VAPORISERS

77. Vaporisers
Classify the types of vaporiser in A vaporiser is a device used during inhalational anaesthesia to administer a
use. given concentration of a volatile anaesthetic agent. There are various types
on the market and they can be classified as follows:

Vaporisers

Variable Bypass Vaporisers Measured Flow Vaporisers

Plenum Vaporisers Desflurane Vaporiser

for for
Halothane Desflurane
Enflurane e.g.
Isoflurane
Sevoflurane Tec 6® - (GE)
e.g. D Vapour 2000® -
Tec 5® & Tec 7® - (GE) SIGMA ALPHA® - (Penlon)
Vapour 2000® - (Drager)
SIGMA DELTA® - (Penlon)

Plenum Vaporisers Direct Injection of

with Volatile Anaesthetic
Electronic Control Vaporiser
for (DIVA)
Halothane for
Enflurane Halothane
Isoflturane Enflurane
Sevoflurane Isoflurane
e.g. Sevoflurane
Aladin Cassette Vaporiser® - (GE) Desflurane
e.g.
The Drager DIVA®
The Maquet 950® Series

Fig. 77.1  Classification of vaporisers

How do variable bypass plenum
vaporisers work?
Variable bypass vaporisers work as the name suggests. There are two
possible paths for fresh gas to flow through the vaporiser: via the vaporising
chamber itself or via the bypass pathway. Gas, which enters the vaporising
chamber, becomes fully saturated with vapour. As it exits the vaporiser it is
reintroduced to the vapour-free bypass gas and the two mix. This mixture
is then delivered to the patient. The resulting concentration of volatile agent
present in the mixture depends on how much fresh gas went through each
of the pathways.

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The path of the fresh gas flow is determined by the ‘splitting valve’, which
is attached to the control dial on the outside of the vaporiser. This dial is
calibrated from 0 to 5% for isoflurane and 0 to 8% for sevoflurane. When
it is turned to zero, the valve is closed and no fresh gas flows through the
vaporising chamber. As the anaesthetist turns the control dial to deliver a
higher concentration of volatile, the splitting valve opens wider, allowing a
greater proportion of the fresh gas flow to travel though the volatile chamber.
The ratio of fresh gas flowing through the chamber to that flowing via the
bypass pathway is called the ‘splitting ratio’.

Temperature
compensation
valve
Non-return valve

Inlet Patient

Cold Hot

Bimetal
strip

Concentration
control valve

Baffles

Wick
Anaesthetic
vapour is
entrained in flow

Liquid
anaesthetic
Fig. 77.2  Variable bypass (plenum) vaporiser

What are the potential problems
with this device and how are they
overcome?
Chapter 62
Problem A high fresh gas flow through the vaporiser could affect its output because it
may result in insufficient vapour being available to fully saturate the fresh gas
passing through the chamber.
Solution Inside the vaporising chamber a series of wicks and baffles are dipped into the
volatile liquid. This greatly increases the surface area of volatile anaesthetic
exposed to fresh gas flow, ensuring that the gas leaves the chamber fully
saturated. In this way, the output concentration is independent of flow.
Problem As an anaesthetic liquid turns to vapour it absorbs energy (the latent heat of
fusion – see Chapter 62, ‘States of matter’). Consequently, there is a fall in
the temperature of the liquid in the chamber, which leads to a decrease in
the rate of vaporisation because fewer molecules will have sufficient energy to
evaporate. This leads to a fall in the SVP of the volatile and so to a fall in the
concentration of anaesthetic agent delivered to the patient. This effect is more
Solution marked at high flow rates when the rate of vaporisation increases.
Plenum vaporisers are not electrically heated however, their casing contains
copper, which is a very good conductor of heat from the environment and so
conducts energy to the liquid as it cools, helping to mitigate this effect.
The addition of a ‘bimetallic strip’ helps to compensate for fluctuations in
output due to temperature. As the chamber cools, the two different metals
comprising the strip contract to different degrees and cause the strip to bend.
This increases the splitting ratio of the free gas flow as the temperature drops
and vice versa.

