” range.
Action: Setting the flow rate within the “1 to 80L/minute” range cancels the alarm.
(23) Apnea alarm
Cause: Alarm occurs when no respiration (trigger) was detected in PSV mode within the standby
time (30 to 60 seconds).
Action: Change the sensitivity so that the trigger can be adequately detected.
(24) MV upper limit alarm
Cause: Alarm occurs when MV measurement reached upper limit of VE (minute) upper limit alarm.
Action: When MV measurement falls below upper limit the alarm cancels.
(25) MV lower limit alarm
Cause: Alarm occurs when MV measurement did not reach lower limit of VE (minute) upper limit
alarm.
Action: When MV measurement rises above lower limit the alarm cancels.
(26) Battery voltage drop alarm
Cause: Alarm occurs after power failure alarm when battery voltage dropped to a specified level
while operating on the internal battery.
Action: Supplying power to cancel the alarm.
(27) BAG-VENT selector defect alarm
Cause: Alarm occurs when BAG-VENT selector is in neutral (not securely switched to BAG or
VENT position).
Action: Securely switching the BAG-VENT selector to BAG or VENT position cancels the alarm.
(28) O2 sensor communication error alarm
Cause: Alarm occurs when O2 sensor unit cable is not attached to connector, or the cable might be
broken or disconnected.
Action: Attaching cable to connector cancels the alarm. If wires are broken then replace the O2
sensor unit.
(29) INJ communication error alarm
Cause: Alarm occurs when data cannot be exchanged with injection board.
Action: Request a repair.
(30) Alarm sound pause
Pressing the Alarm pause button during alarm operations supporting pauses will stop the alarm
sound, and during this pause the alarm mark changes to an Alarm pause mark (bell X). Changing
the conditions automatically cancels the alarm.
* Stopping of some alarm operations not supporting pause is impossible.
７－13
* In respiratory mode operation alarm pause is per conditions in the following table.
BAG
During
Alarm Types Priority VENT (Contino
(2 min.) ALARM
us)
OFF
Excess pressure alarm H No pause allowed
O2 conc. lower limit alarm (When
H No pause allowed
below18%)
Battery voltage drop alarm H No pause allowed
Drive gas pressure alarm H No pause allowed
Fresh gas flow sensor alarm H No pause allowed
Apnea alarm H 2 minutes OFF
Low inspiratory pressure alarm H 2 minutes Contin. OFF
O2 sensor communication error
H No pause allowed
alarm
INJ communication error alarm H No pause allowed
INJ Bottle empty alarm H No pause allowed
Fresh gas ratio alarm H No pause allowed
Setting error alarm H No pause 2 minutes Continuous
O2 gas pressure alarm H No pause allowed
Fresh gas pressure too high alarm M No pause allowed
Fresh gas flow sensor alarm M No pause allowed
INJ excessive setting alarm M No pause allowed
O2 concentration lower limit alarm
M 2 minutes
(variable)
O2 concentration upper limit alarm M 2 minutes
MV lower limit alarm M 2 minutes Contin. OFF
MV upper limit alarm M 2 minutes Contin. OFF
Inspiratory pressure alarm M No pause
BAG-VENT selector defect alarm M No pause allowed
Liquid shortage alarm M 2 minutes Continuous
Power failure alarm M Continuous
O2 flow shortage alarm M Continuous
O2 sensor calibration faiurel alarm M Continuous
O2 sensor Not connected alarm M Continuous
INJ Bottle connection alarm M Continuous
INJ vaporizer nonusable alarm M Continuous
* Priority: H…high priority (red LED flashes), M…mid-level priority (yellow LED flashes)
BAG (2 minutes)…When (BAG mode) alarm stop time set in BAG mode was set to “2 minute pause”
BAG (continuous)…When (BAG mode) alarm stop time set in BAG mode was set to “Continuous
pause”
BAG (during ALARM OFF)…In BAG mode set “ALARM OFF” to “ON”.
2 minutes…Restarts alarm sound after 120 seconds during alarm sound stop
Continuous…Pausing the alarm continues alarm sound stop until the alarm is canceled.
OFF…Turns alarm off
７－14
Check alarm operation conditions
CAUTION
(The ALARM OFF function does not automatically cancel alarms. Turning off
an alarm requires operation according to cancel methods in the manual.)
◎Operational messages
Operational messages differing from alarms are displayed that show equipment breakdowns,
improved operating methods and status.
The following types of operational messages appear on the alarm-message display on the monitor.
When each operational message appears, take the required action for that particular case.
(1) Abnormal liquid sensor
●A message “E1” simultaneously appears on the anesthesia gas concentration indicator on the
operation panel.
Cause: Fluid shortage sensor is not functioning correctly due to dirt or contaminants within the
equipment.
Action: Restore the fluid sensor shortage operation (Repeatedly “Start” and “Stop” to restore
operation) and the alarm will cancel.
(2) Abnormal pump rotation
●A message “E2” simultaneously appears on the anesthesia gas concentration indicator on the
operation panel.
Cause: The liquid feed pump within the equipment is not operating correctly.
Action: Restart the pump. Or restart the device.
* When the above messages (1) and (2) appear, you cannot use the injection vaporizer.
If these messages appear frequently then take action to repair the equipment. Also, when these
messages appear, use a separate vaporizer (sold separately).
(3) Electrical system failure
Cause: Fault occurred in electrical system so flow rate and drive pressure do not function correctly.
Action: Switch the BAG-VENT selector to “BAG”, turn off the power, and request a repair. The
device is usable in BAG mode. However extra care is needed since the monitor on the
control panel is not usable.
(4) Check – fresh gas ON
Cause: Message appears when no fresh gas is flowing
Action: Start fresh gas flowing to allow use of the equipment.
(5) Check - ventilator settings
Cause: Message appears when device capability was exceeded in VCV mode (flow rate exceeded
80L/minute after compliance correction).
Action: Lower the flow rate (Lower the Vti or rate, change the I/E ratio (breath intake vs. breath
expiry) and increase the intake (inspiratory time, etc.)
(6) Check – Spirometer connection
Cause: Message appears when ventilation or volume flow cannot be measured.
Action: Check that the connection is securely attached.
(7) Spirometer zero adjustment
Cause: Message displays status that processor is calibrating the zero-point and does not indicate a
problem.
Action: Calibration ends automatically.
７－15
(8) INJ START preparation
Cause: Message appears when injection vaporizer startup-preparation is in-progress and does not
indicate a problem.
Action: Start-up preparation ends automatically.
(9) INJ END preparation
Cause: Message appears when injection vaporizer end-preparation is in-progress and does not
indicate a problem.
Action: Preparation-end ends automatically.
(10) Check - bellows connection
Cause: Message appears to state where bellows is loose or not attached.
Action: Connect the bellows securely.
* The ventilator cannot be used while this message is displayed.
(11) Abnormal pressure sensor
Cause: Message appears when pressure sensor in device is not operating correctly.
Action: Switch the BAG-VENT selector to “BAG”, turn off the power, and request a repair.
The device is usable in BAG mode.
However, extra care is needed since the pressure meter (digital) is not usable.
(12) APNEA backup ventilation
Cause: Message appears when backup for no-respiration backup device is operating
Action: Reset the trigger sensitivity or change the vent (ventilation mode).
(13) Bellows upper limit
Cause: Message appears when bellows upper limit was reached.
Action: Check for possible leaks. Also check if ventilator settings are correct.
[8] How to measure usage quantities

Hold down the injection vaporizer start-stop
button for “3 seconds” or longer (first time only
after startup) or press RESET-START manually
whenever needed to start measuring the “Usage
time”, “Gas” and “Anesthesia” consumed during
operation.
Injection vaporizer start-
Check the measured time usage and stop button
[Fig.7-18]
consumption quantities from the control panel.
To find display methods, see “operation (1) consumption quantities on the [5] MENU in Chapter 5
Control panel operating methods”.
* Cannot measure unused gas or anesthesia.
７－16
[9] Using the support cylinder
(1) Insert the hole notch on the support cylinder handle
onto the valve head on the upper end of the support
cylinder.
(2) Fully open the valve by turning the support cylinder
handle “counterclockwise” until it stops.
[Fig.7-19]
Shut the support cylinder valve if using gas from the

WARNING in-hospital gas supply pipe
(If the support cylinder valve is left open, the gas will be used up and no longer
７－17
MEMO
Chapter 8
HANDLING AFTER USE
To maintain the performance of this device and accessories, do the following to keep the equipment
in a state where usable whenever needed.
[1] Ending operation

(1)Turning off the vaporizer
a) After the injection vaporizer has been used,
hold down the injection vaporizer start-stop
button for “3 seconds or more.
An “End-Prep” message starts flashing on
the alarm-message display in the monitor of
the control panel, and orange line segments Injection vaporizer start-
stop button
appear “ ” in a clockwise rotating
[Fig.8-1]
display in the anesthesia gas conc.
indicator.
After a while, the“ ”turns off and the injection vaporizer stops.
After checking that it has stopped, remove the bottle adapter from the bottle adapter mounting
port.
Store the removed bottle adapter with the accessory plug still inserted.

