02 PHYSICS
72. Safety features
of the anaesthetic
machine
Despite the advances in technology and the development of newer and more sophisticated anaesthetic machines,
it is still an essential requirement to understand the safety features governing the use of such devices.
What are the principal
functions of the anaesthetic
machine?
What are the safety features
of an anaesthetic machine?
220
9781785230981_text.indb 220
> To receive compressed gases from their supplies (pipeline or cylinder)
> To accurately and continuously deliver a gas and volatile mixture of the
desired composition
> To avoid delivering hypoxic gas mixtures
> To deliver a gas mixture to the patient at a safe pressure (to avoid
barotrauma)
One of the most important safety features is the presence of a trained,
competent anaesthetist and a serviced and checked anaesthetic machine.
A pre-use check to ensure the correct functioning of the anaesthetic machine
and equipment is essential to patient safety. The importance of this check is
recognised internationally and is included in the World Health Organization
Safer Surgical Checklist. Prior to commencing any anaesthetic, it is essential
to have a self-inflating bag, an alternative source of oxygen (e.g. a cylinder),
relevant airway equipment and emergency drugs immediately available.
The anaesthetic machine itself has numerous safety features built in and in
order not to miss anything, it is best to breakdown the anaesthetic machine
into systems and work your way from the back of the anaesthetic machine
to the common gas outlet.
Power supply and battery back-up
> Modern anaesthetic machines have visual and audible indicators to alert
the anaesthetist of a power failure.
> A back-up, re-chargeable battery is present, and this must be checked
as part of the Association of Anaesthetists of Great Britain and Ireland
(AAGBI) anaesthetic machine check to ensure it is charged.
Gas supplies
> Pipeline – colour-coded, flexible hosepipes (black = air, white = oxygen
and blue = nitrous oxide) connect to the wall via a Schrader valve (gas
specific and non-interchangeable) and connect to the back of the
anaesthetic machine via non-interchangeable screw threads (NIST – gas
specific and permanently fixed).
24/02/16 9:36 pm
 SAFETY FEATURES OF THE ANAESTHETIC MACHINE

> Cylinders – colour-coded gas cylinders (oxygen = black body with white
shoulder, nitrous oxide = blue body with blue shoulder and air = black
body with white and black shoulders) act as an emergency source of
gases should primary piped gas delivery fail. They connect to the back
of the anaesthetic machine via a pin-indexed system (oxygen = 2.5,
nitrous oxide = 3.5 and air = 1.5) incorporating a Bodok seal to make the
connection gas-tight. They are now made of molybdenum steel, which is
lighter and stronger than its carbon steel predecessor.
> Pressure regulators reduce the pressure of cylinder gases to
approximately 400 kPa (i.e. the same as piped gas pressure), thereby
protecting the anaesthetic machine from damage due to high gas
pressures.
> Pipeline and gas cylinder pressure indicators (traditional machines used a
Bourdon gauge).
Gas flow measurement and control
> Flow control needle valves govern the transition from high- to low-
pressure systems, reducing the pressure from 4 bar to just above
atmospheric pressure as gas enters the flowmeter block.
> Flowmeters can be mechanical or electronic.
• Mechanical – rotameters are the conventional mechanical flowmeter.
They are constant pressure, variable orifice flowmeters, which
allow fresh gas flow rates to be regulated and measured (calibrated
to individual gases as the density and viscosity of the gases are
important). Oxygen is the last gas to be added to the fresh gas
flow, which prevents delivery of a hypoxic gas mixture should a
proximal crack in the flowmeter occur. Rotameters are produced
with anti-static material to prevent the bobbin ‘sticking’, which could
result in inaccurate fresh gas flow measurement. The control knobs
are labelled and colour-coded. The oxygen control knob is larger,
protrudes further and is grooved to allow differentiation from the air
and nitrous oxide control knobs.
• Electronic – modern anaesthetic machines use microprocessors to
control gas flow and the flow is indicated either electronically by a
numerical display or using virtual flow tubes. There is a pneumatic
back-up in the event of a power failure, which continues the delivery
of fresh gas. Some systems allow low flow rates (<500 mL/min) to be
utilised, reducing cost and pollution.
> Anti-hypoxic mixture devices prevent the inadvertent delivery of a
hypoxic-inspired gas mixture, and they can be mechanical, pneumatic or
electronic.
• Mechanical devices use a chain to link the nitrous oxide flow to a
minimum oxygen flow.
• Pneumatic devices use a ratio mixer valve.
• Electronic devices use a paramagnetic oxygen analyser to
continuously sample the gas mixtures from the flowmeters.
Vaporisers
> They sit on the back bar of the anaesthetic machine and convert volatile
liquid into vapour and add a controlled amount of volatile to the fresh
gas flow. The common manifold systems that prevent the use of more
than one vaporiser at any time are the Selectatec type (Ohmeda) and the
Interlock type (Drager).

221

9781785230981_text.indb 221 24/02/16 9:36 pm

 02 PHYSICS
> They are colour-coded (blue = desflurane, yellow = sevoflurane and
purple = isoflurane) and have a liquid-level indicator. The modern devices
have a non-spill reservoir allowing up to 180 ° of tilt.
> Filling devices are geometrically coded and agent specific, designed to
prevent incorrect vaporiser filling.
> Back-bar pressure relief valves are situated downstream of the
vaporisers and vent off gas mixtures at pressures greater than 35 kPa.
This prevents barotrauma to the flow meters and vaporisers but not the
patient.
Oxygen failure warning device
> British standards specify that the alarm should be powered solely by the
oxygen supply pressure. It is activated when the oxygen supply pressure
falls below 2 bar and when this has occurred flow of all other gases
ceases and atmospheric air is entrained. The alarm produces a sound of
at least 60 dB for a minimum 7 seconds.
Oxygen flush
> 100% oxygen is supplied from the high-pressure circuit upstream,
bypassing flowmeters and vaporisers, and is delivered at rates between
35 and 75 L/min and a pressure of about 400 kPa.
> There is a risk of barotrauma and of anaesthetic agent dilution with its
use.
Adjustable pressure-limiting valve
> Allows excess gas to escape when a preset pressure is exceeded,
thereby reducing risk of barotrauma to the patient.
Common gas outlet
> Standardised 22 mm male outer diameter/15 mm female internal
diameter connection accommodating only breathing system attachments
(circle or T-piece).
Monitoring
> Monitors have now become integrated within modern anaesthetic
machines. Oxygen, inhalation agent and end-tidal carbon dioxide
concentration analysers, gas volume and airway pressure measurements
are all essential and are monitored and displayed on LED screens.
> Prioritised preset alarms with audible and visual components exist. Alarm
limits can also be individualised and the monitor settings can be changed
(e.g. local anaesthesia, cardiopulmonary bypass or to detect pacing
spikes).

222

9781785230981_text.indb 222 24/02/16 9:36 pm