Anesthetic machine

By Dr Ibrahim
Shilbayeh
 Definition and functions
A device which delivers a precisely known but variable gas
mixture, including anesthetizing and life sustaining gases

 Receives anaesthetic gasses from a high-pressure supply

 Reduces the high pressures to ambient pressure
 Regulate gas flow to the anaesthetic vaporizer
 Delivers a precisely-known but variable gas mixture, including
anesthetizing and life-sustaining gases to the fresh gas flow outlet.
 Gases includes oxygen, air, nitrous oxide and vapours such as
halothane, isoflurane, sevoflurane or desflurane
 Monitoring – machine and physiological parameters
 Classification

Intermittent flow machine

- Drawover machine
Continuous flow machine
– Boyle’s machine
- Anaesthesia Workstation
Drawover Anaesthesia Machine
 Continuous flow machine
Components
Source of compressed gas
Inline filters
Pressure reducing valves
Fail-safe valve
Oxygen flush
Flow meters
Oxygen analyzer
Vaporizer
Ventilator
Breathing circuit
Scavenging system
 Anaesthesia Workstation

 Integrated electronic anaesthesia

machine
 CPU controlled
 Electronic flowmeters
 Electronic controlled cassette
vaporizer
 Integrated ventilator
 Integrated patient monitoring
 Automatic record keeping
Delivery system to anesthetic machine
Pipeline system
Cylinder system

Safety system
Diameter index safety system
Pin index safety system
 PROCESSING
 High pressure system
Cylinder supply to pressure
regulator
 Intermediate pressure
system
Pipeline supply to
proportioning system
 Low pressure system
Flowmeters to common gas
outlet
 The Anesthesia Machine
High Intermediate Low Pressure Circuit
 High Pressure System
 Receives gasses from the high pressure E
cylinders attached to the back of the anesthesia
machine (2200 psig for O2, 745 psig for N2O)
Consists of:
Hanger Yolk (reserve gas cylinder holder)
Check valve (prevent reverse flow of gas)
Cylinder Pressure Indicator (Gauge)
Pressure Reducing Device (Regulator)
 Usually not used, unless pipeline gas supply is
off

10
 Hanger Yolk
 Hanger Yolk: orients and
supports the cylinder,
providing a gas-tight seal and
ensuring a unidirectional gas
flow into the machine

 Index pins: Pin Index Safety

System (PISS) is gas
specificprevents accidental
rearrangement of cylinders
(e.g.. switching O2 and N2O)
Hanger Yolk

Hanger-yoke assembly
 Pressure Reducing Device
Reduces the high and variable pressures found in a
cylinder to a lower and more constant pressure found in
the anesthesia machine (45 psig)
Reducing devices are preset so that the machine uses only
gas from the pipeline (wall gas), when the pipeline inlet
pressure is 50 psig.

This prevents gas use from the cylinder even if the cylinder
is left open (saves the cylinder for backup if the wall gas
pipeline fails)
 Pressure Reducing Device
Cylinders should be kept closed routinely.
Otherwise, if the wall gas fails, the machine will
automatically switch to the cylinder supply
without the anesthetist being aware that the wall
supply has failed (until the cylinder is empty too)
 Intermediate Pressure System
 Receives gasses from the regulator
or the hospital pipeline at pressures
of 40-55 psig
 Consists of:
 Pipeline inlet connections
 Pipeline pressure indicators
 Piping
 Gas power outlet
 Master switch
 Oxygen pressure failure devices
 Oxygen flush
 Additional reducing devices
 Flow control valves
 Pipeline Inlet Connections
 Mandatory N2O and O2, usually
have air and suction too
 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)
Oxygen Pressure Failure Devices
Machine standard requires that an anesthesia
machine be designed so that whenever the oxygen
supply pressure is reduced below normal, the
oxygen concentration at the common gas outlet
does not fall below 21%
Pressure Sensor Shut-Off Valve
Oxygen supply pressure
opens the valve as long as
it is above a pre-set
minimum value (25 psig)

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
Pressure Sensor Shut-Off Valve
Oxygen Supply Failure Alarm
 The machine standard
specifies that whenever the
oxygen supply pressure falls
below a manufacturer-
specified threshold (usually
25 psig) a medium priority
alarm shall blow within 5
seconds
Limitations of Fail-Safe Devices/Alarms
 Fail-safe valves do not
prevent administration of a
hypoxic mixture because they
depend on pressure and not
flow

 These devices do not

prevent hypoxia from
accidents such as pipeline
crossovers or a cylinder
containing the wrong gas
 Oxygen Flush Valve (O2+)
 Receives O2 from pipeline
inlet or cylinder reducing
device and directs high,
unmetered flow directly to the
common gas outlet
(downstream of the vaporizer)
 Machine standard requires
that the flow be between 35
and 75 L/min
 The ability to provide jet
ventilation
 Hazards
May cause barotrauma
Dilution of inhaled
anesthetic
Second-Stage Reducing Device

 Located just upstream of the

flow control valves
 Receives gas from the pipeline
inlet or the cylinder reducing
device and reduces it further
to (26 psig for N2O) and (12-
16 psig for O2)
 Low Pressure System
 Extends from the flow control
valves to the common gas
outlet
 Consists of:
Flow meters
Vaporizer mounting device
Check valve
Common gas outlet
Flowmeters
 Components
 Control knob
 Needle valve
 Funnel shaped glass tube
 Aluminum bobbin indicator
(float)
 Specifically calibrated for
each gas
 Flow read at top of
bobbin in L/min
 Low flow tube in ml/min
 Flow Control
• It is composed of a flow control
knob, a needle valve, a valve
seat, and a pair of valve stops.