PROHIBITED
(Do not remove just the anesthesia bottle with the bottle adapter still attached

CAUTION
(Allowing the operating state to continue as is for long periods will cause
used!)
b) Set the concentration adjuster dial to “OFF” if using the

ACOMA vaporizer MK-5i/s or another company’s
vaporizer.
Conc. adjuster dial
[Fig.8-2]
８－1
(2) Set the BAG-VENT selector on the rear right-side of the
[Fig.8-3]
canister to “BAG”.
BAG-VENT selector

WARNING (On the operation status display of the monitor, the background color is light
(3) After using, turn the flow rate adjuster knob of

that gas flow meter fully “clockwise” until it stops.
At that time, check that the float has returned to
the “bottom level”.
Flow rate adjuster knob
[Fig.8-4]
PROHIBITED Leaving open and unsealed CO2 absorbent and leaving

drying.
８－2
(4) If you used the flow rate meter backlight, then turn the flow rate
[Fig.8-5]
meter backlight switch to “OFF".
Flow rate meter

backlight switch
(5) Press the STBY / ON switch to display a popup menu on the monitor. Follow the instructions on
the display to set to“STBY”(power “off” state). Then turn the power switch to “OFF” switch.
[Fig.8-6] [Fig.8-7] Power switch
Number Set-
Enter dial
STBY/ON switch
(6) Remove the Pressure tube connectors from the in-

[Fig.8-8]
hospital gas supply pipe. Also remove the excess
anesthesia gas suction tube or holes from the excess
anesthesia gas discharge system within the clinical
facility.
[If the support cylinder was used]

a) Insert the support cylinder handle into the valve
head on the top edge of the support cylinder and
turn the handle fully “clockwise” to tighten it.
b) If the support cylinder was removed then don’t
forget to attach the yoke plug.
[Fig.8-9]
８－3
Close the valve after using the support cylinder.
CAUTION
(If the valves on the support cylinders are left open then the gas will be used
up and no longer available for emergency use!)

WARNING (In unusual cases, the equipment might not start up normally if the power is
turned on again immediately, It might also lead to equipment breakdowns.
After turning OFF the power, wait at least 5 seconds or more before turning
the power back ON again.)
(7) Remove the power cable plug from the (commercial)

socket. Power plug
Socket
[Fig.8-10]
If not using for extended periods of time then remove

WARNING the power plug cable from the socket
Grip by the plug when removing the power cable

WARNING (Pulling it out by gripping the cable will damage the cable and cause trouble
such as fire or electrical shocks.)
(8) Check for any possible damage or wear on the main unit (especially the operating section and
monitor). Clean by wiping gently with a soft cloth or cloth fully wrung out after soaking in water.
PROHIBITED Do not use benzene or thinner, etc.

(Don’t use benzene or thinner for cleaning the intake or exhaust valves or main
unit (operation unit, monitors, etc.) This might cause damage.)
８－4
[2] Cleaning parts after use
(1) After having used a respiratory set (tube set) remove
components such as bacteria filters and dispose of all of
them since these are used items.
* Please read the attached special material for
information on handling these items.
[Fig.8-11]
WARNING Dispose of properly

●Properly dispose of consumables, residual items, and accessories as medical
waste products.
ordinances of regional civic bodies. Consult the regional civic bodies for
detailed information on pertinent legal regulations and ordinances.
*Disposing by illegal means will not only cause serious societal effects such as
environmental pollution and infection but also carries penalties so consider
carefully what action to take.
Do not attempt to reuse products that were discarded

PROHIBITED
(Doing so might cause infection or gas leaks due to cracks, holes, and
disconnections from couplings that have become loose.)
*Dispose of safely and correctly to prevent contamination and infection.
(2) Clean the inspiratory valve and expiratory valve

Screw ring
a) Turn the screw ring “counterclockwise”.
b)。Dismantle the parts and wipe away dirt on them with a
dry cloth.
*If the dirt or grime is especially tough then wipe it away
with a soft cloth soaked in “neutral detergent” or
“alcohol”, etc.
Inspiratory
valve
Expiratory
valve
[Fig.8-12]
Do not use benzene or thinner, etc.

PROHIBITED
(Don’t use benzene or thinner for cleaning the inspiratory or expiratory valves
or main unit (operation unit, monitors, etc.) This might cause damage.)
８－5
Securely mount the dome caps O-rings into the “O-
WARNING ring grooves” on the intake and exhaust valves
(A non-attached or incompletely attached dome cap O-ring can be the cause of
gas leaks.)
(3)Remove the canister chamber, and dispose of the CO2 absorbent.

How to remove
a) Raise the knob on the chamber release fold-up handle
located on the lower side of the canister toward you. Then
grip that handle and turn 180° “counterclockwise” to release
the chamber lock.
b) Remove the 2 chambers from the canister.
Chamber
Chamber release knob
[Fig.8-13]

PROHIBITED
(This is an alkaline material so if mistakenly touched, wash thoroughly with
large quantities of “tap water”.)
Elimination and disposal method

a) Remove all of the CO2 absorbent filled in each chamber.
b) Dispose of the used CO2 absorbent while complying with local ordinances in that particular
region or locality.
c) Wash away any residual matter remaining within the chamber.
Dispose of properly
WARNING ●Properly dispose of consumables, residual items, and accessories as medical
waste products.
ordinances of regional civic bodies. Consult the regional civic bodies for
detailed information on pertinent legal regulations and ordinances.
*Disposing by illegal means will not only cause serious societal effects such as
environmental pollution and infection but also carries penalties so consider
carefully what action to take.
８－6
(4) Loosen the clamp ring on the periphery of the canister
drain cup on the lower section of the canister, and pull
straight downwards to remove the cup.
Also disinfect and sterilize the drain cup and clean it.
Canister drain
cup
[Fig.8-14]

WARNING accumulates
(5) Remove the bellows unit and disassemble it.

How to remove
a) Loosen the setscrews with a blade (-) driver and pull towards you, removing them from the
Anesthesia apparatus.
b) Loosen the bellows unit setscrews (2 pcs.) and remove them.
Bellows unit
setscrews
Setscrews
[Fig.8-16]
[Fig.8-15]
８－7
c) Grip the pipe section in the upper center section of the
bellows unit, and pull straight upward, removing it from
the main unit (bellows drum).
[Fig.8-17]
How to disassemble
a) Remove the bellows unit from the bellows installation plate
(6) Disinfect and sterilize or clean the items removed or dismantled in the above steps (4) and (5).
How to sterilize
Disinfect, sterilize, and clean the components disassembled up to now (canister drain cup, bellows
installation plate, bellows) using the following procedure.
a)If using autoclave sterilization:sterilize for 15 minutes at 121C°
b)If using antiseptic solution: Disinfect using the disinfecting method for that antiseptic solution.
*Always read the attached special materials before handling the antiseptic solution.
*After disinfecting wash thoroughly with water and fully dry with clean air.
Dismantle in order to sterilize & disinfect

WARNING (Remove the canister drain cup and bellows unit, etc. Remove at all possible
locations and carry out sterilizing and disinfection.)
(7) After finished disinfecting, sterilizing or washing, reassemble the components and install them.
How to assemble and install
a) Bellows unit
a-1) Fit the bellows installation plate into the bellows.
a-2) Grip the pipe on the center, upper section of the bellows unit, and gently insert into the main
unit(bellows drum)from straight upwards. Insert carefully at this time so as not to warp or deform
the bellows.
a-3) Securely tighten the bellows unit setscrews (2 pcs.).
a-4) Insert the anesthesia bottle into the main unit and securely tighten the setscrews.
a-5) Check that it is securely tightened to the Anesthesia apparatus.
８－8
CAUTION Handle gently and carefully
(Be careful not to warp or deform the bellow when inserting it inside the
bellows unit. If the bellows is warped, the unit will not deliver the preset vent
volume. A warped bellow might also lead to accidents.)
b) Canister drain cup

b-1) Insert the drain cup straight up into the attachment
section on the lower section of the canister. Securely
tighten the clamp ring on the outer periphery of the
cap.
Clamp ring
Canister drain
cup
[Fig.8-18]
Connect securely
WARNING (No alarm is given if any of these are poorly connected. If not fully connected
then anesthesia gas might contaminate the room interior.)
c) Canister chamber
c-1) Stack the chambers on each other and mount correctly
on the canister lower lid as shown.
c-2) Grip the chamber release knob, and turn 180°
“clockwise” to lock the chamber
c-3) Lastly, lower the knob down rearwards.
*To find methods for filling the CO2 absorbent see Chapter 4
Pre-usage preparation and Chapter 5 Control panel operating
methods. Chamber release knob
Chamber
[Fig.8-19]
Connect it securely
WARNING (If it should come loose no alarm is given to announce the problem. If the
８－9
Attach correctly
WARNING (Check for any CO2 absorbent caught between one chamber and another, the

