Anesthesia Machine

Purpose of Anesthesia Care

• Maintenance of Vital organ function
• Relief from pain
• Maintenance of Internal Environment
 Gases needed for the delivery of
Anesthesia
• Oxygen: Oxygen provides an essential metabolic substrate for all
human cells
• Air : The primary use of air during anesthesia is as a diluent to
decrease the inspired oxygen concentration.
• Nitrous Oxide: N2O is not an anesthetic, rather it is an analgesic and
an amnestic.
 Introduction
Anesthesia Machine is a device used
to provide an accurate and
continuous supply of medical gases (
such as oxygen and nitrous oxide ),
mixed with an accurate concentration
of anesthetic vapor (such as
isoflurane), and deliver this to the
patient at a safe pressure and
flow.
 Functions of Anesthesia Machine
• The primary function of any anesthetic machine is to deliver a precise
amount of oxygen and volatile anesthetic under controlled conditions
to patients undergoing general anesthesia.
 Types of Anesthesia
• Local Anesthesia: small, specific area of the body.
• Regional Anesthesia: a large or region of the body. e.g Hand,Legs
• General Anesthesia: Makes patient completely unconscious and with
no memory of surgical procedure upon awakening.
 Principle Of Operation
• A three gas system is used and infused into the subjects body. It
contains of nitrous oxide(N20) that is used to carry the anesthetic
gas. The third gas is Oxygen used by the subject to breathe when the
subject is the semi conscious state.
• A ventilator is used to breathe in and breathe out gases when the
patient is in the semi conscious state. Waste gases are taken out of the
subject using the waste gas scavenging system.
Cont.…
• Oxygen comes from either the low pressure source, or from the 15.2 MPa (2200 psi)
high pressure yokes via cylinder pressure regulators and then branches to service several
other functions.
• From 50 psi (345Kpa) to 20 psi then to needle valve and to flowmeter.
• From Oxygen flowmeter gas mixes with other types of flowmeter, and passes to vaporizer,
where specific inhalation anesthetic agents are vaporized and added to the breathing gas
mixture.
• When the oxygen pressure drops lower than 20Psi or lower, then the nitrous oxide
pressure sensor shutoff valve closes and N2O is prevented from entering its needle valve
and is therefore eliminated from the breathing gas mixture.
Cont.…
• In fact, all machines have pressure sensor shutoff valves installed in
the lines to every flowmeter, except oxygen, to prevent the delivery of
a hypoxic gas mixture in the event of an oxygen pressure failure.
• Hypoxic Guard systems are one of the safety systems in anesthesia
machine that are designed to avoid the risk of delivering a hypoxic gas
mixture to the patient during general anesthesia.
 ventilator
Flow
meter