• Gas flow increases when the

flow control valve is turned
counter-clockwise, and vice
versa.
• Extreme clockwise rotation
results in damage to the needle
valve and valve seat.
These flowmeters are commonly referred to as constant –
pressure variable flow.

Density / Turbulent

Viscosity / Laminar Flow

 Flowmeters

The flowmeter subassembly consists of:

1. The flow tube.
2. The indicator scale.
3. The indicator float with float stops.
 Flowmeters
1) Flow tubes
• They are made of glass, have a single
taper in which the inner diameter of the
flow tube increases uniformly from
bottom to top.
• Opening the flow control valve allows
gas to travel through the space
between the float and the flowtube
[the annular space].
 Flowmeters
1) Flowtubes
Manufacturers provide double flow tubes for O2

& N2O to provide better visual discrimination at

low flow rates.
A fine flow tube indicates flow
approximately 1-200 ml.min-1.

A coarse flow tube indicates flow

approximately 1-10 L.min-1.
The two tubes are connected in series & supplied
by a single flow control valve.

The total gas flow is that shown on the hi

flowmeter.
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 Flowmeters
2) Indicator Floats and Float Stops

• There are different types of bobbins or

floats, including plumb-bob floats, rotating
skirted floats & ball floats.

• Flow is read at the top of plumb-bob and

skirted floats and at the center of the ball on
the ball-type floats.
The safety system of the flow meters

1- Proportioning Systems
2- The oxygen flowmeter position.
3- Unique control knob shape
 1- Proportioning Systems
 Mechanical integration
of the N2O and O2
flow-control valves
 Automatically
intercedes to maintain
a minimum 25%
concentration of
oxygen with a
maximum N2O:O2
ratio of 3:1

To prevent hypoxic mixture (hypoxic hypoxia)

 2- The oxygen flowmeter position.
• In the presence of a flowmeter leak, a hypoxic mixture is less likely to occur
if the oxygen flowmeter is located downstream from all other flowmeters.

* Note that a leak in the oxygen flowmeter tube can cause a hypoxic mixture,
even when oxygen is located in the downstream position
 3- Unique control knob shape

• The flow control knob are

colour-coded for their
respective gases.
• The oxygen control knob
is situated to the left, and
larger with larger ridges and
has a longer stem than the
other control knobs.
 Flowmeters
Leaks
• It is a substantial hazard because the flowmeters are
located downstream from all machine safety devices
except the O2 analyzer.

• Gross damage to glass flow tubes is usually apparent,

but subtle cracks & chips may be overlooked, resulting
in errors of delivered flows.
• O2 escapes through the leak & N2O flows toward the common

outlet, particularly at high N2O/ O2 flow ratios.

 Flowmeters
• Flow error can occur even when flowmeters are assembled
properly with appropriate components.
1. Dirt or static electricity can cause a float to stick, and the
actual flow may be higher or lower than that indicated.
2. Sticking is more common in the low flow range.
3. if flowmeters are not aligned properly in the vertical position,
readings can be inaccurate because tilting distorts the
annular space.
Flowmeters
• The oxygen rubber diaphragm will recognize adequate "
O2 " pressure, and flow of both the wrong gas plus N2O
will result.
• The oxygen analyzer is the only machine safety device that
can detect hypoxic gas mixture .
Prevention of hypoxic gas mixture
Oxygen analyzer
Diameter index safety system
Pin index safety system
International colour code
Unique control knob shape
Fail-safe valve
Proportional device – hypoxic guard
 Vaporizers
A vaporizer is an
instrument designed
to change a liquid
anesthetic agent into
its vapor and add a
controlled amount of
this vapor to the fresh
gas flow
44
 The specific heat :
Applied Physics Is the number of
calories required to
raise the
temperature of 1g
of substance by 1C

- It is the number of calories needed to convert 1g of liquid into

vapor at a constant pressure. This value is dependent on the
ambient temperature. The colder the liquid, the more calories
45 needed to a vaporize a given amount of liquid.
 1

46
47
48
 0..