WARNING
(Check that the chamber is fully clamped by the chamber attach-release
d) Inspiratory valve / Expiratory valve

d-1) Assemble and install the Inspiratory
Inspiratory valve Expiratory valve
valve / Expiratory valve in the order of
anti-drop off ring, dome cap O-ring, valve
plate, dome cap and finally securely
tighten the screw ring
[Fig.8-20]
(8) Using disinfecting ethanol, fully wipe off the entire canister, vaporizer, APL valve, and tabletop
(9) After removing dirt and contamination from each unit component, store in a specified location.
During cleaning and inspections, always “turn off” the

WARNING power supply and remove the power plug from the
socket.
Use a soft cloth or similar item during cleaning

WARNING (Using chemicals such as benzene or thinner on the main operation panel may
cause warping or damage.)
８－10
[3] Checking the usage time and other items
(1) Check the elapsed time counter on the rear side of the main
unit. After checking the elapsed time of the device, record this Elapsed time counter
on the inspection sheet.
*Check the usage time or periodic inspection tag and other
items. If these show an approaching inspection period then
promptly get a “periodic inspection” or an “overhaul.”
*Replace the internal battery every 2 years. Carry out
[Fig.8-21]
replacement when that period is near.
WARNING Make sure the device receives “periodic inspections”

and “overhauls”
(To maintain performance make sure the device receives periodic inspections
“once a year” or every “1,000 hours”.)
(2) This device comes with an instruction manual and attached materials. The vaporizer and
humidifier also come with attached materials and instruction manuals. Keep these in a place such
as the drawer on the main unit so they will be readily available when needed.
[4] If not using equipment for extended periods

If not using for an extended period of time then periodically (once every 3 months)check the
remaining power on the internal battery.
〔How to check〕
(1) Turn the power switch to “ON” while the power plug is
inserted into the power supply (commercial) socket. Next Power plug
press the STBY/ON button to set the device to the “ON

(operating)” state.
Socket
[Fig.8-22]
[Fig.8-23] Power switch
STBY/ON
indicator
STBY/ON
switch
[Fig.8-24]
８－11
(2) Remove the power plug from the AC power supply (commercial) socket.
(3) Check the battery remaining power by
viewing the battery remaining power indicator.
[Fig.8-25]
(4) Press the STBY/ON button and follow the instructions on the display to set the device to STBY
(standby).
(5) If the battery is not fully charged, then insert
the power plug into the power supply
(commercial) socket, turn the power switch
“ON”, and check that the battery remaining
power indicator is on (lit up).
This indicator turns off when the battery is fully
charged.
*It takes approximately “20 hours” for the [Fig.8-26]
battery remaining power level to shift from
“Empty” to a “Full Charge” state.
８－12
Chapter 9 Consumable Parts & Replacement Parts
CAUTION Use genuine parts during part replacement

(Using a substitute items will cause breakdowns.)
To order the following parts, contact the dealer where you purchased this unit or the nearest ACOMA
representative.
[1] Consumable parts

●O2 sensor unit sensor element
[2] Replacement parts

●Power cable
No. 204-28-35
(5m)
●Yoke packing for support cylinder
No. 804-30-02
●Canister chamber A
●Inspiratory / Expiratory valves
(1) Intake/exhaust valve screw ring
No. 204-00-01
(2) Intake/exhaust valve set
3-point set: dome cup, valve plate, and dome cap O-ring
(3) Anti-drop off ring
No. 204-00-05
●O2 sensor unit (main unit +sensor element)
●Dedicated respiratory bellows
●Gas pocket plug (with O-ring)
No. 804-00-01
●Ventilator control cable/Flow sensor tube connector
●Bottle adapter
(1) For sevoflurane
No. 204-02-04
(2) For isoflurane
No. 204-02-03
●Drain cup
９－1
MEMO
Chapter 10 Periodic Inspections
Component parts are subject to wear and deterioration over the passage of time.
Refer to the following table and as time passes and as the equipment usage time increases get
“Periodic Inspections and Overhauls“.
[1] Periodic inspections

●Breakdowns and equipment abnormalities can be expected to occur unless the required parts are
replaced and adjustments made in compliance with the periodic inspection.
To maintain performance, have periodic inspections made “once a year” or “every 1,000 hours”.
The following table shows replacement parts, adjustment parts and predictable breakdowns and
abnormalities.
Part Name Cause Predicted Breakdown or Trouble
Non-return valve Deterioration Leaks
BAG-VENT selector Deterioration Leaks

Respiratory Circuit
Packing Deterioration Leaks
Warping,
PEEP valve Leaks, drop in performance
Deterioration
Can’t discharge non-circulating excess anesthesia
APL valve Insufficient grease gas
Can’t stop flow
Yoke packing Deterioration Leaks
O2 sensor unit
Drop in performance Error in O2 concentration display
Sensor element
●Drop in anesthesia gas concentration

Bottle adapter packing Deterioration
●“Empty bottle alarm” triggered by mistake
Fresh gas tube Deterioration Leaks
Backup battery Worn down

Reduction in operating time
* Replace just the part every “2 years” Deterioration
１０－1
[2] Overhaul
●Breakdowns and equipment abnormalities can be expected to occur unless the required parts are
replaced and adjustments made by performing overhauls.
To maintain performance, have an overhaul performed “once every 5 years” or “every 5,000
hours”.
The following table shows replacement parts, adjustment parts and predictable breakdowns and
abnormalities.
*The term “Overhaul” also includes periodic inspections and parts replacement.
Part Name Cause Predicted Breakdown or Trouble
Internal circuit leaks
There is no N2O flow or flow won’t stop
Whistle tone sound won’t stop

Deterioration
Anesthesia circuit unit Defective safety Low O2 supply pressure alarm device won’t function
equipment
N2O shutoff device won’t function
N2O shutoff device triggers
Fluctuations in O2 and N2O flow rates

Flow mtr
Packing Deterioration Internal circuit leaks
Movement stiffens when flow rate adjuster knob is

Interlocking gear Insufficient grease
turned

Respiratory
Circuit
Drain cup Deterioration Leaks
Canister chamber Deterioration Leaks

Ventilator
Tubes Deterioration Internal circuit leaks

Vaporize
Tubes Deterioration Internal circuit leaks

mount
Vaporizer
Internal parts Insufficient grease Wear, abrasion, defective operation
O2 flush Drop in performance There is no O2 flow or flow won’t stop
Tubes for internal piping Deterioration Leaks
BAG-VENT selector sensor components Deterioration Unable to switch to VENT
１０－2
[3] Service contracts
●We recommend obtaining a “Service Contract” for keeping your equipment in good condition by
receiving periodic inspections and maintenance.
Consult your nearest dealer or ACOMA representative for details on “servicing dates" and
“costs”.
* The contents listed in this chapter are subject to changes without prior notice due
to relevant circumstances.
１０－3
MEMO
Chapter 11 Troubleshooting
●When a problem or abnormality occurs, troubleshoot it according to the cause and take the action
shown below.
●If this troubleshooting fails to resolve the problem then a repair is likely needed so request
servicing to deal with the problem.
Symptom Cause Action
1. Power supply trouble
4 beeps and alarm sounds are BAG-VENT selector is set at Set the BAG-VENT selector to “BAG”
heard (STBY : standby) “VENT”
Set the power switch to “ON”
Power switch is set to “OFF”
(1) Set the power switch to “OFF”