vaporizer
bellow

Corrugated
APL valve
tube

Scavenging
Soda lime system
 Flow meter
• Flowmeter indicates the amount of each gas that is delivered, and the
operator can adjust the flowrate to get the desired ratio and total
volume.
• The dial of the flowmeter is turned on and either a ball or rotor rises
to the selected flow rate.
 Cylinder Regulator
• Regulates the pressure of the gas leaving the tank and going into
the anesthesia machine.
• Reduces the pressure of oxygen that leaves the tank at 2200 psi to a
safer 50 psi.
• They read and display the internal tank pressure.
• They meter out the precise flow for patient use.
 Vaporizer
• Converts the liquid anesthetic agent (usually
isoflurane or sevoflurane) into a vapor.
• Adds controlled amount of these vapors to
the carrier gas.
• The mixture of the anesthetic gas and
carrier gas is known as FRESH GAS.
• Once mixed, fresh gas cannot return to the
vaporizer.
 Vaporizer Interlock Mechanism
• Interlock between the vaporizers preventing inadvertent
administration of more than one volatile agent concurrently.
• If one vaporizer opens, the other locks.
 Reservoir Bag
• Fills as gases enter the circuit or patient exhales, deflates as
patient inhales.
• Provides low pressure gas storage to enable for assistant of the
patient when necessary.
FUNCTIONS
1) Stores gas
2) Allows assessment of respiratory rate and
depth
 Pressure Sensor Shut off Valve
• Oxygen supply pressure opens the valve as long as it is above a pre-set
minimum value (e.g. 20 psi)
• If the oxygen supply pressure falls below the threshold value the valve
closes and the gas in that limb (e.g. N2O), does not advance to its
flow-control valve.
 Breathing Circuits
• Open Circuit: no rebreathing of any gases and no CO2 absorber
present. There is a great potential for the patient to rebreath their
own exhaled gases unless the fresh gas inflow is two to three times
the patient’s minute volume.
• Closed Circuit: presence of CO2 absorber and some rebreathing of
other gases.
Open Circuit
Closed Circuit
 Circle System
• Circle is a closed system.
• It is a circle in that a continuous loop that recycles gas and anesthetic
agent from the patient.
 Forms of Ventilation
• Volume Ventilation: the volume of gas delivered to the patient
remains constant regardless of the pressure that is required.
• Pressure Ventilation: where the ventilator provides whatever
volume to the patient that is required to produce some desired
pressure in the breathing circuit.
Cont.…
• Fresh gas Inlet: The fresh gas inlet is where the gas from the
pneumatic part of the machine enters the circuit.
• Unidirectional Valve: One way valve
• The inspiratory and expiratory valves in the circle system
guarantee that gas flows to the patient from the inspiratory limb and
away from the patient through the exhalation limb.
 Oxygen Flush Valve (O2+)
• This valve allows a high flow oxygen to go directly to
the breathing system without going through a
flowmeter and vaporizer.
• Machine standard requires that the flow be between
35 and 75 L/min.
• The ability to provide jet ventilation.
• When connected to Central Gas Supply System or
Back-up Cylinder, even if the machine is power off,
press the “O2+” button, the high flow O2 could be
sent to breathing system or breathing bag.
 Carbon dioxide Absorber

Sodalime (CaOH2 + NaOH + KOH + silica) or

Baralyme (Ba[OH] 2 + Ca[OH]2) contained in the

absorber combines with carbon dioxide, forming
CaCO2 and liberating heat and moisture (H2O)
The canister should be changed when 25% to
50% of the contents has changed color.
 Carbon dioxide absorbents
• Soda lime
• Bara lime
 Carbon dioxide Absorber Functions
• Carbon dioxide absorbents
• conserving gases and volatile agents
• decreasing OR pollution
• avoiding hazards of carbon dioxide rebreathing.
 Breathing Circuit
• The system that brings the fresh gas from the vaporizer to the
patient and takes the expired gases from the patient.
• May contain unidirectional valves, reservoir bag, pop off valve, CO2
canister, O2 flush, negative pressure relief valve, pressure manometer.
 Adjustable Pressure Limiting (APL) Valve

• The APL valve is used to control the pressure in the breathing system
and allows excess gas to escape.
• Manual Ventilation: Valve is usually left partially open. During
inspiration the bag is squeezed pushing gas into the inspiratory limb
until the pressure relief is reached, opening the APL valve.
• Automatic Ventilation: The APL valve is mostly excluded from the
circuit when the selector switch is changed from manual to automatic
ventilation.
 Scavenging Systems

• A scavenging system channels waste gases away from the operating

room to a location outside the hospital building.
• Specific anesthetic gas-scavenging systems should be used
routinely. These systems consist of a collecting system, a transfer
system, a receiving system, and a disposal system.
• The scavenging system must be capable of collecting gas from all
components of the breathing circuit.
 Anesthesia Ventilators

• The bellows is compressed intermittently

when oxygen or air is directed into the
chamber, thereby pressurizing it.
• Most ventilators allow direct adjustment
of tidal volume, with I : E ratio being
dependent on the inspiratory flow rate,
which is set independently.
Inside bellow: Fresh Gas, External bellow:
Driving Gas
What makes bellows UP and Down?
• Driving gas push the mixture of the gas to the patient
• Bellows Up: Fresh Gas
• Bellows Down: Driving Gas
 Bellow Types

• Ascending bellows: rise during expiration

• Descending bellows: fall during expiration
Most modern Anesthesia Machines have Ascending bellows.
Ascending bellows are safer because if a circuit disconnection
occurs, the bellows will not fill.
 Common Gas Outlet

• The common gas outlet is the port where gases exit the
machine and is connected to the breathing system via the fresh
gas hose.
Breathing System
1 Absorber 2 Inspiratory
canister port

