Anesthesia machine

Vaporizers
is a device generally attached to an anesthetic machine which
delivers a given concentration of a volatile anesthetic agent.
It works by controlling the vaporization of anesthetic agents
from liquid to the fresh gas flow.
FACTORS THAT AFFECT
VAPORIZATION
-Temperature
-Volatility
-Surface Area of the Liquid
-Gas Flow over the Liquid
 Filling Systems :
- Screw Fill (old fashion )
- Key Fill Systems : pin safety system is based on color
coding for agents, The various parts are made to align and fit
into each other like a key in a lock.
- Quick-Fill : bottles are sealed and the agent specific filling
device is fitted permanently on to the neck with a tamper
proof crimped metal seal
INTERLOCK DEVICES :
To prevent more than one vaporizer from being turned
on at the same time.
Mac
 MAC (minimum anesthesia concentration): the
concentration of a vapour in the lungs that is needed
to prevent movement (motor response) in 50% of
subjects in response to surgical (pain) stimulus
 Nitrous oxide - 104
 Desflurane - 6.6
 Sevoflurane - 1.8
 Isoflurane - 1.17
 Halothane - 0.75
 I metabolic rate

↓ metabolic rate

dominican
Bpy metabolic
↳
Ghlpnofic
602

↑ metabolic rate

↑ metabolic rate
↑ metabolic rate

B blockers

MAC t.IM 416 &

Breathing System
 Breathing circuits link a patient to an anesthesia
machine .

 Many modifications in circuit design have been

developed, each with varying degrees of efficiency,
convenience, and complexity.

 This will reviews the most important breathing

systems: insufflation, Mapleson circuits, the circle
system
research idea which anesthesia
provider have higher anesthesia intake
:

children provider gases

/ adult .

INSUFFLATION??
↳ induction with inhalation anesthesia
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 The term insufflation is the blowing(‫) نفخ‬of anesthetic

gases across a patient's face.

 Insufflation is categorized as a breathing system, it is

perhaps better considered a technique that avoids
direct connection between a breathing circuit and a
patient's airway
 insufflation avoids any direct patient contact, there is
no rebreathing of exhaled gases .
??
 Because children often resist the placement of a face mask
or an intravenous line, insufflation is particularly
valuable during pediatric inductions with inhalation
anesthetics.
The insufflation has several disadvantages:??

 poor control of inspired gas concentration and depth of

anesthesia,
 inability to assist or control ventilation,
 difficult airway management during head and neck
surgery, and
-

 pollution of the operating room with large volumes of

waste gas.
• not cost efficient
Anesthetic Breathing Systems

A breathing system is defined as an assembly of components,

which connect the patient’s airway to the anesthetic machine
• FUNCTIONS

 delivery of anesthetic gases and vapors;

 oxygenation of the patient

 CO2 elimination
Mapleson Circuits

 The Mapleson systems solve some of these problems

by incorporating additional components :

 breathing tubes,
 fresh gas inlets,
 adjustable pressure-limiting [APL] valves, and
 reservoir bags) into the breathing circuit.
Mapylson CLASSIFICATION :

 MAPLESON A( magil system or lack system)

 MAPLESON B
 MAPLESON C
 MAPLESON D (Bain’s system)
 MAPLESON E
 MAPLESON F(Ayres T Piece System)
 Anesthesia Monitor??
Respiration ↑ RR ✗ VT

Ventilation - (Respiratory rates, tidal volumes,↑ minute ventilation), Airway

pressures
no °z/C0
Gas Exchange - FiO2 (inspired oxygen), Pulse oximetry, (Capnography -
expired carbon dioxide)

&Ñmu :

✓ T :

*
coz indicates ventilation spoz
↳ % Venti J
, Wgp ETCOZ
•
flow@%

-
speed of washing of coz → VT

quint ity of washing of coz qespi wane

→ Bp
↳ RR b
MAP
 Anesthesia Monitor??
Circulation
• Electrocardiogram (ECG)
• Blood Pressures
• Non-invasive blood pressures (NIBP)
not
basic
-
• Invasive Blood Pressures
• CVP → Central venous pressure

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ca program
} important
Pulse oximeter :-#
*
.
& ←
SPO 2
Anesthesia ventilator
 Most modern anesthesia machines are fitted with a
mechanical ventilator that uses a collapsible bellows
within a closed chamber.

 a mechanized substitute for the manual squeezing of the

reservoir bag of the circle system
BAG IN A BOTTLE, DOUBLE
CIRCUIT ANESTHESIA VENTILATOR
 Bellows assembly consists of a rubber or latex-free material
bellows in a clear rigid plastic enclosure. Inside of the
bellows is connected to the breathing system.
 Pressurized oxygen or air from the ventilator power outlet
(45–50 PSIG) is routed to the space between the inside wall
of the plastic enclosure and the outside wall of the bellows.
Classification of anesthesia
ventilators:
 Power source:
1. Compressed gas
2. Electricity
 Bellows
1. Ascending (standing) bellows
2. Descending (hanging) bellows
Anesthesia ventilator
 Modes:
1. Volume controlled mode (VCV)
2. Pressure controlled mode (PCV)
3. Synchronized intermittent mandatory ventilation
mode (SIMV)
4. Pressure support mode (PSV )
 8mV mechanical
µ rent

Volume controlled mode (VCV)??