temporarily
Power won’t turn on even if (2) After finding the cause of the
STBY/ON switch is pressed Over-current safety circuit problem, press the over-current
(STBY/ON indicator does not triggered safety circuit reset switch
light, no display on monitor (3) Set the main power switch to “ON”
panel) (Request a repair if the safety circuit
triggers again)
Power switch is broken Request a repair
Internal component in main unit Request a repair
is broken
(1) Turn power switch “ON” to charge
the internal battery
(Full charge requires “20 hours” or
Internal battery is discharged more)
“Power failure” alarm does not
or has reached its service life (2) Recheck and if “Power Outage”
sound,
limit(about 2 years) alarm does not sound and internal
Internal battery does not
battery does not function then the
function
internal battery must be
replaced(Request a repair)
is broken
Power switch is broken Request a repair
Power won’t turn off Internal component in main unit Request a repair
is broken
Leak in high-pressure gas Make an inspection
connection
2. Abnormal tone sounds
is broken
3. Alarm sounds(Alarm operates and alarm name appears in display)
“O2” conc. dropped to low limit Set O2 conc. to “25 %”or higher
value of “18%” or lower
“O2 conc. lower limit” is
1) Set O2 conc. to higher than lower
displayed O2 conc. dropped to low limit
limit value
value of “18 to 95%” or lower
2) Reset the O2 conc. lower limit value
1) Set O2 conc. below the upper limit
“O2 conc. upper limit” is O2 conc. exceeded upper limit
value
displayed value of “30 to 100%”
2) Reset the O2 conc. upper limit value
Calibration was incorrect Recalibrate
Sensor element in O2 sensor Calibrate the O2 sensor
“O2 sensor calibration failure” is unit was replaced
displayed Defective calibration or 1) Recalibrate the O2 sensor
defective sensor element in 2) Replace the sensor element
sensor unit
１１－1
Sensor element in O2 sensor Install the sensor element
“O2 sensor Not connected” is unit is not connected
displayed Sensor element in O2 sensor Inspect the sensor element installation
unit is poorly connected state
Injection vaporizer “started” Connect the bottle adapter
“INJ Bottle connection” is
while bottle adapter was still
displayed
not attached
“INJ vaporizer nonusable” is O2 is not being supplied Set the O2 flowing
displayed Vaporizer was set to “ON” Set the vaporizer to “OFF”
Refill and replace the anesthesia
“Liquid shortage”(low fluid) is
Anesthesia is low *Some amount of use is possible with
displayed
anesthesia in device internal piping
“INJ Bottle empty” is displayed Anesthesia is low Refill & replace anesthesia
Excessive fresh gas flow 1)Reduce the fresh gas flow rate
“INJ excessive setting” is
relative to anesthesia gas 2)Lower the anesthesia gas content
displayed
content setting setting
“Fresh gas flow excessive” is Gas flow rate exceeded Reduce gas flow rate to
displayed measurement range (10 L/min) “10.0L/minute” or less
N2O or AIR flow rate exceeded 1) Increase the O2 flow rate
for “2 seconds” or more, a level
“Fresh gas ratio” is displayed
where O2 conc. of “28%” 2)Decrease the N2O or AIR flow rate
cannot be maintained
O2 flow rate fell below Increase the O2 flow rate
“0.1L/minute” in state where
“O2 flow shortage” is displayed
N2O is flowing
O2 content was “18%” or less Set O2 content “19%” or higher
Remove cause of blockage
*This alarm also occurs temporarily
“fresh gas flow too high” is
Gas outlet is blocked, etc. when O2 flush was used
displayed
In that case, stopping O2 flush
restores original state so use as is.
Calibration of flow rate sensor Calibrate applicable flow rate sensor
“fresh gas flow sensor” is
was incorrect
displayed
Flow rate sensor is abnormal Request a repair
“Driven gas pressure” is Ventilator Driving gas supply Set Driving gas supply pressure to
displayed pressure fell below “280kPa” “330kPa” or higher
Inspect each section(if cracks or
damage are found then replace with
new part)
●Tubes
Leak in respiratory circuit ●Breathing bag
“Pressure LOW” is displayed ●O2 sensor
●Inspiratory / Expiratory valves
●Drain cup
●Canister chamber
“Low inspiratory pressure Reset appropriately
alarm” setting is too high
１１－2
The “Excess pressure” setting Reset appropriately
is too low
“Pressure HIGH” is displayed Patient airway passage is Suction up the secretions
blocked due to patient
secretions
Make a secure connection.
Leak in respiratory circuit See (Leak in respiratory circuit: “Low
“Insp. Pressure” is displayed inspiratory pressure alarm”)
Inspiratory pressure setting Reset appropriately
(Insp. Press.) is too high
Flow rate is outside the range Reset to within the range
“Setting error” is displayed
of “1 to 80L/minute”
Make a secure connection.
“APNEA” is displayed inspiratory pressure alarm”)
Spontaneous respiration Change the setting
stopped
Setting for MV upper limit Reset appropriately
“MV upper limit” is displayed
alarm is too low
Setting for MV lower limit alarm Reset appropriately
is too high
“MV lower limit” is displayed Make a secure connection.
inspiratory pressure alarm”)
Obtain a power source (can operate
Power outage occurred for about 30 minutes on internal
“Power failure” is displayed battery (when fully charged))
Power cable is broken or Inspect the power cable and replace if
power plug has come loose necessary
Internal battery dropped to a Obtain a power source
“Battery LOW” is displayed
specified level
BAG-VENT selector on Securely switch selector to “BAG” or
“BAG/VENT selector imperfect”
canister was set to neutral “VENT”
is displayed
position
O2 supply pressure dropped Set O2 supply pressure to “250kPa” or
“O2 gas pressure” is displayed below “200kPa” more
O2 sensor unit cable is Connect the cable

disconnected from respiratory
circuit (canister) connector
O2 sensor unit cable is broken Replace main piece of O2 sensor unit
or defective
“O2 sensor communication
Defective respiratory circuit Request a repair
error” is displayed
(canister) connector
Bad connection, non- Connect
connection, or defect on Replace
Ventilator control cable-Flow
sensor tube connector
“INJ communication error” is Cannot communicate with Request a repair
displayed injection board
Alarm triggered and sound Take action after checking applicable
cannot be stopped alarm
4. Cannot stop alarm sound
Alarm pause button is broken Request a repair
Main unit internal part is broken Request a repair
１１－3
Wait for pause time (2minutes)
*Some alarms can be set to a 2
Alarm sound is
minute pause time or continuous
stopped/paused
pause during manual so setting to “2
5. No alarm sound minutes” will sound alarm.
Cancel the setting, set to ALARM ON
Was set to ALARM OFF
and alarm will sound.
Buzzer/speaker broken, Request a repair
Unit internal part broken
O2 supply pipe pressure has Set the O2 to “350kPa” or higher
fallen below “250kPa”
Valve on support cylinder is Open the valve
6. Whistle (Low O2 supply closed
pressure alarm) sounds Support cylinder is “empty” Replace
Leak in high pressure gas Inspect
connection
7. No fresh gas flow
No flow from supply (source) Drop in supply gas source Check source pressure (350 to 500
pipe pressure kPa)
(Reading on supply (source) Defect installation or break in Inspect
pressure meter is “0kPa”) pressure-resistant pipe (Replace in some cases if needed)
Valve on support cylinder is Open the valve
No gas flow from support valve closed
(Supply (source) pressure Support cylinder is empty Replace
meter and cylinder pressure Remove the support cylinder and
Packing is not mounted,
meter show value of 0kPa) check the yoke packing
deteriorated or defective
(Replace in some cases if needed)
Set power switch to “ON”
Power switch is set to “OFF” *If power switch is “OFF” then N2O will
not flow
Select the gas for use with the gas
select button
Gas for use was not selected *N2O and AIR cannot be supplied
unless selected with gas select
No flow of N2O
button
Check applicable alarm and take
action
*When below “18%” at “O2 conc. lower
Alarm was triggered
limit alarm” the supply of N2O
automatically cuts off in the case of
an “O2 flow rate too low” alarm
Select the gas for use with the gas
AIR is not flowing Gas for use was not selected
select button
In all cases other than above Main unit internal part is broken Request a repair
8. Flow of fresh gas won’t stop
Flow meter adjuster knob is Close flow meter adjuster knob
open (Turn “clockwise”)
Gas is flowing from flow meter Gas still flowing from flow Request a repair
meter even if meter adjuster
knob is closed
Gas not flowing from flow Request a repair
O2 flush valve is broken
meter
１１－4
9. Pressure meter (gauge) won’t operate
Fresh gas won’t flow Gas pipe not connected Connect applicable gas pipe
Fresh gas flows Pressure meter broken Request a repair
10. Injection vaporizer won’t operate
Alarm sounds (alarm name is See 3. Alarm sounds: check applicable
Won’t operate even if
displayed on monitor panel) alarm and take action
start/stop button on injection
Injection vaporizer start/stop Request a repair
vaporizer is pressed
button is broken
Liquid shortage sensor in Repeatedly “Start” and “Stop” to
Operational message
equipment won’t function restore fluid shortage sensor functions
“Abnormal liquid sensor” and
correctly due to dirt in pipes, If problem occurs frequently then
“E1” is displayed
etc. request a repair
Operational message Restart the pump or restart the device.
Liquid pump inside unit won’t
“Abnormal pump rotation” and If problem occurs frequently then
operate correctly
“E2” is displayed request a repair
In all cases other than above Main unit internal part is broken Request a repair
11. Vaporizer won’t operates
Both units won’t operate
Injection vaporizer is currently simultaneously
Conc. adjuster dial on
in use If vaporizer must be used then turn off
vaporizer won’t turn
the injection vaporizer
12. Pointer on Circuit pressure gauge won’t function, display is wrong value
Pressure waveform on monitor Request a repair
is fluctuating and value is Circuit pressure gauge is
different from Circuit pressure broken
gauge
Pressure waveform on monitor Inspect connection. See (3. Alarm
is fluctuating and value is sounds: Leak in respiratory circuit:
Leak in respiratory circuit
different from Circuit pressure “Low inspiratory pressure alarm”)
gauge
13. Value on flow rate meter is strange
Flow rate meter value is Calibrate the flow rate sensor(if
Problem with flow rate sensor
different from flow rate indicator display is still wrong even after
calibration
display value calibrating then request a repair)
O2 and N2O flow ratio doesn’t Request a repair
Flow rate meter is broken
match
14. Respiratory circuit trouble
Main unit connection port is Request a repair
Cannot mount bellow unit onto
warped
main unit
Breathing bag arm won’t move Breathing bag arm is warped Request a repair
Cannot mount canister Inspect and mount after wiping it clean