3 Inspiratory 4 Expiratory
valve port

5 Expiratory 6 Bellows
valve

7 Airway 8 Handle
pressure
gauge
9 Bag Arm 10 APL valve

34
Cont.…
• “Breathing system” is an arrangement of tubes and other components
that transports gases between the anaesthetic machine and the
patient. A very common breathing system used in anesthesia is the
“circle breathing system.
• One way valves allow gas to pass one way, and not the other way.
There are 2 one way valves inspiratory one way valve and expiratory
one way valve.
 Ventilation Mode
• Manual Mode
• IPPV Mode
International Color code
GAS COLOUR

Oxygen White

Nitrous Oxide Blue

Medical Air Yellow

Carbon dioxide Grey

3
7
 Pressure Circuits
1. The high–pressure circuit: is the part of the machine that is confined
to the cylinders and their primary pressure regulators.
2. The intermediate–pressure circuit: is the part of the machine that
begins at the regulated cylinder supply sources downstream the flow
control valve.
3. The low–pressure circuit: is the part of the machine that extends
from the flow control valves to the common gas outlet.
1. The high-pressure circuit: consists of those parts which
receive gas at cylinder pressure:

Hanger yoke (reserve gas cylinder holder)

Yoke block(prevent reverse flow of gas)

Cylinder pressure gauge.

Cylinder pressure regulators.

 Hanger Yoke
• Hanger Yolk: orients and supports the cylinder, providing a gas-tight
seal and ensuring a unidirectional gas flow into the machine

• Pin Index Safety System (PISS) prevents accidental rearrangement

of cylinders (eg switching O2 and N2O).
 Pipeline Inlet Connection
• Diameter Index Safety System(DISS):Inlets are
non-interchangeable due to specific threading as
per the Diameter Index Safety System (DISS)
• Each inlet must contain a check valve to prevent
reverse flow (similar to the cylinder yolk)
2. The intermediate pressure circuit: receives gases at
low, relatively constant pressures which is pipeline pressure).

Ventilator power inlet.

Flowmeter valves.

Oxygen second-stage regulator.

Oxygen flush valve.

3.The low-pressure circuit: includes components distal to the flowmeter
needle:

Valves

Flowmeter tubes

Vaporizers

Common gas outlet.

 Oxygen Supply failure Alarm
• The machine standard specifies that whenever the oxygen supply
pressure falls below a manufacturer-specified threshold (usually 20
psi) a medium priority alarm shall blow within 5 seconds.
 Fail-Safe Valve
• Fail-safe valve: is a safety device located downstream from the N2O
supply source. This valve shuts off or proportionally decreases the
supply of N2O if the O2 supply pressure decreases. Recent machines
have an alarm device to monitor the O2 supply pressure.
 Hypoxic-Mixture Alarms(Hypoxia
Guards or ratio controllers)
• To prevent gas mixtures which contains less than 21-25% oxygen
being delivered to the patient.
• Prevent low oxygen delivery
• Ratio of Oxygen to Nitrous Oxide is :3:1
• It is impossible to deliver 100% nitrous oxide, oxygen is automatically
added to the fresh gas flow.
 Check Valve

The check valve has several functions:

• It minimizes gas transfer from a cylinder at high pressure to one with lower
pressure.

• It allows an empty cylinder to be exchanged for a full one while gas flow
continues from the other cylinder into the machine with minimal loss of gas.
Delivery System to Anesthesia Machine

• Pipeline System
• Cylinder System
 Pipeline System
The central gas pipeline supply system is the primary source of
gas supply for the anesthesia machine.
Oxygen, nitrous oxides, and often air are delivered from their
central supply source to the operating room through a pipeline
network
• The tubing is color coded and connects to the pipeline inlet of the
machine through a noninterchangeable diameter-index safety
system (DISS) fitting that prevents incorrect hose attachment
• The check valve, located down stream from the pipeline inlet,
prevents reverse flow of gases (from machine to pipeline, or to
atmosphere)
 Cylinder Supply
• Cylinders attach to the machine via
hanger yoke that utilize a pin
index safety system.
 Safety System
• Diameter Index safety system
• Pin index safety system
 Group Assignment
Types of Flowmeter
• Thorpe flowmeter(needle valve control)
• Bourdon flow gauge(needle valve, fixed size orifice control)
• Pressure compensated flowmeter(rising ball that partially drops from
back pressure in the line variable area flowmeter).
Thank You