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↳ ↳ Predetermine
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w ,
vcv
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) *
+ RR
5 : E -01 : 2 #

 This mode is used in patients with no spontaneous effort

such as those in comatose states or pharmacologically MR
paralysed. The ventilator does not respond to spontaneous '

↳ sensitive &
breaths or changes in flow requirements. → ÷a
EeYa¥ed←→
 With volume-controlled modes, the clinician must set the
flow rate, EEggfEBTggz8TtAgE
triggerosensitivity, tidal volume, respiratory rate,
positive end-expiratory pressure (PEEP), and fraction of
5 / off
3- ↳ basic
inspired oxygen (FiO2). normal Éñ←
not

 A volume-controlled mode thus ensures that the patient

will receive a specific tidal volume.

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 Synchronized intermittent mandatory ventilation mode
controls Pressure
694.6%462 SIMV

2%16658 (SIMV )?? trigger

↳ controlled
{ volume

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p
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≤ ↳
→ triggers ,
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pressure
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negative
Pressure @← j.gs
← 9
↳
negative #i → spontaneous breath
→
→

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 Synchronized intermittent mandatory ventilation (SIMV) is a

type of volume control mode of ventilation. With this mode, the
ventilator will deliver a mandatory (set) number of breaths with
a set volume while at the same time allowing spontaneous
breaths. C- ] airway pressures end enpi
pressure
 Spontaneous breaths are delivered when the airway pressure
drops below the end-expiratory pressure ( trigger).
 In contrast, to assist control ventilation (ACV), SIMV will deliver
spontaneous volumes that are 100% driven by patient effort.
[O - CZ Cm H2O

 Pressure support (PS) may be added to enhance the volumes of

spontaneous breaths. ↳ { Wish # ,

 You must site (tidal volume , PEEP, RR, Fio2, PS)

↳ ICUS
 Pressure controlled mode (PCV)??
↳ Die > I 318
, .
pressure
18cm H2O
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big us
°
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18 -
20 cm H2O

 determines the pressure which is administered to the patient’s

lungs. The inspiratory pressure (pInsp) is used as the control
variable. VT ☆ -25b¥ # d) Is %

 The tidal volume is determined by the compliance of the lungs

and the applied pressure.
 This mode is used on patients who have no spontaneous
respiration .
 The following ventilation parameters can be set:
 pInsp: Inspiratory pressure in mbar
: Freq.: Ventilation rate
☆ PEEP: Positive end-expiratory pressure in mbar not basic →

☆ I:E: Inspiratory-expiratory time ratio

 basic modeobssmv ,
5mV , PCV

Pressure support mode (PSV )??

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↳
↳ spontaneous
breathing mode D8
↳ I 2L
¥4,614s 24min * spontaneous
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~É%&'s sponu-a.j.gl breathing
breathing
 Pressure support ventilation (PSV) is a mode of positive pressure
mechanical ventilation in which the patient triggers every
breath.
 PSV is deliverable with invasive (through an endotracheal tube)
I

or non-invasive (via full face or nasal mask) mechanical

ventilation.
 This ventilator mode is the most comfortable for patients and is a
useful ventilator setting for weaning from invasive ventilation
and for providing supportive care with non-invasive ventilation.
 Settings for PSV mode include positive end-expiratory pressure
(PEEP), and the fraction of inspired oxygen (FiO2).
 noninvasive ventilation (NIV)??
↳ Facemask ( good fitting 9- or the face to reduce
Leakage )

 continuous positive airway pressure (CPAP) and

a

bilevel positive airway pressure (BPAP): CPAP delivers

a single pressure during the respiratory cycle, and
BiPAP delivers two different pressures. breathing weak
↑
 Remember with continuous positive airway pressure
Ii ←

tho 'd (CPAP) ventilation, constant pressure is delivered over

time. ↳ positives@# ( OSA )
is
min
in
30 .m
.

 With BiPAP two different pressures are delivered, one

duringc.inspiration and one during expiration.@ PD)
↳& #
2 Pressures
atelectasis •
of any cause
Cpap mask
Typical Ventilator Alarms:
 High pressure
 Pressure below threshold for 15–30 seconds (apnea or
disconnect)
 Low tidal or minute volume
 High respiratory rate
 Low oxygen-supply pressure.
Control knobs of ventilator
 I/E ratio
 Respiratory Rate :R/R
 Tidal Volume : v/t
 PEEP
 Minute volume : M/V
 Pressure support : P\S
Questions