CO2 absorbent is adhering
chamber
15.BAG-VENT selector trouble
Cannot switch even if BAG- Request a repair
Main unit internal part is broken
VENT selector is turned
BAG-VENT selector sticks at a Request a repair
BAG-VENT selector is broken
halfway position
１１－5
16. Ventilator trouble
Make a secure connection See (3.
Vti preset figure does not
Alarm sounds: Leak in respiratory
match actual measurement Leak in respiratory circuit
circuit: “Low inspiratory pressure
(difference of more than
alarm”)
±10%,±20mL)
Flow sensor is blocked Replaced
Make a secure connection See (3.
Alarm sounds: Leak in respiratory
PEEP not having effect Leak in respiratory circuit
circuit: “Low inspiratory pressure
alarm”)
17. Gas pocket trouble
Gas pocket plug is not fully Inspect and reconnect (replace if
connected, disconnected or necessary)
missing
Gas pocket plug O-ring is Replace
Gas is leaking
deteriorated or defective
Excess anesthesia gas suction Inspect and reconnect
tube is not fully connected or is
disconnected
Excess anesthesia gas has Set suction flow rate between15 to 30
large suction flow rate L/minute.
No vent due to negative
Defective excess anesthesia See instruction manual of excess
pressure
gas suction system or suction anesthesia gas suction system or
pump suction pump
* The contents listed in this chapter are subject to changes without prior notice due
to relevant circumstances.
１１－6
Chapter 12 After-Sales Service
[1] Warranty
Warranty-Quality Approval Card
The accessories for this unit include a warranty-quality approval card.
Check the contents of this card and store it in a safe location.
The backside of the card includes warranty provisions so be sure to read it carefully.
●The warranty period is “1 year” from the date of purchase.
●The warranty contents are listed on the backside of the warranty-quality approval card.
●Usage contrary to or in violation of “Warning”, “Caution”, as well as “Prohibited” and “Compulsory”
(instruction) items displayed on this unit and the instruction manual and attached materials will cause
breakdowns and accidents so no compensation will be provided.
[2] Repairs
In the event that this devices breaks down, please request a repair from the dealer where purchased
or your ACOMA customer support representative.
At that time, please provide the following information.
(1) Product name (ACOMA ANESTHESIA SYSTEM PRO-NEXT+i)

(2) Production No. (listed on tag on rear side of main unit)
(3) Description of breakdown or trouble
(4) Date of purchase (Yr. Mo. Dy.)
(5) Hospital name, clinic name, telephone No.
Remarks-Notes
Purchase date: YR MO DY
Sales dealer or representative:
Staff:
１２－1
MEMO
Chapter 13 Specifications
Product Name
ACOMA ANESTHESIA APPARATUS PRO-NEXT+i
Medical equipment production sale approval No.
22400BZX00194000
Purpose of usage
This device has the purpose of applying inhalant anesthetic to the patient during surgery.
Power supply unit
Rated voltage AC220V (or as specified)

Power frequency 50-60Hz.
Power supply input 120VA
Protective class per Class I devices, internal power supply
electrical shocks
Extent of protection B type mounting
versus electrical shocks
Standard No. IEC60601-1-2:2001+A1
Electromagnetic Publication Date :2005
compatibility (EMC) CISPR11:2009
Special Notes
Group 1 Class B
12VDC, lead storage battery
Internal battery 30minute backup possible(when fully charged, including ventilator
section)
Safety standard JIS T0601-1:1999
Anesthesia mechanism
Gas supply pressure 350 to 500kPa for O2, N2O, and AIR
O2: 0 to 10L/minute (continuously variable)
Flow range N2O: 0 to10L/minute (continuously variable)
AIR: 0 to 10L/minute (continuously variable)
Flow rate meter
30%
Minimum O2 (at O consumption “0.2L/minute”,
2
concentration at N2O consumption “0.05L/minute”)
1 unit attachable
ACOMA vaporizer MK-5i/s
Vaporizer mounting stand
* Vaporizer sold separately
CO2 absorbent device Capacity 1,340 mL(1,200g)

Oxygen flush Flow rate 35 to 75L/minute
１３－1
1 each for O2 and N2O
Aux. cylinder yoke
* O2/AIR Option set prior to shipping
Pipeline pressure 0 to10x100 kPa for O2, N2O, AIR
Aux. Cylinder 0 to 200x100kPa for O2 and N2O
Pressure gauge
pressure *O2/AIR:Option set prior to shipping
Specifications are same as above
O2 extra flow
0 to10L/minute variable *Option set prior to shipping
meter(slot shape)
Injection vaporizer
Sevoflurane:0 to 8.0%
Setting range
Isoflurane:0 to 6.0%
Ventilator
Respiratory mode VCV, PCV, PSV *PSV is an option set prior to shipping
AIR or O2 *O2 is an option set prior to shipping
Drive method
Also can be driven by aux. cylinder
Tidal Volume 30 to 1,300mL (VCV)
Rate 5 to 60bpm (VCV, PCV)
I/E ratio 1:0.5 to 1:5 (VCV, PCV)
Inspiratory 5 to 50hPa (PCV,+PEEP:Max 60hPa)
pressure(+PEEP)
Flow rate AUTO, 5 to 70L/min (PCV)
Plateau 0 to 30% (VCV)
Trigger * -1 to -5hPa
PEEP OFF, 3 to 20hPa
Support pressure(+PEEP)
0,5 to 50hPa (PSV,+PEEP:Max 60hPa)
*
PSV Inspiratory pressure 5 to 20hPa
*
PSV rate * 5 to 15bpm
PSV intake time * 1 to 5 seconds
*When PSV is selected
Monitor
Display device LCD monitor