49
50
 Systems using CO2 Absorbents
Carbon dioxide absorbents :
• Sodalime
• Baralime
 Systems using CO2 Absorbents
These systems were developed to conserve gases, to
save costs, minimize pollution, and to some degree
retain heat and moisture. All the exhaled gases are
rebreathed except the carbon dioxide which is
removed by different formulations of carbon dioxide
absorbents (Soda lime, Baralyme). Fresh gases are
added to the system based on the leaks in the system,
uptake of oxygen and inhalational anesthetic agents
by the body, arrangements of various components of
the system, and clinical state and duration of
anesthesia.
 Systems using CO2 Absorbents
The CO2 from exhaled gases combines with water to become a
weak acid, carbonic acid, which reacts with a strong alkali
(calcium hydroxide) producing a carbonate and water. This
reaction of neutralization is exothermic and steps are as
follows:
1. CO2 + H2O ⇔ H2CO3
2. H2CO3 + Ca(OH)2 ⇔ CaCO3 + 2H2O + Heat
The reaction with calcium hydroxide is slow, hence catalysts
are used to improve the performance. Traditionally soda lime
has sodium and potassium hydroxides as catalysts
 Systems using CO2 Absorbents
The modern day soda lime has only sodium
hydroxide as a catalyst. Baralyme has barium
hydroxide octahydrate as a catalyst.
The absorbent is presented as porous granules or
pellets with a size between 4-8 mesh. Traditionally
silica is added to give hardness to the granules, but
the modern technology makes this unnecessary. The
absorbents can either be packed into canisters or
available as pre-packed canisters.
 Systems using CO2 Absorbents
 Theoretically 100 grams of wet soda lime contains approximately 74
grams of calcium hydroxide (one gram molecular weight). This can
absorb one gram molecular weight of CO2 (44 g CO2 is equivalent to 24
liters at room temperature and pressure according to Avogadro’s
principle).
 Assuming that a resting adult produces CO2 at the rate of 12 liters/hour
(200 ml/min), 100 g of soda lime at 100% efficiency is expected to last for
about two hours. However in practice one can never achieve this level of
efficiency particularly in single chamber canisters and 100 g soda lime
roughly lasts for about 60 minutes. Dual chamber canisters demonstrate
better efficiency if canisters are changed one at a time and reversed.
However in order to minimize the effects of desiccation of the absorbent,
the consensus statement from Anesthesia Patient Safety Foundation
recommends that the absorbent from both canisters be changed at the
same time.
 11

56
 Inhaled Anaesthetic agents and
CO2 absorbents
 The absorbents will, to some extent, interact with inhaled anesthetics and result in
the production of degradation products.
 Compound A: Sevoflurane decomposes to form several degradation products.
However, only ‘Compound A’ has a dose dependent nephrotoxicity in rats. Human
studies have produced contradicting results.
 The circumstances that produce higher levels of ‘compound A’ include :
 1. low total gas flow rate (below 1 L/min),
 2. higher concentration of sevoflurane,
 3. the use of Baralyme rather than Soda lime,
 4. higher absorbent temperatures, and
 5. desiccated carbon dioxide absorbent (hence the addition of calcium chloride

reduces the production of compound A).

 Inhaled Anaesthetic agents and CO2
absorbents
 Absorbents free of strong alkali, having smaller concentration of sodium hydroxide, or
containing calcium chloride produce little or no ‘compound A’
 Carbon Monoxide: Carbon monoxide (CO) is produced when desflurane, enflurane,
or isoflurane is passed through dry absorbent containing a strong alkali.
 The factors that increase the carbon monoxide production include :

(1) higher anaesthetic concentration,

(2) higher temperature,
(3) dry absorbent. The magnitude of CO production from greatest to least is desflurane >
enflurane > isoflurane > halothane = sevoflurane.
 The use of Baralyme produces more CO rather than Soda lime.
 the manufacturers of Baralyme have stopped the distribution of Baralyme since late
2004.
 :Indication of Absorbent exhaustion
 1. Capnography: Appearance of CO2 in the inspired gas is the best way to detect
absorbent exhaustion
 2. Indicators: An indicator is an acid or base whose color depends on the pH and
the color change is indicative of absorbent exhaustion.

 3. Temperature in canister: Since the CO2 neutralization is an exothermic

reaction, changes in the absorbent temperature occur earlier than color change.
Studies have suggested that when temperature of the downstream canister is
higher than that of the upstream canister the absorbent should be changed in both
canisters.
 4. Clinical signs: Clinical signs of hypercapnia like tachycardia, hypertension,
cardiac arrhythmias, and sweating are usually late signs and are non-specific.
 Figure . Capnography and rebreathing

A: Normal capnogram. PETCO2 is normal

B: Exhaustion of soda lime. Base line is elevated

above zero indicating rebreathing (shaded area
during inspiration). PETCO2 is increased

C: Camel hump during inspiration indicating

rebreathing of mixed gas (alveolar and fresh)
during later part of inspiration. This is typical of
Mapleson D in controlled ventilation. The
PETCO2 may remain normal despite
rebreathing.

D: Rebreathing during controlled

ventilation with Mapleson A or malfunctioning
inspiratory unidirectional valve in circle system.
The expiration appears prolonged due to
rebreathing of alveolar gases without any
60 change in CO2 content. PETCO2 is increased.
OUTPUT: SCAVENGING SYSTEM
 Scavenging is the collection and removal of vented
anesthetic gases from the OR

 Scavenging may be active (suction applied) or

passive (waste gases proceed passively down
corrugated tubing through the exhaust grill of the
OR)