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Describe the plenum vaporisers
with electronic control.
Why is it necessary to have
a special vaporiser to deliver
desflurane?
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VAPORISERS
Problem The ‘pumping effect’. Positive pressure ventilation of the patient will cause
intermittent pressure changes, both upstream to the patient (desirable) and
downstream to the vaporiser (undesirable). If positive pressure is transmitted
to the vaporiser chamber, it can result in gas saturated with vapour being
displaced ‘backwards’ and into the bypass channel. As the positive pressure is
released, there will be an expansion of gas forward towards the patient. When
the vapour from the usually vapour-free bypass channel mixes with the fully
saturated gas from the vaporiser chamber it will result in an increase in the
concentration of anaesthetic agent delivered to the patient.
Solution
A non-return valve is inserted at the outlet of the vaporiser.
The vaporiser is designed to have a high internal resistance, to resist the
changes in flow caused by positive pressure ventilation.
Problem Incorrect anaesthetic liquid introduced to vaporiser.
Solution Standardised colour coding of vaporisers and bottles (sevoflurane – yellow,
isoflurane – purple, desflurane – blue), and keyed fillers reduce this risk.
Problem Over-filling can cause overdose and spillage of anaesthetic liquid onto the
patient circuit is potentially fatal.
Solution Low filling ports help to reduce the risk of overfilling. Transparent window with a
‘fill line’ is visible on the front of the vaporiser.
Problem Tipping. If the vaporiser tips past 45° anaesthetic liquid can obstruct the
valves and result in very high concentrations of vapour being delivered to the
patient.
Solution Take care when moving vaporisers. Regularly check the seating of the vaporiser
on the back bar.
These vaporisers are manufactured by GE, who have called them ‘Aladin
cassettes’. Although these cassettes look very different from the standard
plenum vaporisers, they function in essentially the same manner and
are colour-coded in the standard way. They can supply desflurane.
Each cassette is a sump for anaesthetic liquid and the concentration of
anaesthetic delivered to the patient depends on the splitting ratio of the free
gas flowing through the cassette, just as in the ‘ordinary’ plenum vaporisers.
Each different cassette plugs into a single slot in the front of the anaesthetic
machine during use (i.e. one cassette is removed and replaced with another
to change anaesthetic agent) and when it is inserted, it pushes open an
inflow and an outflow valve.
The electronic control mechanism is situated inside the anaesthetic machine
and the anaesthetist uses a digital display to programme the machine to
deliver a specified concentration of anaesthetic or to target an end tidal
concentration of anaesthetic agent.
These vaporisers are portable, can be tipped and are maintenance free but
they cannot be used without power.
The physical properties of desflurane made it necessary to design its unique
vaporiser.  Desflurane is extremely volatile and its boiling point is 23 °C
at atmospheric pressure, i.e. around room temperature.  Because of its
volatility, small changes in ambient temperature would result in large changes
in desflurane’s saturated vapour pressure (SVP) inside the vaporisation
chamber and this would affect the concentration of anaesthetic agent
delivered to the patient (see Chapter 62, ‘States of matter’ for a detailed
explanation of this concept).  This is not a problem with other volatile
anaesthetic agents, because their boiling points are well above room
temperature and so small variations in ambient temperature in theatre do not
have a clinically significant effect on the SVP inside the vaporising chamber.
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What considerations should be
taken when building a vaporiser?
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To overcome this problem, the desflurane vaporiser heats the anaesthetic
agent to precisely 39 °C to ensure a constant SVP.  Rather than free gas
flowing into the vaporiser as in the plenum vaporisers, the anaesthetic