Waveform display Pressure -10 to 75hPa (excess pressure+5hPa as scale display)
Circuit internal pressure Analog display -10 to 70hPa
gauge Digital display -10 to 100hPa(Max, EIP, Ave., PEEP)
Vti 0 to 9,999mL
Vent flow meter Rate 0 to 99bpm
MV 0.0 to 99.9L
１３－2
Oxygen conc. meter Detection range 0 to 100% O2
Gas consumption 0 to 9,999.9L for O2, N2O, and AIR
Anesthesia consumption 0 to 999.99mL for both sevoflurane and isoflurane
Hour meter 999999.9 hours
Safety devices & alarms
Unit can be operated from internal battery (when fully charged) for
approximately 30 minutes when there is a power outage while operating
Power supply backup
from the power supply, when the power cable was disconnected or the
power plug removed, etc.
Alarm (whistle) sounds when O2 supply pressure falls to “250kPa”. When
Low O2 supply pressure
O2 supply pressure falls below “200kPa” along with the whistle alarm the
alarm
N2O is also cut off.
When there is both an injection vaporizer and separately mounted
Vaporizer select vaporizer, selecting either one automatically locks the other vaporizer to
prevent its operation.
The O2 and N2O flow rate adjuster knobs are controlled by an internal
Minimum O2 concentration mechanism called a “special interlocking gear” to maintain a minimum O2
concentration of “30%”.
Positive pressure safety Triggers when excessive pressure is applied inside the respiratory circuit.
valve 60 to 75hPa
Triggers during PSV mode operation at VENT when the apnea alarm
Apnea backup ventilation
occurs, and starts backup ventilation at a preset PCV operation.
The message “Power failure” appears on the monitor in the control panel
Power failure alarm and alarm sounds during a power outage or when the power cable was
disconnected or the power plug removed.
The message “INJ Bottle connection” appears on monitor in control panel
INJ Bottle connection
and alarm sounds when injection vaporizer was operated with no
alarm
anesthesia bottle adapter connected.
The message “INJ vaporizer nonusable alarm” appears on the monitor in
INJ vaporizer nonusable
the control panel and alarm sounds when injection vaporizer was started
alarm
in the state O2 is not being supplied or while vaporizer was in “ON” state.
The message “Liquid Shortage” appears on the monitor in the control
Liquid shortage alarm panel and the alarm sounds when fluid shortage sensor could not detect
anesthesia during injection vaporizer “operation”.
The message “INJ bottle empty” appears on the monitor in the control
panel and the alarm sounds when anesthesia could not be detected (no
INJ bottle empty alarm
anesthesia) even after injecting a specified amount in “Startup-Prep” or
when there is no anesthesia during vaporizer injection “operation”.
The message “INJ excessive setting” appears on the monitor in the
INJ excessive setting control panel and the alarm sounds when the setting exceed the fluid
alarm feed capacity of the injection vaporizer pump.
１３－3
The message “fresh gas flow excessive” appears on the monitor in the
Fresh gas flow excessive control panel “- - -” appears on the applicable flow rate indicator and the
alarm alarm sounds when a flow (“10L/minute” or more) exceeding the
measurement range on the flow rate sensor occurred.
The message “Fresh gas ratio” appears on the monitor in the control
panel and an alarm sounds when the flow ratio of O2 and another gas
Fresh gas ratio alarm
falls below a preset figure, and that state continues for “2 seconds” or
more.
The message “O2 flow shortage” appears on the monitor in the control
panel and an alarm sounds when the O2 flow rate fell below
O2 flow shortage alarm “0.1L/minute” while N2O was still flowing or O2 concentration dropped
below “18%”. The supply flow of N2O is then automatically cut off at this
time.
All gas flow is temporarily cut off and the display “P.P.P” flashes on the
flow rate indicator, and “fresh gas pressure too high” appears on the
Fresh gas pressure too
monitor in the control panel and an alarm sounds when there is an
high alarm
extreme pressure rise within the device gas circuit due to a blocked gas
outlet.
The display “E.E.E” or “L.L.L.” flashes on the applicable flow rate
Fresh gas flow sensor indicator and the message “Fresh gas flow sensor” appears on the
alarm monitor in the control panel and an alarm sounds when the flow rate
sensor is not correctly calibrated or there is an abnormality.
The message “O2 gas pressure” appears on the monitor in the control
O2 gas pressure alarm panel and an alarm sounds when the alarm activated due to a drop
below “200kPa” in O2 source pressure.
The message “O2 conc. LOW” appears on the monitor in the control
O2 concentration lower panel and an alarm sounds when the oxygen concentration fell below a
limit alarm preset concentration of “18 to 95%” (Number display flashes at 20% or
below. Alarm can’t be stopped when 18% or below.)
The message“O2 conc. HIGH” appears on the monitor in the control
O2 concentration upper
panel and an alarm sounds when the oxygen concentration exceeded a
limit alarm
preset concentration of “OFF, 30 to 100%” level.
The message“O2 sensor cal. failure” appears on the monitor in the
O2 sensor calibration
control panel and an alarm sounds when the sensor element in the
failure alarm
oxygen sensor unit is deteriorated or defective.
The message “O2 sensor Not connected” appears on the monitor in the
O2 sensor Not connected
control panel and an alarm sounds when the sensor element of the
alarm
oxygen sensor unit is not attached or is poorly connected.
The message “Drive gas pressure” appears on the monitor in the control
panel and an alarm sounds when the O2 or the AIR (option set prior to
Drive gas pressure alarm
shipping) serving as the driving gas for the ventilator has fallen below
“280kPa”
The message “Pressure LOW” appears on the monitor in the control
Low inspiratory pressure panel and an alarm sounds when the alarm activates due to no pressure
alarm added above a preset alarm level within the setting time (15 seconds or
30 seconds).
１３－4
During VENT:When the circuit internal pressure reaches a preset alarm
level during air intake, it promptly sets to exhaust phase, the
message “Pressure HIGH” appears on the monitor in the
control panel and an alarm sounds.
During BAG:The message “Pressure HIGH” appears on the monitor in
the control panel during any of the following conditions.
Condition(1):The instantaneous pressure value momentarily exceeded
Excess pressure alarm preset alarm level for 3 continuous seconds or more.
Condition(2):When the instantaneous pressure value is “5hPa” and
moreover the average value consecutively rose “3 times” while
monitoring the average value in “5 second periods”, the
difference between the instantaneous value and average value
was less than “3hPa”.
Condition(3):When “25hPa” was exceeded for a continuous “3 seconds”
or more regardless of the alarm setting
The message “Insp. pressure” appears on the monitor in the control
panel and the alarm sounds when the inspiratory pressure flow rate
Inspiratory pressure alarm
during intake is inadequate and the circuit internal pressure doesn’t
reach the preset pressure within the intake time.
The message “Setting error” appears on the monitor in the control panel
Setting error alarm and the alarm sounds when the in inspiratory pressure flow rate is
outside the “1 to 80L/minute” range.
The message “Apnea” appears on the monitor in the control panel and
Apnea alarm the alarm sounds when the alarm triggers due to detecting no breath
(respiration) within a standby time (30 seconds or 60 seconds).
The message “MV HIGH” appears on the monitor in the control panel
MV upper limit alarm and the alarm sounds when the alarm is triggered due to the measured
minute volume reaching a preset upper limit for the minute volume alarm.
The message “MV LOW” appears on the monitor in the control panel and
the alarm sounds when the alarm is triggered due to the measured
MV lower limit alarm
minute volume not reaching a preset lower limit for the minute volume
alarm.
The message “Battery LOW” appears on the monitor in the control panel
and the alarm sounds when the alarm triggers due to the battery voltage
Battery voltage drop alarm
falling by a preset level during internal battery operation after a power
outage occurs.
The message “BAG/VENT imperfect” appears on the monitor in the
BAG-VENT selector
control panel and the alarm sounds when the alarm activates when the
defect alarm
BAG-VENT selector on the canister is in the neutral position.
The message “O2 sensor I/F error” appears on the monitor in the control
O2 sensor
panel and the alarm sounds when the alarm activates because the
communication error
oxygen sensor unit cable was removed from the respiratory circuit
alarm
connector or the cable is broken or defective.
“INJ I/F error” appears on the monitor in the control panel and an alarm
INJ communication error
sounds when the alarm activates due to no data transfer with the
alarm
injection board.
１３－5
Pressing the alarm pause button when a pausable alarm occurred, starts
the Alarm pause mark flashing and the alarm sound is paused.
If the paused alarm is a 2 minute pause time, then “120” appears on the
monitor upper right and the figure starts to count down.
Alarm pause button
After 2 minutes the alarm starts to sound again(if alarm was not cancelled).
Pressing the pause button during the count-down, restarts the count-down
again from “120” seconds.
Alarm automatically cancels if correct conditions are restored.
Operational Messages
Operational messages(OM) express states such as equipment breakdowns on this unit and improved
usage methods. These are not alarms but are shown on the alarm display in the monitor in the control
panel.
The following list shows the display sequence. These messages are shown following the alarm display
when an alarm occurred.
Additional OM messages may appear simultaneously according to message content.(shown on
waveform display section)
Fluid shortage sensor within device is not operating correctly due to dirt or
contamination in pipes, etc.
Abnormal liquid sensor
*An “E1” is simultaneously displayed on the Anesthesia gas conc.
indicator.
Fluid feed pump inside device is not operating correctly.
Abnormal pump rotation * An “E2” is simultaneously displayed on the Anesthesia gas conc.
indicator.
Problem or abnormality occurred in electrical system and flow rate or drive
Electrical system failure
pressure is not operating correctly.
Check - fresh gas ON Fresh gas is not flowing
Check - ventilator settings Ventilator setting is exceeding the device capacity.
Check - Spirometer Cannot measure ventilation flow
connection
Spirometer zero Spirometer zero point adjustment is being performed(displayed during
adjustment calibration)
INJ START preparation Injection vaporizer is now in the Startup-Prep state.
INJ END preparation Injection vaporizer now in the End-Prep state.
Check - Bellows
Currently in state where bellows unit was removed.
Connection
Abnormal pressure sensor Pressure sensor within device is not operating correctly.
APNEA backup ventilation Apnea backup is currently in operation.
Bellows upper limit State where upper limit of bellows was reached
Test Mode
User (performed by electro flowmeter calibration, oxygen monitor calibration, vent flow zero-
user/operator) point calibration
１３－6
Dimensions & Weight
Main unit:600(width)×755(depth)×925 (height)mm

Outer dimensions Canister:355(width) ×400(depth) ×800(height)mm
*Not including protrusion
Dedicated stand
Dimensions:610(width)×790(depth)×475(height)mm
Dimensions (with main unit):610(width)×790(depth)×1400(height)mm
Stand Total lock canister stand

Dimensions:610(width)×820(depth) ×475(height)mm
Dimensions (with main unit):610(width)×820(depth)×1400(height)mm
*Not including protrusion
Dimensions:430(width)×355(depth)mm
*Actual depth dimensions are smaller since both corners along depth are
Monitor shelf
rounded
*permissible weight: approximately 10kg
525(width)×290(depth)×830(height)mm
Tabletop *Comes with dedicated stand or total lock stand (both are options set
prior to shipping)
Main unit: Approximately 98kg (including canister:14kg)
Weight
Main unit + stand:Approximately125kg
Service life
10 years[Self-certification(per in-house data)]

*Period of 10 years provided user performs regular inspections and overhauls.
Usage environment
Category per extent of

protection from harmful IPx0
fluid penetration
Ambient temperature 10 to 40C°
Relative humidity 30 to 75%
Atmospheric (air) 700 to 1,060hPa
pressure
Storage conditions
Ambient temperature 0 to 50C°

Relative temperature 10 to 98% *no condensation
Atmospheric (air) 700 to 1,060hPa
pressure
*Please refer to the special attached materials and instruction manuals for specifications and
operating methods for the ACOMA vaporizer MK-5i/s and other products.
１３－7
MEMO
Chapter 14 Piping-tubing system diagram
●VENT (Automatic ventilation) mode
１４－1
●BAG (hand-operated breathing) mode
１４－2
Chapter 15 Inspection items for before-during-after usage
1. Inspect and check the record results for all items and record them in each inspection table.
2. If inspection and check items are normal then enter a checkmark (✓) within the box.
3. If there is a problem or error then enter an x and enter the symptoms in the remarks box.
4. Make corrections after referring to “Chapter 11 Troubleshooting”.
If repairs are required then carry out the procedure according to “Chapter 12 After-service.”
5. Copy each of the inspection tables or list for actual use.
１５－1
Pre-usage check items
I. Pre-usage preparation
Check that power cable is connected to power socket, and secured by cable clamps. Power plug shall be connected to AC
1
socket.
Gas supply source, excess anesthesia gas suction
a)Install support cylinder onto O2, N2O (or AIR: option prior to shipment) support cylinder yoke
b) Connect the pressure-resistant pipe to each of the O2, N2O, AIR gas inlets.
2 Connect the piping connectors for the attached Pressure tube to the in-hospital gas supply pipe.
c-1) Connect the surplus anesthesia gas suction inlet to the in-hospital anesthesia gas scavenging system by using a hose
or tube (both sold separately).
c-2)When using an anesthesia gas monitor, also use a tube in the same way to connect the gas discharge outlet on the
monitor to the monitor excess anesthesia gas suction port.
3 Insert O2 sensor unit into the installation hole in the respiratory circuit (canister) and connect the cable.
Respiratory circuit set, respiratory bag
a)Connect the respiratory circuit set (tube set) for use at the intake port and exhaust port.
4 b)Attach the respiratory bag to the respiratory bag connection port.
c)Connect an artificial respirator tube between the ventilator gas out and the ventilator connection port.
d)Connect an excess anesthesia gas discharge tube between the gas pocket connection ports.
Fill the CO2 absorbent up to the “Fill up to this line mark” After filling the CO2 absorbent install the chamber onto the
5
canister.
Install the dedicated bottle adapter onto the anesthesia bottle for use:sevoflurane (or isoflurane: sold separately).
6
Connect the bottle adapter attached to the anesthesia bottle, to the bottle adapter connection port.
7 Install the vaporizer (sold separately) onto the vaporizer mounting stand and clamp in place.
II .Pre-usage operation checks

Check the supply gas pressure
a) Check that the O2, N2O, AIR in-hospital gas supply pipe pressures are within the range of “350 to 500kPa”.
1
b-1)Check that the O2 support cylinder supply pressure is “50x100kPa” or more.
b-2)Check that the N2O support cylinder supply pressure “40x100kPa” or more.
b-3)Check that the AIR(option set prior to shipment)support cylinder pressure is “50x100kPa” or more.
Checks during power-on
a)Set the power switch to “ON” and check that when the STBY/ON switch is set to “ON”, the startup screen (BAG mode) is
displayed.
2
b) Check the state of the operation power supply and battery.
c)Check the cumulative usage time on the device.
Check the flow rate meter

a-1)Press the select button for N2O and AIR and check that switching is performed.
a-2)Check that only O2 and AIR flow when the device is not operating.
3
b)Check that the float rises to a position of “10L/minute” or more when the O2 and N2O or AIR Flow rate control knobs are
fully open,
c)Check that the float stops at the bottom-most position and the gas flow stops when the O2 and N2O or AIR Flow rate
control knobs are fully closed.
Check the safety devices
a)Check that due to the interlocking gear, increasing the N2O flow rate also increases the O2 flow rate. On the other hand,
4 also check that reducing the O2 flow rate also decreases the N2O flow rate which is linked by the interlocking gear.
b)Check that when O2 and N2O are both flowing, disconnecting the O2 Pressure tube from the in-hospital gas supply pipe,
the whistle tone sounds and that the N2O is shut off.
Check that reconnecting the O2 Pressure tube stops the whistle tone and that the N2O once again starts to flow.
１５－2
c)N2O cutoff
c-1)Check that when O2 is not flowing, there is no flow of N2O.
4
c-2)Check that the N2O is cutoff when the O2 is 0.1L/minute or less.
c-3) Check that the N2Ois cutoff when the O2 concentration is18% or less.
5 Close the APL valve and check that when the O2 flush button is pressed, the respiratory bag swells up and O2 is supplied.
6 Test (leak test) the respiratory circuit.
a)Check that numerical values are displayed on the O2 concentration (conc.) display section.
7
b)Calibrate the O2 sensor.
Check the vaporizer

a-1)Set the injection vaporizer to “Startup-Prep” and check that the numeric values on the anesthesia gas concentration
indicator light up.
a-2) Check that turning the anesthesia gas concentration dial increases and decreases the numeric value displayed on the
anesthesia gas concentration indicator.
8 a-3) Set the injection vaporizer to “INJ END Preparation” and check that the numeric value displayed on the anesthesia gas
concentration indicator turns off.
b) Start the O2, N2O or AIR flowing and check that the flow rate value is displayed on the flow rate indicator and that the
numeric value matches the value displayed on the glass tube flow gauge.
c-1)Check that the injection vaporizer does not start up when the bottle adapter is not connected.
c-2) Check that the injection vaporizer does not start up when the concentration adjuster dial on vaporizer is at “ON” while
the MK-5i/s vaporizer or another company’s vaporizer is mounted.
Check the alarm devices
a)Check that the power failure alarm operates correctly.
b)Check that the INJ Bottle connection alarm operates correctly.
c)Check that the INJ vaporizer nonusable alarm operates correctly.
d)Check that the INJ Bottle empty alarm operates correctly.
e)Check that the INJ excessive setting alarm operates correctly.
f)Check that the fresh gas flow excessive alarm operates correctly.
g)Check that the fresh gas ratio alarm operates correctly.
h)Check that the O2 flow shortage alarm operates correctly.
i)Check that the O2 concentration lower limit alarm operates correctly.
j )Check that the O2 concentration upper limit alarm operates correctly.
k)Check that the O2 sensor Not connected alarm operates correctly.

9
l )Check that the Drive gas pressure alarm operates correctly.
m)Check that the O2 supply pressure alarm operates correctly.
n)Check that the low inspiratory pressure alarm operates correctly.
o)Check that the excess pressure alarm operates correctly.
p)Check that the inspiratory pressure alarm operates correctly.
q)Check that the setting error alarm operates correctly.
r)Check that the apnea alarm operates correctly.
s)Check that the O2 sensor communication error alarm operates correctly.
t )Check that the MV upper limit alarm operates correctly.
u)Check that the MV lower limit alarm operates correctly.

v)Check that the alarm sound pause operates, and that the alarm sound is restored 2 minutes afterwards.(Check by way of
the low inspiratory pressure alarm, when the alarm sound pause is set to “2 minutes”.
w)Check that the alarm volume can be normally adjusted.(Check by way of the low inspiratory pressure alarm)
If the flow rate value on the flow rate indicator does not match the value shown on the glass tube flow gauge, then calibrate
10
the flow rate sensor.
Check ventilator
11 a)Check that operating the selector switches the operating status display.
b)Check that each respiratory mode operates correctly.
１５－3
c)Check that each type of measurement value and waveform is displayed.
11
d)Check that the trigger operates correctly during PSV.(PSV:option prior to shipment)
12 Check that the mounted vaporizer operates correctly.(vaporizer sold separately)
１５－4
ACOMA Anesthesia System PRO-NEXT+i Pre-usage inspection table
●This inspection table sheet is the original. Make copies for actual use.
●If inspection and check items are normal then enter a checkmark (✓) within the box.
●If there is a problem or error then enter an x and enter the symptoms in the remarks box.
Production No. or Control No
Mo. / Dy. / / / / / /
Inspector
I.Pre-usage preparation
Connect power cable, check lock, connect
1
clamps
2 a)Install support cylinders
b)Connect Pressure tubes and piping
connectors
c-1)Connect surplus anesthesia gas removal
tube
c-2) Connect surplus anesthesia gas
removal tube for monitor
Install O2 sensor unit
3
Connect cable
4 a)Connect respiratory circuit set
b)Attach breathing bag
c) Connect ventilator tube

d) Connect surplus anesthesia gas removal
tube
Fill a specified amount of CO2 absorbent,
5
Attach the canister chamber
Attach the anesthesia bottle
6
Connect the bottle adapter
7 Install and clamp the vaporizer
II.Pre-usage operation checks