vapour is injected into the free gas flow downstream of the vaporisation
chamber.  The anaesthetist will control the concentration of desflurane
delivered to the patient using a dial calibrated from 0 to 12%.  As the
setting of the dial increases, the resistance to the flow of desflurane into the
fresh gas flow decreases and more is injected, and vice versa.  The rate
of injection of desflurane must be adjusted according to the fresh gas flow
otherwise turning the gas flow up would result in a dilution of the anaesthetic
agent in the final gas mixture.  This coupling is achieved by an electronic
control unit in the vaporiser.
Inflow
Control Outflow
electronics
Differential
pressure
Sump transducer
shut-off
valve
Desflurane Pressure Concentration
vapour control control
valve
Desflurane
Sump at liquid
39°C
Fig. 77.3  Desflurane vaporiser
For completeness, we describe the DIVA (direct injection of volatile
anaesthetic) vaporiser very briefly, although it’s unlikely you’ll be grilled
about it…
The DIVA is a measured flow meter that can give all types of anaesthetic
agent, including desflurane. In simple terms, the anaesthetic is heated to a
specific temperature in an evaporation chamber before the vapour is passed
into the patient gas circuit. As in the desflurane vaporiser, a microprocessor
couples fresh gas flow to the rate of injection of the anaesthetic agent.
The properties of the anaesthetic to be delivered should be taken into
account. These are explained above, but listed below:
• Saturated vapour pressure at room temperature
• Boiling point at atmospheric pressure
• MAC of anaesthetic agent: range on dial must increase with MAC
such that:
o Isoflurane MAC = 1.15, range 0–5% on dial
o Sevoflurane MAC = 2.10, range 0–8% on dial
o Desflurane MAC = 6.00, range 0–12% on dial
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How are vaporisers affected by
altitude?
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VAPORISERS
There is no clinical difference in using the plenum vaporiser at altitude, but
the examiners seem to love this question because it brings out the physics
in you! The answer below may be long-winded and obvious to many, but
for the benefit of those of us who are mathematically challenged, here is the
explanation in words of one syllable.
Please start by looking at chapter 62 for an explanation of SVP.
Plenum vaporisers (e.g. Tec 5 and 7)
Although we dial up the percentage of anaesthetic agent we want to deliver
to the patient, it is not actually the percentage concentration of volatile being
inhaled that determines whether a patient is anaesthetised, but the partial
pressure of that volatile. Because we usually work at sea level at a pressure
of 1 atmosphere, the values for ‘percentage concentration’ and ‘partial
pressure’ delivered are happily inter-changeable (see proof below).
We can work out the partial pressure of a gas using Dalton’s law of partial
pressures, which states:
1 Each gas in a mixture exerts a pressure, known as its ‘partial pressure’,
that is equal to the pressure the gas would exert if it were the only gas
present. And for completeness, Dalton goes on to say:
2 The total pressure of the mixture is the sum of the partial pressures of all
the gases present.
At sea level
So, the partial pressure of sevoflurane delivered as 4% of a gas mixture at
sea level is:
• Psevoflurane = 4/100 × 1 atm = 0.04 atm (i.e. 4% of 1 atmosphere) and for
completeness:
• Ptotal = Psevoflurane + Poxygen + Pnitrogen + Pother gases
The partial pressure of sevoflurane may also be expressed using different
units of pressure, as follows:
• Psevoflurane = 4/100 × 101.3 kPa = 4.05 kPa (i.e. 4% of 101.3 kPa)
• Psevoflurane = 4/100 × 760 torr = 30.4 torr (i.e. 4% of 760 torr)
• Psevoflurane = 4/100 × 760 mmHg = 30.4 mmHg (i.e. 4% of 760 mmHg)
Remembering that:
1 atm = 101.3 kPa = 760 torr = 760 mmHg
Or:
0.04 atm = 4.05 kPa = 30.4 torr = 30.4 mmHg
At altitude
At 5.5 km or 3.5 miles high, ambient partial pressure reduces to 0.5 atm.
If we take our vaporiser up to this altitude and set it again to deliver
sevoflurane as 4% of the total gas mixture, we can use Dalton’s law once
more to work out the partial pressure of sevoflurane:
• Psevoflurane = 4/100 × 0.5 atm = 0.02 atm (i.e. 2% of 1 atmosphere)
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We can see that the partial pressure of the sevoflurane has dropped by half.
However, this is not the end of the story. At the top of our mountain, the
ambient pressure of air has dropped by half. Since the pressure inside the
vaporising chamber will be approximately equal to atmospheric pressure, as
this falls, the concentration of the volatile agent delivered by the vaporiser will
increase proportionately. The reasoning is described below, after a couple of
facts have been emphasised:
1 SVP does not change with ambient pressure. It only changes with
temperature.
2 The pressure inside the vaporising chamber will be approximately equal
to the ambient air pressure (there must be a small difference in pressure
between the two to cause flow of vapour out of the vaporiser).
Now consider the following three situations. In each, the only condition
that changes is the altitude and consequently, the ambient air pressure.
The temperature is kept at 20 °C. The SVP of sevoflurane at 20 °C is 100
mmHg (we will use mmHg in these calculations to make the numbers more
manageable).
1  At sea level at 20 °C
• Atmospheric pressure is 760 mmHg
• SVP of sevoflurane is 100 mmHg
This means that, per unit volume of gas leaving the vaporising chamber, 100
‘parts’ of the 760 will be sevoflurane and 660 ‘parts’ will be air.
This is true because Dalton’s law states:
• Ptotal = Psevoflurane + Pair
and so
• 760 mmHg = 100 mmHg + 660 mmHg
Therefore, the concentration of sevoflurane in the gas leaving the vaporiser
is 100/750 = 13%.
2  At an altitude of 5.5 km at 20 °C
• Atmospheric pressure is 380 mmHg
• SVP of sevoflurane is 100 mmHg (unchanged)
This means that, per unit volume of gas leaving the vaporising chamber,
100 ‘parts’ of the 380 will be sevoflurane and 280 ‘parts’ will be air.
Therefore, the concentration of sevoflurane in the gas leaving the vaporiser
is 100/380 = 26%.
3  At the bottom of a mine at 20 °C
• Atmospheric pressure is say, 1000 mmHg
• SVP of sevoflurane is 100 mmHg (unchanged)
This means that, per unit volume of gas leaving the vaporising chamber, 100
‘parts’ of the 1000 will be sevoflurane and 900 ‘parts’ will be air.
Therefore, the concentration of sevoflurane in the gas leaving the vaporiser is
100/1000 = 10%.
So (finally!) we can see that a vaporiser calibrated at sea level and set to
deliver 4% sevoflurane will actually deliver 8% at an altitude of 5.5 km.
Since the partial pressure of 4% sevoflurane at 1 atmosphere/760 mmHg
(0.04 atm/30.4 mmHg) is the same as 8% at 0.5 atmosphere/380 mmHg
(0.04 atm/30.4 mmHg) the clinical effect of the sevoflurane on the patient
remains the same. In this way, the anaesthetist can use the dial on the
vaporiser in the usual way to achieve anaesthesia.
Simples…!?

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 VAPORISERS
The measured flow vaporiser (e.g. Tec 6) at 5.5 km altitude
Unfortunately, the same is not true of the Tec 6 vaporiser. As explained
earlier, the Tec 6 heats desflurane to 39 °C to ensure that its SVP is constant
and so fluctuations in ambient temperature do not result fluctuations in
delivery of the anaesthetic agent. As a result, the SVP of desflurane inside
this vaporising chamber at 39 °C is 2 atmospheres, regardless of ambient
pressure.
Turning the dial on the Tec 6 vaporiser to 4% reflects the volume of gas
that will be injected into the fresh gas flow to result in a gas mixture of 4%
desflurane being delivered to the patient. However, as the desflurane leaves
the vaporiser at altitude, this is 4% of a much lower ambient pressure and so
the partial pressure of desflurane in the alveoli will be much lower.
Using Dalton’s law again, we can see why this results in a drop in the partial
pressure of desflurane being delivered when compared to sea level:
• Pdesflurane = 4/100 × 0.5 atm = 0.02 atm (i.e. 2% of 1 atmosphere)
Because of the way the vaporiser works, SVP remains constant at altitude.
This means the anaesthetist will have to dial in a higher percentage of
desflurane to achieve the same clinical effect at altitude as at sea level.

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