1 a)Check the in-hospital supply pipe pressure
b)Check the support cylinder supply
pressure
a)Check that the main unit power is “ON”,
2
check the start-up screen
b)Check the operation power supply, and the
battery status
c)Check the cumulative time
3 a-1)Check the switching by the select button

a-2)Check the O2-AIR flow rate while not in
operation
b)Check flow rate adjuster knob at fully open
c) Check flow rate adjuster knob is fully
closed, and gas turns off
4 a)Check interlocking gear
b)Check whistle tone, and N2O cutoff
c)Check N2O cutoff
5 Check O2 flush operation
6 Check respiratory circuit test(leak test)
１５－5
7 a) Check display of O2 concentration
b)Calibrate the O2 sensor

a) Check that anesthesia conc. indicator
8
light turns on/off, check anesthesia conc.
setter dial operation
b) Check display value on glass tube and
flow rate indicator
c) Check injection vaporizer non-operation
due to certain conditions
9 a)Check power failure alarm operation
b)Check INJ Bottle connection alarm
operation
c) Check INJ vaporizer nonusable alarm
operation
d)Check INJ Bottle empty alarm operation
e)Check INJ excessive setting alarm
operation
f)Check fresh gas flow excessive alarm
operation
g)Check fresh gas ratio alarm operation
h)Check O2 flow rate too low alarm operation
i)Check O2 conc. lower limit alarm operation
j)Check O2 conc. upper limit alarm operation

k)Check O2 sensor Not connected alarm
operation
l)Check Drive gas pressure alarm operation
m)Check O2 gas pressure alarm operation

n)Check low inspiratory pressure alarm
operation
o)Check excess pressure alarm operation
p)Check inspiratory pressure alarm
operation
q)Check setting error alarm operation
r)Check apnea alarm operation

s) Check O2 sensor communication error
alarm operation
t)Check MV upper limit alarm operation
u) Check MV lower limit alarm operation

v)Check alarm sound pause-restore
operation
ｗ)Check alarm volume adjust operation
Calibrate if mismatch between display value
10
on glass tube and flow rate indicator
11 a)Check ventilator operation display
b)Check operation in each respiratory mode

c)Check each measurement value, and
waveform display
d)Check trigger operation during PSV
12 Check operation of mounted vaporizer
Remarks
１５－6
Inspection items during usage
III. Operation preparation during use
1 Check that each in-hospital gas supply pipe pressure for O2, N2O, AIR is within the specified range.
2 Check that the respiratory circuit set (tube set) is securely connected and there is no damage or gas leakage.
3 Check if excessive water is possibly accumulating inside the respiratory circuit (tube) or the drain cup.
4 Check that the preset anesthesia gas concentration and ventilation conditions are being maintained.
5 Check that the preset alarm conditions are being maintained.

Check from the patient’s chest movement and the circuit pressure meter operation that ventilation is being performed
6
normally.
7 Check that Vti / MV and O2 content are the desired values.
8 Check that ventilation by way of the respiratory bag is being performed normally in BAG mode.
１５－7
ACOMA Anesthesia System PRO-NEXT+i In-use inspection table
Production No. or Control No
Mo./Dy. / / / / / /
Inspector
III. In-use operation checks

Check the in-hospital gas supply pipe
1
pressure
2 Check the respiratory circuit connections
Remove excess water from the respiratory
3
circuit and drain cup
4 Check that set state is being maintained
Check that the alarm settings are being
5
maintained
Check for normal ventilation operation,
6
check that there are no abnormal sounds or
odors
7 Check actual measured values
Check that ventilation operation is normal
8
during BAG mode
Remarks
１５－8
After-use inspection items
IV. After-use operation checks
1 Ending vaporizer operation
a) Stop the injection vaporizer that is being used and remove the bottle adapter from the mounting port.
b) Set the vaporizer concentration adjuster dial on the MK-5i/s vaporizer or other company’s vaporizer being used to “OFF”
2 Switch the BAG-VENT selector to “BAG”.
3 Turn the flow rate adjuster knob of the gas being used “clockwise” to stop the gas flow.
4 Set the STBY/ON switch to “STBY” and turn “OFF” the power switch.
Shut off the supply gas.
5 a)Remove each O2, N2O, and AIR Pressure tubes from the in-hospital gas supply pipes.
b)Close the cylinder head “valve” securely when using the support cylinder.
6 Remove the power cable plug from the socket.
7 Remove all disposable items and dispose of them in a safe manner.
8 Dismantle the intake (inspiratory) and exhaust (expiratory) valves and clean them.
Remove the canister chamber from the canister.
9
Discard the CO2 absorbent and clean the chamber interior.
Remove the drain cap and throw away water accumulated inside it.
10
Disinfect, sterilize, and clean the drain cup.
Take the bellow unit out of the main unit.
11
After dismantling the bellows, disinfect, sterilize, and clean it.
Thoroughly dry all the items that were disinfected, sterilized, and cleaned.
12
Reassemble the dismantled items and install them.
Check for any external damaged/broken locations.
13
Clean locations contaminated with chemicals or blood, etc.
Record the cumulative time. Check the inspection periods via the usage time and periodic inspection tags. If the inspection
14
period has arrived then quickly take measures to perform an inspection.
If not using for an extended period of time:
15
Then check the remaining power on the internal battery once every 3 months to ensure a fully charged state.
１５－9
ACOMA Anesthesia System PRO-NEXT+i After-usage inspection table
Production No. or Control No.
Mo. / Dy. / / / / / /
Inspector
IV. After-usage checks

Stop the injection vaporizer and remove the
1
bottle adapter
O2 conc. adjuster dial is “OFF”
2 BAG-VENT selector switches
3 Gas flow is stopped on flow rate meter
4 Main unit power switch is “OFF”
5 Remove each pressure-resistant pipe
Support cylinder valves are shut
6 Power plug is removed
7 Disposable items are discarded

Dismantle and clean Inspiratory valves &
8
expiratory valves
9 Remove CO2 absorbent and clean chamber
Remove drain cup, remove moisture, and
10
clean
11 Take out bellows unit, dismantle and clean
Dry parts that were cleaned, and
12
reassemble and install into main unit.
Inspect & check external appearance and
13
clean
Take measures to record cumulative time
14
and inspect.
Check remaining battery power once every 3
15
months.
Remarks
Maintenance record
1,000 hour periodic inspection
Mo. / Dy. / / / / / /
Checker’ stamp
5,000 hour overhaul

Mo. / Dy. / / / / / /
Checker’ stamp
１５－10

Acoma PRO NEXT+iüiIM V1.02E) 20140407

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TABLE OF CONTENTS

Chapter 1 Ensuring safe operation·········································1-1-14

Compulsory and/or command item

・Display shown to express lethal or extremely serious and irreversible

・Shown to indicate a state where errors in handling might cause a

・ Shown to indicate notable items handy to know about, such as

O Power switch OFF

IEC symbol expressing standby state

IEC symbol expressing B type mounting

～ IEC symbol expressing alternating current

IEC symbol urging caution to follow usage instructions

Symbol indicating alarm volume is continuously adjustable (non-stepped)

Symbol indicating stop or muting of alarm sound

Symbol indicating starting or restoring alarm sound

Symbol for “BAG” indicating “hand-operated” breathing by respiratory bag

Symbol for “VENT” indicating “automatic breathing” by artificial respirator

Symbol indicating AC power is being supplied

Symbol indicating battery is being charged

[Display shows extent of injury and loss-damage]

-Shown to indicate patients where usage is not allowed due to patient

Indicates a "Prohibited" item so never attempt this action.

Indicates a "compulsory" or "command" item so always perform this action.

<Terms used in this manual>

<Carefully read the attached text>

Data output cable must be shorter than 3 meters

<Making connections & attachments>

Check that the joint cap is connected

Be sure to use an O2 concentration meter

Fasten devices on the monitor shelf with straps to prevent

Take adequate precautions against “residual gas” in the

Close the valve after using the support cylinder

<Usage environment & conditions>

<Caution items involving usage methods>

If the injection vaporizer “operates” during vaporizer use

Check that the vaporizer is securely clamped

Handle gently and carefully

Keep water or chemicals away from the unit

The alarm volume involves patient safety so set loud

Be aware of the N2O flow rate (non-attached interlocking

Be aware of flow rate ratio setting errors when using O2 and

<Measures to take during breakdowns and abnormalities>

To prevent fires and so on in sections in contact with O2 do

Leaving open and unsealed CO2 absorbent and leaving

Do not use in a state where there is a problem or

Do not dismantle or modify

Do not scratch or damage the power cable

Do not use benzene or thinner, etc.

Don’t let the cable of an electrical scalpel or similar item

Do not attach unauthorized parts to the side rail

<Making connections & attachments>

Avoid joint use with items that cannot maintain a secure

Avoid joint use that might cause blockages connections,

Avoid joint use with items that cannot be easily

Do not directly touch CO2 absorbent material

Do not fill above a fixed quantity

<Operation & adjustments>

Don’t change the flow rates during “calibration”

Do not remove just the anesthesia bottle

Do not pull on the control cable

Don’t take your eyes off the circuit pressure gauge

<Making connections & attachments>

Insert plugs securely into unused gas pocket ports

Discharge the gas before installing the Aux. cylinder